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259 Background: Patients with cancer and their caregivers often describe the fragmented, multi-modal and multi-provider cancer care experience as undertaking a difficult expedition without a map. Based on her experience in 2020 and using self and family management theories (doi: 10.1016/j.outlook.2008.10.004.), Daswani developed a pan-cancer patient planner, which helps patients and families prepare for appointments, track symptoms, and manage their care. It has been available since 2021 through hospitals, advocacy organizations and online retail channels. We adapted and customized the pan-cancer planner for patients with mNSCLC. We tested acceptability through a series of structured patient interviews, and a brief, in-person survey tool. Methods: A lung cancer survivor recruited members of the lung cancer community to participate in a 30-minute structured virtual interview. After reviewing the planner, interviewees were asked: 1) about their diagnosis and treatment experience and 2) to provide semi-structured feedback. We conducted interviews until thematic saturation was reached. We modified the planner based on interview results, distributed planners to patients and care-partners at a major lung cancer patient summit and immediately collected a brief survey to assess patient knowledge of their diagnosis and motivation for planner access. Results: The table shows high level thematic groups of interview responses. Interviewed patients concluded that the planner would have improved their experience because they would have: Stayed organized, facilitated note-taking during appointments, better tracked and managed symptoms & meds, been more confident in decision-making and been able to journal, stay grounded and more mindful. Of 94 planners distributed at the summit, 49 patients knew their diagnosis, 31 knew their stage, 28 knew their cancer mutation status. Of the four domains of self-management, positive responses were: 1. Increase confidence 44 (47%) 2. Gain peace of mind 40 (43%) 3. Stay organized 58 (62%) 4. Manage meds & symptoms 42 (45%). Conclusions: A paper based mNSCLC specific planner is acceptable to patients and they anticipate it would help with all four domains of self management (confidence, peace of mind, organization, med and symptom management) and enhance a difficult experience. We plan further usability testing as we did with the breast cancer planner (JCO Oncol Pract 19, 2023 (suppl 11; abstr 552)). Interviews of 8 (7 female, 1 male) patients (3 with English as a second language) were held in December 2023. Diagnosis Biomarker Testing Treatment Living with lung cancer Medical terms difficult to understand "Mutation" term caused anxiety Understanding options important Need for community Diagnosis often delayed Loss of agency Gratitude for care team Digital tools desired Cumulative trauma Additional languages Young adult survivorship desired [ABSTRACT FROM AUTHOR]

Earthquake nowcasting has been proposed as a means of tracking the change in large earthquake potential in a seismically active area. The method was developed using observable seismic data, in which probabilities of future large earthquakes can be computed using Receiver Operating Characteristic methods. Furthermore, analysis of the Shannon information content of the earthquake catalogs has been used to show that there is information contained in the catalogs, and that it can vary in time. So an important question remains, where does the information originate? In this paper, we examine this question using stochastic simulations of earthquake catalogs. Our catalog simulations are computed using an Earthquake Rescaled Aftershock Seismicity ("ERAS") stochastic model. This model is similar in many ways to other stochastic seismicity simulations, but has the advantage that the model has only 2 free parameters to be set, one for the aftershock (Omori‐Utsu) time decay, and one for the aftershock spatial migration away from the epicenter. Generating a simulation catalog and fitting the two parameters to the observed catalog such as California takes only a few minutes of wall clock time. While clustering can arise from random, Poisson statistics, we show that significant information in the simulation catalogs arises from the "non‐Poisson" power‐law aftershock clustering, implying that the practice of de‐clustering observed catalogs may remove information that would otherwise be useful in forecasting and nowcasting. We also show that the nowcasting method provides similar results with the ERAS model as it does with observed seismicity. Plain Language Summary: Earthquake nowcasting was proposed as a means of tracking the change in the potential for large earthquakes in a seismically active area, using the record of small earthquakes. The method was developed using observed seismic data, in which probabilities of future large earthquakes can be computed using machine learning methods that were originally developed with the advent of radar in the 1940s. These methods are now being used in the development of machine learning and artificial intelligence models in a variety of applications. In recent times, methods to simulate earthquakes using the observed statistical laws of earthquake seismicity have been developed. One of the advantages of these stochastic models is that it can be used to analyze the various assumptions that are inherent in the analysis of seismic catalogs of earthquakes. In this paper, we analyze the importance of the space‐time clustering that is often observed in earthquake seismicity. We find that the clustering is the origin of information that makes the earthquake nowcasting methods possible. We also find that a common practice of "aftershock de‐clustering", often used in the analysis of these catalogs, removes information about future large earthquakes. Key Points: Earthquake nowcasting tracks the change in the potential for large earthquakes, using information contained in seismic catalogsWe analyze the information contained in the space‐time clustering that is observed in earthquake seismicityWe find that "aftershock de‐clustering" of catalogs removes information about future large earthquakes that the nowcasting method uses [ABSTRACT FROM AUTHOR]

The inability of labor markets to function effectively to satisfy the needs of employers and workers suggests that there is a growing need for policy interventions to promote workplace cultures of learning and innovation. Past research suggests that publicly funded incumbent worker training programs are a promising antidote against market failures. With only a handful of studies published in the last two decades, however, this is one of the least-researched types of business support programs. This paper examines the impact of a state program in California that uses a pay-for-performance approach to reimburse employers that train their employees: the California Employment Training Panel (ETP). Based on a mixed-methods study of ETP, the authors found that, overall, ETP had positive and significant impacts on company sales and firm size. The study suggests the need to abandon ideological debates and engage in more evidence-based policy discussions about incumbent worker training programs. [ABSTRACT FROM AUTHOR]

Hydraulic jacking is a serious threat to concrete spillway chutes, demonstrated by the catastrophic spillway chute failure at California's Oroville Dam in 2017. To improve the understanding of uplift pressure and joint flow developed at open, offset joints and enable design and evaluation of anchors, drain systems, and joint remediations that could help prevent such failures, laboratory tests were performed in a supercritical flume furnished with a model joint where the gap width to offset height ratio was varied over a 725∶1 range. The tests included measurement of boundary layer velocity profiles approaching the joint. Uplift pressures were normalized to the velocity head near the boundary, which is related to the depth-wise velocity profile exponents determined in the experiments and can be estimated for field applications from the chute friction factor. The normalized uplift varies with the joint aspect ratio and the flow depth to offset height ratio. The new relations reduce the uncertainty of modeled uplift pressures by a factor of 2.87 over previous methods. Example applications demonstrate practical upper limits for potential uplift pressure. Subsequent articles will address discharge into offset joints, the dissipation of uplift via drainage, and the effect of different methods for remediating existing offsets to reduce uplift. Practical Applications: Concrete spillway chutes develop cracks and must necessarily be constructed with joints, both of which are prone to displacement over time that may create offsets into the flow. Flow striking such offsets is brought suddenly to rest, similar to a pedestrian tripping on a sidewalk crack. The local stoppage of flow at the offset creates dangerously high pressures that can be injected into the foundation, leading to erosion beneath the slab and potential uplift failure, often called 'hydraulic jacking'. This mechanism has caused several notable failures including the Oroville Dam spillway in 2017. Protection against such failures is usually provided by a combination of the weight (thickness) of the slab itself, anchors that hold the slab down, and subsurface drains that reduce the buildup of pressure. This paper provides experimentally based equations for predicting uplift pressure to enable effective design of new spillways and evaluation of existing spillways. The new equations are significantly more accurate than previous methods because they account for the roughness of the chute surface and the reduced flow velocity near the boundary. Subsequent papers will address flow rate through joints, pressure dissipation by drainage, and methods for treating existing offsets to reduce potential uplift. [ABSTRACT FROM AUTHOR]

