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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]

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]

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]

STEM-related educational outreach offers students enriching opportunities to become more familiar with science, in terms of how it relates to their daily lives and with respect to possible career paths that they might want to follow. At the same time, graduate student trainees providing that outreach act as important resources for elementary and high school teachers while they hone their teaching skills and build confidence in the classroom. In this paper, six graduate students and recent graduates share their experiences with a variety of outreach programs that link young people with science in both Canada and the United States.

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]

Background: Global research hotspots and future research trends in the neurobiological mechanisms of late-life depression (LLD) as well as its diagnosis and treatment are not yet clear. Objectives: This study profiled the current state of global research on LLD and predicted future research trends in the field. Methods: Literature with the subject term LLD was retrieved from the Web of Science Core Collection, and CiteSpace software was used to perform econometric and co-occurrence analyses. The results were visualized using CiteSpace, VOSviewer, and other software packages. Results: In total, 10,570 publications were included in the analysis. Publications on LLD have shown an increasing trend since 2004. The United States and the University of California had the highest number of publications, followed consecutively by China and England, making these countries and institutions the most influential in the field. Reynolds, Charles F. was the author with the most publications. The International Journal of Geriatric Psychiatry was the journal with the most articles and citations. According to the co-occurrence analysis and keyword/citation burst analysis, cognitive impairment, brain network dysfunction, vascular disease, and treatment of LLD were research hotspots. Conclusion: Late-life depression has attracted increasing attention from researchers, with the number of publications increasing annually. However, many questions remain unaddressed in this field, such as the relationship between LLD and cognitive impairment and dementia, or the impact of vascular factors and brain network dysfunction on LLD. Additionally, the treatment of patients with LLD is currently a clinical challenge. The results of this study will help researchers find suitable research partners and journals, as well as predict future hotspots. [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]

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]

This study examines the impact of the California Nonprofit Integrity Act of 2004 on CEO compensation costs in affected organizations. Contrary to the stated objective of the Act that executive compensation is ''just and reasonable,'' we find that CEO compensation costs for affected nonprofits during the post-regulation periods have increased by about 6.3 percent when compared with a control group of comparable unaffected nonprofits. In addition, the relative increase in CEO compensation appears to come from nonprofits that have experienced greater regulatory cost increases. We do not find evidence that the Act resulted in a change in CEO pay performance sensitivity. The observed CEO pay increase is not systematically different across nonprofits that underpaid versus those that overpaid their CEOs during pre-Act periods. Overall, this paper highlights the unintended consequences of regulatory attempts to enhance governance in the not-for-profit sector. [ABSTRACT FROM AUTHOR]

apidly changing wildfire regimes across the Western United States have driven more frequent and severe wildfires, resulting in wide-ranging societal threats from wildfires and wildfire-generated smoke. However, common measures of fire severity focus on what is burned, disregarding the societal impacts of smoke generated from each fire. We combine satellite-derived fire scars, air parcel trajectories from individual fires, and predicted smoke PM2.5 to link source fires to resulting smoke PM2.5 and health impacts experienced by populations in the contiguous United States from April 2006 to 2020. We quantify fire-specific accumulated smoke exposure based on the cumulative population exposed to smoke PM2.5 over the duration of a fire and estimate excess asthma-related emergency department (ED) visits as a result of this exposure. We find that excess asthma visits attributable to each fire are only moderately correlated with common measures of wildfire severity, including burned area, structures destroyed, and suppression cost. Additionally, while recent California fires contributed nearly half of the country’s smoke-related excess asthma ED visits during our study period, the most severe individual fire was the 2007 Bugaboo fire in the Southeast. We estimate that a majority of smoke PM2.5 comes from sources outside the local jurisdictions where the smoke is experienced, with 87% coming from fires in other counties and 60% from fires in other states. Our approach could enable broad-scale assessment of whether specific fire characteristics affect smoke toxicity or impact, inform cost-effectiveness assessments for allocation of suppression resources, and help clarify the growing transboundary nature of local air quality. [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]

