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Overdiagnosis of Clostridioides difficile (C. difficile) is associated with increased hospital length of stay, antibiotic overuse, unnecessary infection prevention efforts and excess costs. This study evaluated a paper-based bedside C. difficile screening tool on the number of C. difficile laboratory tests performed and number of C. difficile infection (CDI) diagnoses. Nurses used the tool to determine whether stool should be sent for C. difficile testing. The tool provided indications for stool testing. We collected data on the number of C. difficile stool tests performed and CDI diagnoses for nine months before (PreT) and after (PostT) tool implementation in the hospital. We found a 31% reduction in the mean monthly number of C. difficile tests performed (37 PreT to 25 PostT) and a 56% reduction in CDI diagnoses (19 PreT to 8 PostT). This study demonstrates the success of using nurses and a bedside tool to decrease inappropriate C. difficile testing. This intervention has implications for patient management, infection prevention and cost containment. This low-cost paper-based tool may be helpful for the 25% of hospitals in the USA not using clinical decision support in their electronic health record (EHR), as well as for hospitals outside the United States who may not have access to EHRs. [ABSTRACT FROM AUTHOR]

While a growing body of research has examined immigrants' health generally, less is known specifically about the impact of immigration policy on the health of Chinese immigrants, the second-largest foreign-born population in the United States. This is due, in part, to the lack of methodologically well-trained, cross-cultural researchers who have both the cultural and linguistic expertise and health knowledge to engage with Chinese immigrant populations. This paper addresses this gap by examining Chinese cross-cultural researchers' roles in the qualitative phase of the Research on ImmiGrant HealTh and State policy (RIGHTS) project, which sought to assess how immigration policies shaped Chinese and other immigrants' experiences in healthcare and other related sectors in California. We used reflexivity to assess Chinese cross-cultural researchers' positionality of insiderness and outsiderness and its influence on the process of data collection (i.e., recruitment, conducting interviews, transcription, and translation). Our reflexivity guides the assessment of the opportunities (e.g., expanding the recruitment pool, engaging participants more effectively in interviews, ensuring data integrity, and discussing heterogeneity within the Chinese immigrant community) and challenges (e.g., the difficulty of recruiting low-income and undocumented immigrants, addressing participants' in-depth thoughts, the time-consuming nature of transcription and translation, and the assessment of power dynamics) in conducting immigrant health research with the Chinese community. These results highlight the need for cross-cultural researchers to help build trusting relationships with ethnic-minority communities, thus gaining new insights and advancing knowledge within the field of ethnic minority health research. These insights can guide future investigations of Chinese and other immigrant communities as research on immigration policy and health expands. [ABSTRACT FROM AUTHOR]

In 2017 and 2018 the California Legislature passed two packages of bills aiming to address the state's massive housing shortage. The bills focus on the state '.S' housing element law and Regional Housing Needs Assessment (RHNA) system. These two mechanisms were created to require cities to plan for their long-term housing growth and to ensure cities built their fair share of housing. This Note will give an overview of these bills and the systems they amend. It will then analyze historic issues and possible fixes for the systems. Historically these systems have lacked enforcement mechanisms and have perpetuated economic and racial disparity in housing development. This paper looks at how the recent changes might address those issues, and what further improvements might still be necessary. [ABSTRACT FROM AUTHOR]

Graphical abstract Highlights • Technology cost and utility rate structure are key drivers of economic viability of solar and storage systems. • Solar-plus-storage systems are more often economical under time of use and demand charge rates. • Savings from storage-only projects come mainly from demand charge reductions; solar combined with storage also provides energy charge savings. • Savings from solar with storage is largely independent of building load variability, likely due to the energy cost reductions from the solar. Abstract This paper explores the economics of solar-plus-storage projects for commercial-scale, behind-the-meter applications. It provides insight into the near-term and future solar-plus-storage market opportunities across the U.S. We explore the impacts of location, building load profile, technology cost, utility rate structure, and policies on solar-plus-storage economic viability, and identify which factors are most significant to project economics. While savings from storage-only projects are largely derived from demand charge reductions, solar combined with storage also provides significant energy charge savings. A common assumption is that load profiles with peaks are likely candidates for savings from storage, due to the opportunity for demand charge reduction. Our results indicate that potential for savings from combining solar with storage is independent of building load variability, likely due to the energy cost reductions from the solar. Systems are more often economical under time of use and demand charge rates, particularly when demand charges are >$10 per kilowatt. Where systems were found to be economical, expected lifetime savings averaged between 7%–10%, with savings of 30% in numerous cases. Near term markets exist for solar-plus-storage in locations such as California and New York. As technology prices drop, the number of building types that can benefit increase, and additional markets appear in Colorado, New Mexico, and Alaska. All data from the study and interactive modeling results are available at: https://openei.org/wiki/Solar+Storage. [ABSTRACT FROM AUTHOR]