This paper explores how the Taiwanese-Chinese religious movement Yiguandao ("Way of Pervading Unity") creates a community of non-Chinese followers by utilizing Daoism-related beliefs and practices. Drawing on ethnographic data from fieldwork conducted in California in early 2018, published Yiguandao materials, and internet resources, the paper argues that Yiguandao activists specifically invest their messages in Daoist symbols, beliefs, and practices to reach out to non-Chinese sympathizers of "Asian philosophies" and eventually to establish a global and cross-cultural community of Dao followers. By discussing a case study from Los Angeles, the paper seeks to understand the patterns of Yiguandao activists' engagement with Daoism and how their efforts blend into establishing a global Daoist field. Finally, it thereby invites us to rethink the often haphazardly drawn boundaries—both by practitioners and scholars—between Daoism and other religious phenomena, including New Age, spirituality, and Chinese popular sects. [ABSTRACT FROM AUTHOR]

Prisons in the United States serve as a site and embodiment of gendered and racialized state violence. The US incarcerates more people than any other nation in both numbers and per capita rates. Individuals incarcerated in women's prisons are 10% of the total prison population, yet women's prisons remain understudied, and the violence that occurs in women's facilities is rampant, widespread, and operates in particular racialized and gendered ways. This paper centers the forced sterilizations that occurred in California state prisons over the last two decades. We consider how reproduction and the nuclear family have served as a primary site of racial capitalism and eugenic ideology. While eugenic policies were popularized and promoted across the US and globally in the 20th century, the violent ideas underlying eugenic ideology have been a constant presence throughout US history. The height of the eugenics era is marked by the forcible sterilization of institutionalized 'deviant' bodies. While discussions of eugenics often center these programs, the reach of eugenic policies extends far beyond surgical interventions. We utilize a reproductive justice lens to argue that the hierarchical, racialized social stratification necessary for the existence of prisons constructs and sustains the 'deviant' bodies and families that predicate eugenic logic, policies, and practices. In this conceptual paper, we draw from ongoing research to argue that prisons, as institutions and as a product of racial capitalism, perpetuate the ongoing violent legacy of eugenics and name abolition as a central component of the fight to end reproductive oppression. [ABSTRACT FROM AUTHOR]

In order to realize the accurate and reliable prediction of the change trend of dissolved oxygen (DO) content in California perch aquaculture water, this paper proposes a second-order hybrid optimization support vector machine (SVR) model based on Differential Evolution (DE) and Gray Wolf Optimizer (GWO), shortened to DE-GWO-SVR, to predict the DO content with the characteristics of nonlinear and non-smooth water quality data. Experimentally, data for the water quality, including pH, water temperature, conductivity, salinity, total dissolved solids, and DO, were collected. Pearson's correlation coefficient (PPMCC) was applied to explore the correlation between each water quality parameter and DO content. The optimal DE-GWO-SVR model was established and compared with models based on SVR, back-propagation neural network (BPNN), and their optimization models. The results show that the DE-GWO-SVR model proposed in this paper can effectively realize the nonlinear prediction and global optimization performance. Its R2, MSE, MAE and RMSE can be up to 0.94, 0.108, 0.2629, and 0.3293, respectively, which is better than those of other models. This research provides guidance for the efficient prediction of DO in perch aquaculture water bodies for increasing the aquaculture effectiveness and reducing the aquaculture risk, providing a new exploratory path for water quality monitoring. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Patients are being encouraged to complete forms electronically using patient portals rather than on paper, but willingness of older adults to make this transition is uncertain. METHODS: The authors analyzed data for 4105 Kaiser Permanente Northern California 2020 Member Health Survey respondents aged 65-85 years who answered a question about willingness to complete online forms and questionnaires using a patient portal. Data weighted to the Kaiser Permanente Northern California membership were used to estimate percentages of older adults willing to complete patient portal forms and questionnaires. Chi-square tests and log-Poisson regression models that included sociodemographic, internet use, and patient portal variables were used to identify factors predictive of willingness. RESULTS: Overall, 59.6% of older adults were willing to complete patient portal forms, 17.6% were not willing, and 22.8% were not sure. Adults aged 75-85 (49.5%) vs 65-74 years (64.8%) and Black (51.9%) and Latino (46.5%) vs White (62.8%) adults were less likely to indicate willingness. In addition to racial and ethnic differences and younger age, higher educational attainment, use of the internet alone (vs internet use with help or not at all), having an internet-enabled computer or tablet, and having sent at least 1 message through the patient portal increased likelihood of being willing. CONCLUSIONS: Health care teams should assess older adults' capabilities and comfort related to completion of patient portal-based forms and support those willing to make the digital transition. Paper forms and oral collection of information should remain available for those unable or unwilling to make this digital transition. [ABSTRACT FROM AUTHOR]

Purpose: This paper aims to measure the trade price impact of a recent regulatory disclosure intervention in municipal securities secondary markets, which required broker-dealers to disclose securities trading information on a near-real-time and continuing basis. Design/methodology/approach: The author analyzes trade price outcomes in the preintervention and postintervention regimes using a suite of time series estimations that give heteroskedasticity-robust standard errors (Prais–Winsten and Cochrain–Orcutt), accommodate higher-order lag structure in the error term (autoregressive integrated moving average) and account for volatility clustering in the time series (generalized autoregressive conditional heteroskedasticity). Findings: Results show that regulatory disclosure intervention significantly improved trade price efficiency in municipal securities secondary markets as daily trade price differential and volatility both declined market-wide after the disclosure intervention. Research limitations/implications: The sample consists of trades in State of California general obligation bonds; therefore, empirical findings may not be generalizable to other states, local governments and different types of bonds. Practical implications: The findings highlight voluntary information disclosure as a practical and effective mechanism in disclosure regulation of municipal securities secondary markets. Originality/value: Only a small body of work exists that examines information disclosure regulation in municipal securities secondary markets; therefore, this paper expands knowledge on the topic and should provide renewed impetus for regulatory efforts aimed at improving the efficiency of municipal capital markets. [ABSTRACT FROM AUTHOR]