Background: A growing body of research has found a link between firearm availability and police shootings of citizens across place. The problem, however, is that the previous studies on the topic tend to suffer from several limitations: a near exclusive focus on citizen fatalities, units of analysis at the state or county levels, and a variety of proxy measures tapping into community-level firearm access. The current study set out to address these issues by examining the relationship between different forms of firearm availability and both fatal and nonfatal injurious police shootings of citizens at the city level. Methods: More specifically, it merged The Trace's "Missing Pieces" measures of guns reported lost and stolen to police as well as licensed firearms dealers across jurisdictions from the Bureau of Alcohol, Tobacco, Firearms, and Explosives as proxies for firearm availability with data on police shootings of citizens in California and Florida from California's URSUS system and the Tampa Bay Times' "Why Cops Shoot" database, respectively. Negative binomial regression analyses were performed on a sample of 253 cities across the two states and a sub-sample of cities with licensed firearms dealers. Results: Findings uncovered a small positive association between rates of federally licensed guns stores and the number citizens shot by police as well as police shooting incidents while controlling for several community-level measures (e.g., concentrated disadvantage, gun homicide rates). Rates of guns lost or reported stolen were generally not significantly associated with the outcome measures in the multivariate models. Conclusions: Firearm availability is a significant correlate of police shootings. Pooled counts of both citizens shot by police and police shooting incidents are heightened in jurisdictions with higher rates of licensed gun dealers, which may be due to the fact that all firearms sold in the USA first make their way to the public through these mechanisms. Such licensed gun dealers must be appropriately monitored and audited to reduce illicit behavior and prevent firearms from making their way into secondary markets. Addressing access to firearms can be meaningful for a host of gun-related morbidity and mortality outcomes, including police shootings of citizens. [ABSTRACT FROM AUTHOR]

Copyright of Education Policy Analysis Archives / Archivos Analíticos de Políticas Educativas / Arquivos Analíticos de Políticas Educativas is the property of Educational Policy Analysis Archives & Education Review and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Interactions between invaders and resource availability may explain variation in their success or management efficacy. For widespread invaders, regional variation in plant response to nutrients can reflect phenotypic plasticity of the invader, genetic structure of invading populations, or a combination of the two. The wetland weed Alternanthera philoxeroides (alligatorweed) is established throughout the southeastern United States and California and has high genetic diversity despite primarily spreading clonally. Despite its history in the United States, the role of genetic variation for invasion and management success is only now being uncovered. To better understand how nutrients and genotype may influence A. philoxeroides invasion, we measured the response of plants from 26 A. philoxeroides populations (three cp haplotypes) to combinations of nitrogen (4 or 200 mg/L N) and phosphorus (0.4 or 40 mg/L P). We measured productivity (biomass accumulation and allocation), plant architecture (stem diameter and thickness, branching intensity), and foliar traits (toughness, dry matter content, percent N, and percent P). A short‐term developmental assay was also conducted by feeding a subset of plants from the nutrient experiment to the biological control agent Agasicles hygrophila, to determine whether increased availability of N or P to its host influenced agent performance, as has been previously suggested. Alternanthera philoxeroides haplotype Ap1 was more plastic than other haplotypes in response to nutrient amendments, producing more than double the biomass from low to high N and 50%–68% higher shoot: root ratio than other haplotypes in the high N treatment. Alternanthera philoxeroides haplotypes differed in seven of 10 variables in response to increased N. We found no differences in short‐term A. hygrophila development between haplotypes but mass was 23% greater in high than low N treatments. This study is the first to explore the interplay between nutrient availability, genetic variation, and phenotypic plasticity in invasive characteristics of the global invader, A. philoxeroides. [ABSTRACT FROM AUTHOR]