Introduction Collabo RATE is a brief patient survey focused on shared decision making. This paper aims to (i) provide insight on facilitators and challenges to implementing a real-time patient survey and (ii) evaluate Collabo RATE scores and response rates across multiple clinical settings with varied patient populations. Method All adult patients at three United States primary care practices were eligible to complete Collabo RATE post-visit. To inform key learnings, we aggregated all mentions of unanticipated decisions, problems and administration errors from field notes and email communications. Mixed-effects logistic regression evaluated the impact of site, clinician, patient age and patient gender on the Collabo RATE score. Results While Collabo RATE score increased only slightly with increasing patient age ( OR 1.018, 95% CI 1.014-1.021), female patient gender was associated with significantly higher Collabo RATE scores ( OR 1.224, 95% CI 1.073-1.397). Clinician also predicts Collabo RATE score (random effect variance 0.146). Site-specific factors such as clinical workflow and checkout procedures play a key role in successful in-clinic implementation and are significantly related to Collabo RATE scores, with Site 3 scoring significantly higher than Site 1 ( OR 1.759, 95% CI 1.216 to 2.545) or Site 2 (z=−2.71, 95% CI −1.114 to −0.178). Discussion This study demonstrates that Collabo RATE can be used in diverse primary care settings. A clinic's workflow plays a crucial role in implementation. Patient experience measurement risks becoming a burden to both patients and administrators. Episodic use of short measurement tools could reduce this burden. [ABSTRACT FROM AUTHOR]

For Salvadorans who relocated to the United States, the marginalization imposed by American society, the victimization enacted by Mexican gangs and their negative experience with El Salvador's practice of citizenship brought them to create the Mara Salvatrucha (MS-13) and modify 18th Street gangs in the neighborhoods of Los Angeles. Living on the fringes of society, they were kept from attaining the social, civil and economic benefits of a liberal democratic model of citizenship. This paper claims that, in order to survive, they took it upon themselves to create a parallel model of citizenship, combining anarchism with ''citizenship as agency'' under the gang structure. Following Philip Oxhorn's analysis of models of citizenship, this study examines how Salvadoran refugees came to create such alternative citizenship in the framework of the MS-13 and 18th Street gangs. Analysis asserts that the structure and development of membership in the gangs is not a coincidence, but rather a response to their marginalization, negative experience of state citizenship, and their participation in public arenas modeled as an extension of social contracts. Understanding the views of these, now transnational, gangs in terms of citizenship can aid policymakers and Central American governments as they approach these groups, eliminating violence and promoting development. [ABSTRACT FROM AUTHOR]

This paper analyzes process of Mexican inmigrants associations in different cities of California. The study is based on data collected from twelve first level associations or “clubes de oriundos". Using qualitative techniques, we document the complexity of the internal organization of these associations, as well as the variety of individual and social efforts to keep them working The research highlights the importance of the role played by the localities of destination in our understanding of the organization process of Mexican immigrants, as well as the possibilities of their collective actions. In this way, we discuss and complement the studies focused on Hometown Associations from the Mexican ;localities of origin. Our findings show that the “clubes de oriundos" are complex associations that impose a high organizational cost on its members, as well as spheres of sociability that members use to satisfy a set of social needs related to their position as immigrants. [ABSTRACT FROM AUTHOR]