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Recently, the United States has experienced, on average, costs of USD 20 billion due to natural and climate disasters, such as hurricanes and wildfires. In this study, we focus on wildfires, which have occurred more frequently in the past few years. This paper examines how various factors, such as the PM10 levels, elevation, precipitation, SOX, population, and temperature, can influence the intensity of wildfires differently across counties in California. More specifically, we use Bayesian analysis to classify all counties of California into two groups: those with more wildfires and those with fewer wildfires. The Bayesian model incorporates prior knowledge and uncertainty for a more robust understanding of how these environmental factors impact wildfires differently among county groups. The findings show a similar effect of the SOX, population, and temperature, while the PM10, elevation, and precipitation have different implications for wildfires across various groups. [ABSTRACT FROM AUTHOR]

The weather-dependent uncertainty of wind and solar power generation presents a challenge to the balancing of power generation and demand in highly renewable electricity systems. Battery energy storage can provide flexibility to firm up the variability of renewables and to respond to the increased load demand under decarbonization scenarios. This paper explores how the battery energy storage capacity requirement for compressed-air energy storage (CAES) will grow as the load demand increases. Here we used an idealized lowest-cost optimization model to study the response of highly renewable electricity systems to the increasing load demand of California under deep decarbonization. Results show that providing bulk CAES to the zero-emission power system offers substantial benefits, but it cannot fully compensate for the 100% variability of highly renewable power systems. The capacity requirement of CAES increases by ≤33.3% with a 1.5 times increase in the load demand and by ≤50% with a two-times increase in the load demand. In this analysis, a zero-emission electricity system operating at current costs becomes more cost-effective when there is firm power generation. The least competitive nuclear option plays this role and reduces system costs by 16.4%, curtails the annual main node by 36.8%, and decreases the CAES capacity requirements by ≤80.7% in the case of a double-load demand. While CAES has potential in addressing renewable variability, its widespread deployment is constrained by geographical, societal, and economic factors. Therefore, if California is aiming for an energy system that is reliant on wind and solar power, then an additional dispatchable power source other than CAES or similar load flexibility is necessary. To fully harness the benefits of bulk CAES, the development and implementation of cost-effective approaches are crucial in significantly reducing system costs. [ABSTRACT FROM AUTHOR]

Background. Permanent supportive housing (PSH) is an evidence‐based solution to chronic homelessness. There are two common PSH models: place‐based (PB) programs where clients live in one building with services provided onsite and scattered‐site (SS) programs, which use community apartments coupled with mobile case management and support. Understanding the relative strengths and weaknesses of PB and SS is important for PSH planning and service delivery. This paper explores homeless service provider perspectives on these two models after the onset of the COVID‐19 pandemic. Methods. Service providers (N = 37) from across 5 PSH agencies in Los Angeles that provided either PB or SS services during the pandemic participated in focus groups. Discussions were recorded, transcribed, and analyzed using template analysis, grounded theory, and inductive techniques. Results. Providers identified four major differences between PB and SS services: (1) challenges in finding placements; (2) managing relationships with landlords/property managers; (3) frequency of contact; and (4) community integration. Advantages of PB included ease of finding units, ease of managing relationships with landlords/property managers, greater ability to serve clients efficiently, more frequent client contact, and more community among residents. SS was seen to provide tenants with more opportunities to grow, live in healthier environments, and develop independence. During the pandemic, finding units for SS clients became more difficult, while differences between PB and SS related to frequency of contact and community integration became more attenuated. Conclusions. PB can be advantageous for clients with higher levels of acuity, whereas SS could be more appropriate for clients who are more stable and independent. PB programs are seen to have practical and logistical advantages, but some providers prefer SS services. Clients and providers should be matched to PSH configurations that best match their needs and preferences, and providers should be aware that public health emergencies may impact PB and SS settings differently. [ABSTRACT FROM AUTHOR]

In 2004, California became the first state to require that employers provide paid family leave (PFL) to their employees. This paper examines the effect of California's PFL law on time spent caregiving to parents and to grandchildren by older adults aged 50–79. To identify the effect of the law, the paper uses the 1998–2016 waves of the Health and Retirement Study and a difference-in-differences approach comparing outcomes in California to other states before and after the implementation of the law. Results suggest that the law induced a switch in caregiving behavior with older adults spending less time caring for grandchildren and more time helping parents. Focusing on women, results further suggest that PFL affected older adults both through their own leave-taking and through reallocations of their caregiving time in response to leave-taking by new parents. The findings motivate thinking more broadly when calculating the costs and benefits of PFL policies; to the extent that California's PFL law enabled older adults to provide more care for their parents they otherwise would not have received, such an outcome represents an indirect benefit of the policy. [ABSTRACT FROM AUTHOR]

This paper evaluates the performance of a multirotor uncrewed aircraft and AirCore system (UAAS) for measuring vertical profiles of wind velocity (speed and direction) and the mole fractions of methane (CH 4) and carbon dioxide (CO 2) , and it presents a use case that combines UAAS measurements and dispersion modeling to quantify CH 4 emissions from a dairy farm. To evaluate the atmospheric sensing performance of the UAAS, four field deployments were performed at three locations in the San Joaquin Valley of California where CH 4 hotspots were observed downwind of dairy farms. A comparison of the observations collected on board the UAAS and an 11 m meteorological tower show that the UAAS can measure wind velocity trends with a root mean squared error varying between 0.4 and 1.1 m s -1 when the wind magnitude is less than 3.5 m s -1. Findings from UAAS flight deployments and a calibration experiment also show that the UAAS can reliably resolve temporal variations in the mole fractions of CH 4 and CO 2 occurring over periods of 10 s or longer. Results from the UAAS and dispersion modeling use case further demonstrate that UAASs have great potential as low-cost tools for detecting and quantifying CH 4 emissions in near real time. [ABSTRACT FROM AUTHOR]