Simple Summary: The western yellowjacket, Vespula pensylvanica, is an important seasonal pest of recreational and outdoor venues in the western United States. Effective control strategies are limited, and the objective of this study was to determine the potential of the isoxazoline fluralaner as a bait toxicant. A minimum of 27 colonies were detected foraging at an individual monitoring station using microsatellite markers. As colonies disappeared after baiting, new colonies were detected. Minced chicken and hydrogel baits containing 0.022% and 0.045% fluralaner bait significantly reduced the number of foragers. The western yellowjacket, Vespula pensylvanica (Saussure), is an important seasonal pest of recreational and outdoor venues in the western United States. Its propensity to scavenge food increases the likelihood of stinging incidences. Control measures are limited to intensive trapping and treating subterranean nests. The only toxicant registered for baiting in the US is esfenvalerate, which is ineffective. The objective of this study was to determine the potential of the isoxazoline fluralaner as a bait toxicant. With microsatellite genotyping, a minimum of 27 different colonies were shown to forage at a single monitoring site. Some colonies disappeared after baiting, and new colonies were detected. The implications for baiting and monitoring are discussed. Minced chicken and hydrogel baits containing 0.022% and 0.045% fluralaner significantly reduced foraging yellowjackets. Several bait applications covering large areas will be necessary to provide long-term control. [ABSTRACT FROM AUTHOR]

Environmental impact assessment (EIA) has become one of the most widespread environmental management instruments. Despite this, EIA is routinely criticized for being ineffective at impacting decision-making. This study compared the EIA systems of Paraná, Brazil and California, United States using the effectiveness dimensions from the EIA literature. This study formats the cases into contextual conditions using the fuzzy-set qualitative comparative analysis (fsQCA) to identify the necessary or sufficient conditions that cause effective outcomes. These effectiveness outcomes are then ranked by EIA stakeholders via the analytical hierarchy process (AHP) to identify stakeholder priorities and to improve stakeholder management. The results show that in Paraná stakeholders identified normative effectiveness as the most important dimension, while stakeholders in California identified this dimension as the second-most important following substantive effectiveness. Public participation was found to be a necessary condition for both substantive and normative effectiveness to occur. Early project definition was found to be sufficient for substantive effectiveness and necessary for normative effectiveness, for which stakeholder coordination was a sufficient condition. This suggests that in order for EIA to influence decision-making and foster sustainable development, greater care needs to be taken to actively engage stakeholders in public participation, with clear roles and project design communicated early on, and a clear role for regulatory authority to promote stakeholder coordination for acceptable outcomes. These findings suggest that some effectiveness dimensions are caused by similar conditions, which could help focus stakeholder management efforts and point to new avenues for future EIA effectiveness research., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

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]