Background: An emerging model for sexuality education is the rights-based approach, which unifies discussions of sexuality, gender norms, and sexual rights to promote the healthy sexual development of adolescents. A rigorous evaluation of a rights-based intervention for a broad population of adolescents in the U.S. has not previously been published. This paper evaluates the immediate effects of the Sexuality Education Initiative (SEI) on hypothesized psychosocial determinants of sexual behavior. Methods: A cluster-randomized trial was conducted with ninth-grade students at 10 high schools in Los Angeles. Classrooms at each school were randomized to receive either a rights-based curriculum or basic sex education (control) curriculum. Surveys were completed by 1,750 students (N = 934 intervention, N = 816 control) at pretest and immediate posttest. Multilevel regression models examined the short-term effects of the intervention on nine psychosocial outcomes, which were hypothesized to be mediators of students' sexual behaviors. Results: Compared with students who received the control curriculum, students receiving the rights-based curriculum demonstrated significantly greater knowledge about sexual health and sexual health services, more positive attitudes about sexual relationship rights, greater communication about sex and relationships with parents, and greater self-efficacy to manage risky situations at immediate posttest. There were no significant differences between the two groups for two outcomes, communication with sexual partners and intentions to use condoms. Conclusions: Participation in the rights-based classroom curriculum resulted in positive, statistically significant effects on seven of nine psychosocial outcomes, relative to a basic sex education curriculum. Longer-term effects on students' sexual behaviors will be tested in subsequent analyses. [ABSTRACT FROM AUTHOR]

• Renewable hydrogen can compete with lithium-ion batteries for seasonal storage. • Hydrogen's competitiveness depends on heat rate of plant it is replacing. • Net present value of hydrogen-fired gas turbine varies based on operation of plant. • Lack of infrastructure will impede demand growth for hydrogen in the United States. Non-emitting variable renewable energy (VRE) resources are needed on the power grid if the United States is to "deeply decarbonize" the power sector. The intermittent nature of these resources makes them difficult to integrate into the power system. Existing energy storage technologies, such as lithium-ion (LI) batteries, could be used to aid the integration of these resources, but these technologies are sized to produce power for hours at a time before needing to be charged again. While these energy storage technologies could address daily imbalances between supply and demand for electric power, they cannot address the seasonal nature of power production of VREs. This paper details a methodology to estimate the levelized cost of energy (LCOE) of meeting this seasonal imbalance with either a hydrogen-fired gas turbine (HFGT) or lithium-ion battery system (LI) as a measure of economic efficiency of the technologies. Applying our model, we find the average LCOE associated with meeting this seasonal imbalance is $2400/MWh using a HFGT fueled with green hydrogen and $3000/MWh using a LI. If we allow the model to operate the HFGT with blue hydrogen the average LCOE decreases to $1560/MWh. However, we find the power prices required to justify investment in an HFGT to replace a natural gas-fired gas turbine are considerably higher than those seen in the market today. [ABSTRACT FROM AUTHOR]

Recent regulatory and legislative developments in the state of California (e.g., Assembly Bill (AB) 1647 and AB 617) will increase the extent of air quality monitoring in communities near petroleum refineries and at facility fencelines. This work reports results over a three-year period for currently-installed community and fenceline air quality monitoring for the Chevron refinery in Richmond, California, USA. This paper presents the most comprehensive air quality dataset that has been published to date for a community near a petroleum refinery, including concentration of different air toxics (e.g., benzene, toluene, xylenes, etc.) and criteria air pollutants (e.g., ozone (O3), sulfur dioxide (SO2), and particulate matter (PM)). Instrumental techniques such as ultra-violet differential absorption spectroscopy (UV-DOAS), laser-based spectroscopy and real-time gas chromatography (GC) were used in the community and fenceline monitors. From 2015 to 2017, measured concentrations at community monitors near the Richmond refinery were generally below California thresholds for acute and chronic health (only two exceedances were observed for 8-h average benzene concentrations during the three-year monitoring period). Although more detailed speciation for volatile organic compounds (VOCs) and fine particulate matter (PM2.5) would be needed to confirm certain source profile identities, preliminary application of source apportionment methods indicates the prevalence of typical urban emission profiles, such as from traffic, in the measured community data. [ABSTRACT FROM AUTHOR]