BACKGROUND: Following the removal of lead from gasoline, paint and pipes were thought to be the main sources of lead exposure in the United States. However, consumer products, such as certain spices, ceramic and metal cookware, traditional health remedies, and cultural powders, are increasingly recognized as important sources of lead exposure across the United States. OBJECTIVE: This paper reviews data from four US jurisdictions that conduct in-home investigations for children with elevated blood lead levels (BLLs) to examine the prevalence of lead exposures associated with consumer products, in comparison with housing-related sources. METHODS: Authors reviewed investigation data (2010–2021) provided by California, Oregon, New York City, and King County, Washington, and compared the extent of lead exposures associated with housing-related vs. consumer products–related sources. DISCUSSION: The proportion of investigations identifying consumer products–related sources of lead exposure varied by jurisdiction (range: 15%– 38%). A review of US CDC and US FDA alerts and New York City data indicates that these types of lead-containing products are often sourced internationally, with many hand carried into the United States during travel. Based on surveillance data, we believe that US immigrant and refugee communities are at an increased risk for lead exposures associated with these products. To engage health authorities, there is a need for evidentiary data. We recommend implementing a national product surveillance database systematically tracking data on consumer products tested by childhood lead poisoning prevention programs. The data repository should be centralized and accessible to all global stakeholders, including researchers and governmental and nongovernmental agencies, who can use these data to inform investigations. Effectively identifying and addressing the availability of lead-containing consumer products at their source can focus resources on primary prevention, reducing lead exposures for users abroad and in the United States. [ABSTRACT FROM AUTHOR]

Atmospheric rivers (ARs), responsible for extreme weather conditions, are mid-latitude systems that can cause significant damage to coastal areas. While forecasting ARs beyond two weeks remains a challenge, past research suggests potential benefits may come from properly accounting for the changes in sea surface temperature (SST) through air–sea interactions. In this paper, we investigate the impact of ARs on SST over the North Pacific by analyzing 25 years of ocean reanalysis data using an SST budget equation. We show that in the region of strong ocean modification, ocean dynamics can offset over 100% of the anomalous SST warming that would otherwise arise from atmospheric forcing. Among all ocean processes, ageostrophic advection and vertical mixing (diffusion and entrainment) are the most important factors in modifying the SST tendency response. The SST tendency response to ARs varies spatially. For example, in coastal California, the driver of enhanced SST warming is the reduction in ageostrophic advection due to anomalous southerly winds. Moreover, there is a large region where the SST shows a warming response to ARs due to the overall reduction in the total clouds and subsequent increase in total incoming shortwave radiation. Strong air-sea interactions during atmospheric rivers often lead to modest upper ocean heat changes. The authors show that interior ocean dynamics are compensating for these air-sea exchanges. These findings can help improve subseasonal forecasts. [ABSTRACT FROM AUTHOR]

The impact of air pollution is one of the hotspots attracting continuous scholarly attention, but the comprehensive statistical and visual analysis reviews are few. Employing the method of bibliometric analysis, this paper took the relevant literature from 1996 to April 2022 on the Web of Science as the research object. Through the methods of keyword co-occurrence analysis and burst analysis, the spatiotemporal evolution trend, cooperation network, outstanding scholars, knowledge base, and research focus of air pollution impact research are visually presented. Via constructing a common word matrix of high-frequency words, clustering analysis is used to aggregate high-frequency keywords into 24 clusters. By the strategic coordinate analysis method, the relationships within and between clusters were revealed. The main findings include (1) research on the impact of air pollution mainly focusing on human health; (2) the six keywords with the highest centrality are California, hydrocarbons, dioxide, generation, Asia, and diesel; (3) these 11 clusters may be developed into future research hotspots: particulate matter, nitrogen oxides, mortality, ozone, pollution, air quality, asthma, children, epidemiology, aerosols, and polycyclic aromatic hydrocarbons; and (4) seven topics are research hot: daily mortality, long-term exposure, coronary heart disease, concentration, North China plain, traffic-related air pollution, and air pollution. [ABSTRACT FROM AUTHOR]

For evaluating the resistance performance of cement-stabilized soils in cold regions, the variation of the strength of the cemented sand–gravel (CSG) mixture concerning the hydration process should be explored. This paper aims to study the effect of freeze–thaw (F–T) cycles on the strength and microstructure of a CSG mixture with 10% cement that is subjected to 12 cycles of freezing at a temperature of −23°C for 24 h and then melted at room temperature of 24°C for the next 24 h. The uniaxial compressive strength (UCS), California bearing ratio (CBR), and weight volume loss of the samples were measured after individual F–T cycles. Furthermore, the change in the microstructure of the CSG mixture in various F–T cycles was explored. The results showed a considerable reduction in the UCS up to Cycle 3, then a slight increase for Cycles 3–6, and finally a gradual decrease for further cycles. However, the CBR and weight loss slightly fluctuated up to Cycle 6, and then gradually decreased for subsequent cycles. The majority of compounds of hydrated cement were damaged in the first three cycles. In the following cycles, between Cycles 3 and 6, the portlandite compound was dissolved and recrystallized within the microvoids. Depending on the environmental conditions, carbonation may be generated from the hydrated cement fraction, which fills the microvoids and improves the strength and structure of the mixture. During further cycles after the sixth cycle, the mechanical action of the ice lenses coupled with the disintegration of the hydrate compounds imposed many new microvoids and cracks with considerable length and width, which intensified the strength reduction of the moisture and weakened the adhesion between grains. Since cement is widely used in pavement and dam engineering for stabilizing soils, the durability of cemented soils is of prime concern. This study may help improve the durability and resistance of cemented soils in cold climates. The F–T action not only influences the macrostructure of cement-stabilized soils by imposing a wide crack and ice lens but also induces a considerable change in the complexes existing in the hydrated cement paste of the mixture. Three patterns govern the change of the mixture microstructure in various F–T cycles that correspond to the observed trend in strength. The mentioned trend for the microstructure change and, consequently, the strength variation of the CSG mixture are associated with many factors such as pH, cement content, CO2 content, moisture content within the mixture, and relative humidity within the environment. Accordingly, the pattern of microstructural changes in the CSG mixture after the middle F–T cycles may vary depending on environmental conditions. [ABSTRACT FROM AUTHOR]

Coordinating management of groundwater, surface water, and irrigated crops is fundamental economically for many arid and semi-arid regions. This paper examines conjunctive water management for agriculture using hydro-economic optimization modeling. The analysis is integrated across two timescales: a two-stage stochastic decadal model for managing annual and perennial crops spanning dry and wet years and a far-horizon dynamic program embedding the decadal model into a longer groundwater policy setting. The modeling loosely represents California's San Joaquin Valley and has insights for many irrigated arid and semi-arid regions relying on groundwater with variable annual hydrology. Results show how conjunctive water management can stabilize crop decisions and improve agricultural profitability across different water years by pumping more in dry years and increasing recharging groundwater in wetter years. Using groundwater as a buffer for droughts allows growing more higher-value perennial crops, which maximizes profit even with water-scarce conditions. Nevertheless, ending overdraft in basins with declining groundwater for profit-maximizing farming reduces annual crops to maintain more profitable perennial crops through droughts. Results are affected by economic discount rates and future climates. Operating and opportunity costs from forgone annual crops can reduce aquifer recharge early in regulatory periods. [ABSTRACT FROM AUTHOR]

Aim: As climate change increases the frequency and severity of droughts in many regions, conservation during drought is becoming a major challenge for ecologists. Droughts are multidimensional climate events whose impacts may be moderated by changes in temperature, water availability or food availability, or some combination of these. Simultaneously, other stressors such as extensive anthropogenic landscape modification may synergize with drought. Useful observational models for guiding conservation decision‐making during drought require multidimensional, dynamic representations to disentangle possible drought impacts, and consequently, they will require large, highly resolved data sets. In this paper, we develop a two‐stage predictive framework for assessing how drought impacts vary with species, habitats and climate pathways. Location: Central Valley, California, USA. Methods: We used a two‐stage counterfactual analysis combining predictive linear mixed models and N‐mixture models to characterize the multidimensional impacts of drought on 66 bird species. We analysed counts from the eBird participatory science data set between 2010 and 2019 and produced species‐ and habitat‐specific estimates of the impact of drought on relative abundance. Results: We found that while fewer than a quarter (16/66) of species experienced abundance declines during drought, nearly half of all species (27/66) changed their habitat associations during drought. Among species that shifted their habitat associations, the use of natural habitats declined during drought while use of developed habitat and perennial agricultural habitat increased. Main Conclusions: Our findings suggest that birds take advantage of agricultural and developed land with artificial irrigation and heat‐buffering microhabitat structure, such as in orchards or parks, to buffer drought impacts. A working lands approach that promotes biodiversity and mitigates stressors across a human‐induced water gradient will be critical for conserving birds during drought. [ABSTRACT FROM AUTHOR]

Background: Traditional competency evaluations and manual tracking created a problem within one organization. Subjective competency assessments and inconsistent recordkeeping resulted in increased organizational costs. These factors increased the workload of nursing professional development (NPD) practitioners, leading to job dissatisfaction and turnover. Method: The project lead evaluated how implementing a digital competency management system (CMS) affected nurse training costs and assessed NPD practitioners' satisfaction after the digital CMS conversion. Results: A cost analysis compared training costs before and after implementation of a digital CMS. A pre- and postsurvey compared NPD practitioners' satisfaction before and after digital implementation. A digital CMS provided a centralized repository and educational platform, which saved $500,000 in training costs and increased NPD practitioners' job satisfaction by decreasing workload and creating meaningful mechanisms to accurately assess staff knowledge and skills. Conclusion: The NPD practitioners showed tangible outcome measures and return on investment by combining adult learning and technology. [J Contin Educ Nurs. 2024;55(5):239–245.] [ABSTRACT FROM AUTHOR]

Soil bulk density (BD) is important for measuring changes in soil chemical, physical, and biological properties; however, the measurement is tedious to collect and requires specialized equipment. Database measurements for soil surface BD do not always correspond to present field conditions as field management can alter BD in time. Saturation percentage (SP) is a routine lab measurement. The objectives of this study are to (1) understand if a relationship between BD and SP can be developed and (2) build a model that predicts BD based on a routine low‐cost lab analysis. We collected 83 soil samples from different experimental sites around California's Central Valley. At each site, BD, SP, soil organic matter (OM), and soil total organic carbon were measured. A set of models were generated and compared based on their Akaike information criterion (AIC) and adjusted R2. The best two models are presented in this paper, and their accuracy and precision in estimating BD were further compared by calculating the root mean square error (RMSE) and the R2 of the predicted versus values measured in the field. We determined that a strong relationship between BD and SP exists (R2 = 0.70) and that a cubic model that includes SP and OM resulted in the best model to predict BD in California soils. Inclusion of additional data may further strengthen this model or make it applicable for other grower regions. Core Ideas: Database bulk density values may not correspond to field conditions as management can alter bulk density.Bulk density is hard to measure and requires specialized equipment, but is needed to quantify soil carbon changes.There is a significant correlation between soil bulk density, soil saturation paste, and soil organic matter.Three models to predict bulk density based on saturation paste and organic matter were developed and evaluated. [ABSTRACT FROM AUTHOR]

Pay-as-you-go contracts reduce minimum purchase requirements, which may increase market participation. This paper randomizes the introduction and price(s) of a novel pay-as-you-go contract to the California auto insurance market, where 17% of drivers are uninsured. The pay-as-you-go contract increases take-up by 10.8 p.p. (89%) and days with coverage by 4.6 days over the 3-month experiment (27%). Demand is relatively inelastic, and pay-as-you-go increases insurance coverage in part by relaxing liquidity requirements: most drivers' purchasing behavior is consistent with a cost of credit in excess of payday lending rates, and 19% of drivers have a purchase rejected for insufficient funds. [ABSTRACT FROM AUTHOR]

Background: This paper describes the protocols for a randomized controlled trial using a parallel-group trial design that includes an intervention designed to address social isolation and loneliness among people experiencing homelessness known as Miracle Friends and an intervention that combines Miracles Friends with an economic poverty-reduction intervention known as Miracle Money. Miracle Friends pairs an unhoused person with a volunteer "phone buddy." Miracle Money provides guaranteed basic income of $750 per month for 1 year to Miracle Friends participants. The study will examine whether either intervention reduces social isolation or homelessness compared to a waitlist control group. Methods: Unhoused individuals who expressed interest in the Miracle Friends program were randomized to either receive the intervention or be placed on a waitlist for Miracle Friends. Among those randomized to receive the Miracle Friends intervention, randomization also determined whether they would be offered Miracle Money. The possibility of receiving basic income was only disclosed to study participants if they were randomly selected and participated in the Miracle Friends program. All study participants, regardless of assignment, were surveyed every 3 months for 15 months. Results: Of 760 unhoused individuals enrolled in the study, 256 were randomized to receive Miracle Friends, 267 were randomized to receive Miracle Money, and 237 were randomized to the waitlist control group. In the two intervention groups, 360 of 523 unhoused individuals were initially matched to a phone buddy. Of the 191 study participants in the Miracle Money group who had been initially matched to a volunteer phone buddy, 103 were deemed to be participating in the program and began receiving monthly income. Discussion: This randomized controlled trial will determine whether innovative interventions involving volunteer phone support and basic income reduce social isolation and improve housing outcomes for people experiencing homelessness. Although we enrolled unhoused individuals who initially expressed interest in the Miracle Friends program, the study team could not reach approximately 30% of individuals referred to the study. This may reflect the general lack of stability in the lives of people who are unhoused or limitations in the appeal of such a program to some portion of the unhoused population. Trial registration: ClinicalTrials.gov NCT05408884 (first submitted on May 26, 2022). [ABSTRACT FROM AUTHOR]

Purpose This paper compares and contrasts the implementation of pharmacist-led services for 3 different sexual and gender minority populations across California, Mississippi, and Florida. Summary Implementation of pharmacist-led services tailored to sexual and gender minorities may be a potential mechanism to address health disparities in these populations. Clinical pharmacists have the potential to provide care with cultural humility and improve health outcomes by optimizing medication regimens, reducing adverse drug events, enhancing medication acquisition, and improving medication adherence. Conclusion The services provided by clinical pharmacists varied across sites and included management of gender-affirming hormone therapy, HIV antiretroviral medication adherence programming, primary care and chronic disease state management, and involvement in care related to mental health, psychiatry, and substance use as well as sexual health. Various legislative and regulatory barriers and differences in scope of practice for pharmacists were also identified. This paper advocates for the expansion of pharmacy-led services and the adoption of a culturally humble approach to patient care. [ABSTRACT FROM AUTHOR]

This paper analyzes the emergence of two well-defined peaks during the morning peak period in the traffic flow diurnal curve. It selects six California cities as research targets, and uses California employment and household travel survey data to explain how and why this phenomenon has risen during the pandemic. The final result explains that the double-humped phenomenon results from the change in the composition of commuters during the morning peak period after the outbreak. [ABSTRACT FROM AUTHOR]

Reduced defense against large herbivores has been suggested to be part of the "island syndrome" in plants. However, empirical evidence for this pattern is mixed. In this paper, we present two studies that compare putative physical and chemical defense traits from plants on the California Channel Islands and nearby mainland based on sampling of both field and common garden plants. In the first study, we focus on five pairs of woody shrubs from three island and three mainland locations and find evidence for increased leaf area, decreased marginal leaf spines, and decreased concentrations of cyanogenic glycosides in island plants. We observed similar increases in leaf area and decreases in defense traits when comparing island and mainland genotypes grown together in botanic gardens, suggesting that trait differences are not solely driven by abiotic differences between island and mainland sites. In the second study, we conducted a common garden experiment with a perennial herb—Stachys bullata (Lamiaceae)—collected from two island and four mainland locations. Compared to their mainland relatives, island genotypes show highly reduced glandular trichomes and a nearly 100-fold reduction in mono- and sesquiterpene compounds from leaf surfaces. Island genotypes also had significantly higher specific leaf area, somewhat lower rates of gas exchange, and greater aboveground biomass than mainland genotypes across two years of study, potentially reflecting a broader shift in growth habit. Together, our results provide evidence for reduced expression of putative defense traits in island plants, though these results may reflect adaptation to both biotic (i.e., the historical absence of large herbivores) and climatic conditions on islands. [ABSTRACT FROM AUTHOR]

PURPOSE: We previously implemented paper-based screening for health-related social resource needs (HRSN) in our gynecologic oncology clinic and found that 36% of patients who completed the screening reported HRSN. We identified two primary deficiencies with our process. First, only 52% of patients completed the screening. Second, 37% of patients with needs failed to indicate if they desired resource referral or not. Therefore, we conducted a quality improvement project to integrate screening and referral processes into the electronic medical record (EMR) and routine clinic workflow to achieve at least 90% screening compliance and 90% elicited referral preference. METHODS: A multidisciplinary team consisting of physicians, a health outcomes researcher, a computer programmer, project assistants, and the staff of a partner community organization designed and implemented an intervention that screened for HRSN online via the EMR patient platform or in person during visits. The primary outcome was the percentage of eligible patients who completed the HRSN screening (ie, reach). Outcomes were reviewed weekly, and feedback was provided to stakeholders monthly. Iterative changes were incorporated into five successive Plan-Do-Study-Act (PDSA) cycles completed from January 2021 to March 2023. RESULTS: Screening compliance increased from the baseline of 52% (paper-based) to 97% in PDSA 4. Completion via the online patient portal increased from 17% in prelaunch to 49% in PDSA 4. Of patients who reported needs, 100% had a documented referral preference. CONCLUSION: Compared with paper-based screening, an EMR-integrated HRSN screening and referral system significantly improved reach to patients at a gynecologic oncology clinic. Implementation efforts to expand to other ambulatory clinic settings are in process. [ABSTRACT FROM AUTHOR]

Morro manzanita Arctostaphyos morroensis (Ericaceae) is a long-lived, shrub endemic to San Luis Obispo County, southern California, USA. It was listed as threatened under the U.S. Endangered Species Act in 1994, with identified threats being residential and urban development, including lack of protection on private land and lack of management on public lands, competition with invasive non-native plants, and risks of extinction associated with small and isolated populations. Our goal in this paper is to summarize and supplement the current knowledge of Morro manzanita. We review the literature on the species' description, reproductive ecology, germination cues, short-term response to fire. and distribution. We conducted field surveys to report on long-term response to fire, resampling the previously studied prescribed burn site 25 yr post-fire. Finally, we summarize the current land management of sites that support Morro manzanita and threats faced by this species. We conclude with specific recommendations for management and future study towards supporting conservation of this species and its maritime chaparral community. [ABSTRACT FROM AUTHOR]

Background: Vaccine hesitancy, delaying or refusing to vaccinate despite the availability of vaccines, impedes the progress of achieving optimal HPV vaccine coverage. Little is known about the sources of human papillomavirus (HPV) vaccine hesitancy among racially/ethnically and geographically diverse communities. The purpose of this paper is to explore HPV vaccine hesitancy among rural, Slavic, and Latino communities that reside in counties with low HPV vaccine uptake rates. Methods: Key informant interviews and focus groups were conducted with rural, Slavic, and Latino communities that reside within counties in California that have low HPV vaccine up to date rates (16–25%). Qualitative data were transcribed verbatim and analyzed using inductive and deductive thematic analysis. Results: A total of seven focus groups and 14 key informant interviews were conducted with 39 individuals from seven California counties. Salient themes that contributed to HPV vaccine hesitancy included the following: social media and the anti-vaccination movement; a strong belief in acquiring immunity naturally; prior vaccine experiences; and vaccine timing concerns. Participants suggested the provision of culturally appropriate, in-language, in-person easy to understand HPV vaccine education to mitigate HPV vaccine hesitancy. Conclusions: Our findings can inform future interventions to increase HPV vaccine uptake among hesitant communities. [ABSTRACT FROM AUTHOR]

The increase in both the frequency and magnitude of natural disasters, coupled with recent advancements in artificial intelligence, has introduced prospects for investigating the potential of new technologies to facilitate disaster response processes. Preliminary Damage Assessment (PDA), a labor-intensive procedure necessitating manual examination of residential structures to ascertain post-disaster damage severity, stands to significantly benefit from the integration of computer vision-based classification algorithms, promising efficiency gains and heightened accuracy. Our paper proposes a Vision Transformer (ViT)-based model for classifying damage severity, achieving an accuracy rate of 95%. Notably, our model, trained on a repository of over 18,000 ground-level images of homes with damage severity annotated by damage assessment professionals during the 2020–2022 California wildfires, represents a novel application of ViT technology within this domain. Furthermore, we have open sourced this dataset—the first of its kind and scale—to be used by the research community. Additionally, we have developed a publicly accessible web application prototype built on this classification algorithm, which we have demonstrated to disaster management practitioners and received feedback on. Hence, our contribution to the literature encompasses the provision of a novel imagery dataset, an applied framework from field professionals, and a damage severity classification model with high accuracy. [ABSTRACT FROM AUTHOR]

Traffic accidents are a nationwide public health concern, but autonomous vehicles (AVs) have the potential to significantly reduce accident severity and frequency by eliminating their most common cause, human error. By analyzing the data published by California's Department of Motor Vehicles, researchers have identified the factors that influence AV crash severity, however, none do so through a literature review. This paper's aims are multi-faceted: to understand AVs' operation on public roadways by identifying and classifying the factors contributing to accident severity, to develop a list of strategies that address the public's safety concerns, and to acknowledge the ethics of unavoidable collisions. To fulfill these objectives, a comprehensive literature review was conducted based on a keyword search. Following a multi-step screening and exclusion process, detailed review was performed of 107 relevant publications, and the factors contributing to increased crash severity were classified into 14 categories. The literature revealed that AVs are not at fault in most accidents, although they have a higher propensity than conventional cars to be involved in rear-end collisions, and they are specifically designed to minimize the number of accidents, but may face unavoidable ones. For the benefit of policymakers and manufacturers, 11 strategies that address the moral dilemma of these accidents and 7 strategies that address concerns about AV safety to improve public perception were identified. [ABSTRACT FROM AUTHOR]

Purpose: In an effort to address persistent inequities in maternal and infant health, policymakers and advocates have pushed to expand access to doula care. Several states, including California, now cover doula services through Medicaid. As coverage expands, research on the impact of doula care will likely increase. To develop best practices for research, it is critical to engage community doulas, clients, and other key stakeholders. Description: Our overarching goal was to build capacity for future doula- and client-centered research on community doula care. First, we established a Steering Committee with members from seven relevant stakeholder groups: community doulas, former or potential doula clients, clinicians, payers, advocates, researchers, and public health professionals. Second, we conducted a needs assessment to identify and understand stakeholders' needs and values for research on community doula care. Findings from the needs assessment informed our third step, conducting a research prioritization to develop a shared research agenda related to community doula care with the Steering Committee. We adapted the Research Prioritization by Affected Communities protocol to guide this process, which resulted in a final list of 21 priority research questions. Lastly, we offered a training to increase capacity among community doulas to engage in research on community doula care. Assessment: Our findings provide direction for those interested in conducting research on doula care, as well as policymakers and funders. Conclusion: The findings of our stakeholder-engaged process provide a roadmap that will lead to equity-oriented research centering clients, doulas, and their communities. Significance: What is Already Known on this Subject?: Doula care is often cited as a cost-effective intervention to improve maternal and infant health and health care experiences. However, research that focuses on the community-based model of doula care is limited. What this Study Adds?: This paper describes a stakeholder-engaged process that identified important understudied research questions about community doula care. Researchers can further refine these questions to conduct partnered research with multiple stakeholder groups, including community doulas, former or potential doula clients, clinicians, payers, advocates, and public health professionals. Further, this paper outlines best practices for research on community doula care. [ABSTRACT FROM AUTHOR]

This case study examines overheard speech in a third-generation heritage Spanish Mexican family. It presents Spanish use longitudinally and describes overheard Spanish word use in interaction. Transcribed on CLAN to create a plurilingual corpus, ethnographic video data consisted of 24 h across three sampling periods, yielding nearly 30,000 Spanish, English, and language mixed utterances. Quantitative analyses indicate strong Spanish use in the first sample, before dropping. Qualitative descriptions show the third-generation target-child's attunement to overheard Spanish, and her agency to use Spanish. Overheard input helps her use Spanish words, influencing her social encounters. This paper examines what we coded as overheard input in heritage language acquisition and socialization research. The language practices of one multigenerational Mexican family in California are explored, accounting for how their language practices in multiparty interaction co-create meaning, and how they help a third-generation child use Spanish words grounded in daily experiences. The findings contribute to the discussion of bilingualism in general and definitions of heritage bilingualism in particular. The results underscore the understudied role of overhead speech produced by a diversity of multigenerational family members and word learning. Participation frameworks are dynamically constructed by all participants as permeable, inclusive, and engage the children's use of inherited bilingual and bicultural practices, suggesting that heritage bilingualism is not just about abstract grammar. [ABSTRACT FROM AUTHOR]

This paper presents a comprehensive study of using xanthan gum (XG), sodium alginate (SA) and gelatin (G) to stabilise collapsible soil. Modified Proctor, one-dimensional collapse, unconsolidated-undrained triaxial and California bearing ratio (CBR) tests were conducted to estimate the engineering characteristics of the untreated and treated soil. Additionally, x-ray diffraction (XRD) and scanning electron microscopy (SEM) tests were utilised to demonstrate the changes in the microstructure of the treated samples. It was found that biopolymers decreased the maximum dry density and increased the optimum water content. The results also indicated that a 4% content of XG, SA and G significantly reduced the collapse index by 96, 95 and 82%, respectively. Shear tests showed that biopolymers slightly reduced the internal friction angle and significantly increased the cohesion intercept, which led to shear strength improvement. The results also indicated that 4% XG-treated, 4% SA-treated and 4% G-treated samples exhibited higher shear strengths by 145, 106 and 73%, respectively, than the untreated samples under the same conditions. The findings also indicated that when the soil was mixed with a 4% concentration of XG, SA and G, the unsoaked CBR value increased by about 185, 157 and 141%, respectively. [ABSTRACT FROM AUTHOR]

In California, wildfires caused by electrical infrastructure have left the state's investor-owned power utilities with major and growing liabilities. But even in such an incendiary environment, the financial industry has demonstrated that it can profit from disaster. This paper uses the 2019-2020 bankruptcy of Pacific Gas & Electric to explain how. In it, I show how "risk" in California's electricity industry is legally constituted, mediated, and allocated. First, I explain how financial perceptions of wildfire risk in California's electricity industry are shaped by the state's legal and regulatory environment, and how the law is used to manage this risk. I then turn to PG&E's bankruptcy to show how litigation functions as a financial strategy. In court, risk is endogenous to legal-financial practice. I develop the concepts of "legal arbitrage" and "leverage" to explain how law mediates the relationship between risk and finance. I adapt the concept of legal arbitrage to show how financial assets (like those in a utility with unprecedented wildfire liabilities) can possess both legal and market value, which can and often do diverge in circumstances of distress. I use the term leverage to refer to a particular kind of legal-financial power which enables actors to transfer risk away from themselves and onto others. In working through these concepts, I argue that that mainstream perceptions of risk in the financial industry are inadequate, especially in an era of increasing climate insecurity. [ABSTRACT FROM AUTHOR]

Water system management models represent different purposes, such as water supply, flood control, recreation, and hydropower. When building large-scale system models to represent these diverse objectives, their most appropriate time steps for each purpose often do not coincide. A monthly time step is usually sufficient for water supply modeling, but it can be too coarse for flood control, hydropower, and energy operations, where hourly time steps are preferred. Large-scale water management and planning models mostly employ monthly time steps, but using monthly average energy prices underestimates hydropower revenue and overestimates pumping energy cost because these plants tend to operate during times with above- or below-average energy prices within any month. The approach developed here uses hourly varying prices depending on the percent of monthly operating hours. This paper examines an approach that approximately incorporates hourly energy price variations for hydropower and pumping into large-scale monthly time-step water system model operations without affecting water delivery results. Results from including hourly varying energy prices in a large-scale monthly water supply model of California (CALVIN) are presented. CALVIN is a hydroeconomic linear programming optimization model that allocates water to agricultural and urban users with an objective to minimize total scarcity costs, operating costs, and hydropower revenue loss. Thirteen hydropower plants are modeled with hourly varying prices, and their revenue increased by 25 to 58% compared to revenue calculated with monthly average constant energy prices. Hydropower revenue improvements are greater in critically dry years. For pumping plants modeled with hourly varying prices, the energy use cost decreased by 10 to 59%. This study improves system representation and results for large-scale modeling. [ABSTRACT FROM AUTHOR]

Background: Barriers exist for the provision of surgery for permanent contraception in the postpartum period. Prenatal counseling has been associated with increased rates of fulfillment of desired postpartum contraception in general, although it is unclear if there is impact on permanent contraception specifically. Thus, we aimed to investigate the association between initial timing for prenatal documentation of a contraceptive plan for permanent contraception and fulfillment of postpartum contraception for those receiving counseling. Methods: This is a planned secondary analysis of a multi-site cohort study of patients with documented desire for permanent contraception at the time of delivery at four hospitals located in Alabama, California, Illinois, and Ohio over a two-year study period. Our primary exposure was initial timing of documented plan for contraception (first, second, or third trimester, or during delivery hospitalization). We used univariate and multivariable logistic regression to analyze fulfillment of permanent contraception before hospital discharge, within 42 days of delivery, and within 365 days of delivery between patients with a documented plan for permanent contraception in the first or second trimester compared to the third trimester. Covariates included insurance status, age, parity, gestational age, mode of delivery, adequacy of prenatal care, race, ethnicity, marital status, and body mass index. Results: Of the 3103 patients with a documented expressed desire for permanent contraception at the time of delivery, 2083 (69.1%) had a documented plan for postpartum permanent contraception prenatally. After adjusting for covariates, patients with initial documented plan for permanent contraception in the first or second trimester had a higher odds of fulfillment by discharge (aOR 1.57, 95% C.I 1.24–2.00), 42 days (aOR 1.51, 95% C.I 1.20–1.91), and 365 days (aOR 1.40, 95% C.I 1.11–1.75), compared to patients who had their first documented plan in the third trimester. Conclusions: Patients who had a documented prenatal plan for permanent contraception in trimester one and two experienced higher likelihood of permanent contraception fulfillment compared to those with documentation in trimester three. Given the barriers to accessing permanent contraception, it is imperative that comprehensive, patient-centered counseling and documentation regarding future reproductive goals begin early prenatally. Plain language summary: Permanent contraception is a highly desired form of postpartum contraception in the United States, however there are several barriers to accessing it. In this paper, we investigate whether the timing of when a patient has a documented plan for postpartum contraception has an impact on if they achieve postpartum contraception. This is a cohort study from four hospitals in Illinois, Ohio, California, and Alabama for patients with a desire for postpartum permanent contraception documented in their medical record. We specifically investigated the trimester (first, second, or third) where a patient had a plan for permanent contraception first documented. We then used univariate and multivariate models to determine the relationship between the timing of a plan for permanent contraception and if a patient achieved the procedure at three time-points: hospital discharge, 42-days, and 365-days. Our findings showed that of the 3103 patients in our cohort, only 69.1% of them had a documented plan for postpartum contraception at any point before going to the hospital for their delivery admission. We additionally found that patients who had a documented plan for permanent contraception in the first or second trimester had a higher odds of receiving their postpartum contraception procedure compared to people who had their first documented plan in the third trimester. This showed us the importance of earlier counseling regarding contraception for pregnant patients. There are many barriers to accessing postpartum contraception, so having patient focused counseling about future goals around reproductive health early on in pregnancy is critical. [ABSTRACT FROM AUTHOR]

Current literature emphasizes the necessary and increasing role of the emergency department (ED) psychologist. This perspective paper will illustrate that the recent focus on an ED psychologist is necessary, but insufficient. Equally important, is an understanding of when a patient in a potential crisis does not require an ED admission, but rather an assessment that is made prior to the patient going to the ED. The essential role of an outpatient crisis team is vital in differentiating when an ED admission is indicated for a psychiatric crisis (true positive) and when an ED admission is not indicated for a psychiatric crisis (false positive). Evaluating crises prior to ED admissions accomplishes two critical healthcare objectives in a parallel process: 1) accurately assessing the proper level of care needed when a patient reports they are experiencing acute psychiatric symptoms (which may or may not necessitate emergency department level of care, and 2) reducing burden on an already over-extended ED when emergency care is not indicated. Our findings are uniquely drawn from a highly diverse youth patient population in Northern California, United States. [ABSTRACT FROM AUTHOR]

Navigating the healthcare conundrum in the Blue Zone of Loma Linda, California, requires understanding the unique factors that make this region stand out in terms of health and longevity. But more important is understanding the healthcare system sustaining the Blue Zone in Loma Linda, California. In an era marked by soaring healthcare costs and diminishing reimbursement rates, hospitals and physicians face an unprecedented challenge: providing excellent patient care while maintaining financial sustainability. This leadership perspective publication paper delves into the multifaceted struggles encountered by healthcare and hospital leaders, exploring the root causes, implications, and potential solutions for this complex issue. As we examine the evolving healthcare landscape, we aim to shed light on the critical need for innovative approaches to sustain the future of healthcare excellence in one of the five original Blue Zones. [ABSTRACT FROM AUTHOR]