Atmospheric rivers (ARs) are narrow bands of enhanced integrated water vapor transport, modulated by large-scale and synoptic-scale variability. Here, we investigate how ARs and snowpack are shaped by large-scale variability such as arctic oscillation (AO) by examining the synoptic conditions and characteristics of ARs and snowpack in the different phases of AO. Using Integrated Multi-Satellite Retrievals for Global Precipitation Measurement (IMERG) data, Modern-Era Retrospective analysis for Research and Applications, Version 2 (MERRA2) reanalysis data, and in-situ observation data over the eastern Pacific and western United States. we found that more precipitation is observed in lower latitudes (35° N–45° N) during negative AO months and farther north (north of 45° N) in latitude during positive AO months. These are associated with wavelike synoptic patterns in negative AO months and more straight-line type synoptic patterns in positive AO months. The different phases of AO also modulate the AR characteristics: 2.6% less intense (5.3% more intense) integrated water vapor transport and total precipitation, and 16.0% shorter (21.1% longer) duration of ARs than the climatological mean (1980–2019) for positive AO (negative AO) phase. AR frequency is also higher (~50.4%) than the climatological mean for negative AO phase, but there is no statistically significant difference between either negative AO or positive AO phase, especially in southern California. In addition, the snow water equivalent (SWE) tends to be reduced in the positive AO phase and under high-temperature conditions, especially in recent years (2010s). The similar relationships are found in the early 1990s and 2000s, but their statistical significances are low. Considering that lower atmospheric temperature keeps increasing over the eastern Pacific and the western U.S., and SWE tends to be reduced in the positive AO phase in recent years, SWE may decrease over northern California if the warming condition persists. These findings highlight how the characteristics of local extreme weather can be shaped by large-scale climate variability. [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: The Deferred Action for Childhood Arrivals (DACA) program provides temporary relief from deportation and work permits for previously undocumented immigrants who arrived as children. DACA faced direct threats under the Trump administration. There is select evidence of the short-term impacts of DACA on population health, including on birth outcomes, but limited understanding of the long-term impacts.Methods: We evaluated the association between DACA program and birth outcomes using California birth certificate data (2009-2018) and a difference-in-differences approach to compare post-DACA birth outcomes for likely DACA-eligible mothers to birth outcomes for demographically similar DACA-ineligible mothers. We also separately compared birth outcomes by DACA eligibility status in the first 3 years after DACA passage (2012-2015) and in the subsequent 3 years (2015-2018) - a period characterized by direct threats to the DACA program - as compared to outcomes in the years prior to DACA passage.Results: In the 7 years after its passage, DACA was associated with a lower risk of small-for-gestational age (- 0.018, 95% CI: - 0.035, - 0.002) and greater birthweight (45.8 g, 95% CI: 11.9, 79.7) for births to Mexican-origin individuals that were billed to Medicaid. Estimates were consistent but of smaller magnitude for other subgroups. Associations between DACA and birth outcomes were attenuated to the null in the period that began with the announcement of the Trump U.S. Presidential campaign (2015-2018), although confidence intervals overlapped with estimates from the immediate post-DACA period.Conclusions: These findings suggest weak to modest initial benefits of DACA for select birthweight outcomes during the period immediately following DACA passage for Mexican-born individuals whose births were billed to Medicaid; any benefits were subsequently attenuated to the null. The benefits of DACA for population health may not have been sufficient to counteract the impacts of threats to the program's future and heightened immigration enforcement occurring in parallel over time. [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]

California's Mental Health Services Act (MHSA) substantially expanded funding of county mental health services through a state tax, and led to broad prevention efforts and intensive services for individuals experiencing serious mental disorders. We estimated the associations between MHSA and mortality due to suicide, homicide, and acute effects of alcohol. Using annual cause-specific mortality data for each US state and the District of Columbia from 1976–2015, we used a generalization of the quasi-experimental synthetic control method to predict California's mortality rate for each outcome in the absence of MHSA using a weighted combination of comparison states. We calculated the association between MHSA and each outcome as the absolute difference and percentage difference between California's observed and predicted average annual rates over the postintervention years (2007–2015). MHSA was associated with modest decreases in average annual rates of homicide (−0.81/100,000 persons, corresponding to a 13% reduction) and mortality from acute alcohol effects (−0.35/100,000 persons, corresponding to a 12% reduction). Placebo test inference suggested that the associations were unlikely to be due to chance. MHSA was not associated with suicide. Protective associations with mortality due to homicide and acute alcohol effects provide evidence for modest health benefits of MHSA at the population level. [ABSTRACT FROM AUTHOR]

Hospitals have for centuries been considered safe havens for immigrants and people on the move. However, immigrants and migrants who seek health care have also been targeted for exclusion and deportation. This article discusses the history of how hospitals and health care facilities in the United States have acted both as sanctuaries and as sites of immigration enforcement. This debate came to a head in California in the 1970s, when conservatives began attacking local public health facilities' informal sanctuary practices. Following the California battles, which culminated in Proposition 187 in 1994, immigrant rights movements have increasingly connected calls for sanctuary with demands for a right to health care. [ABSTRACT FROM AUTHOR]

Extensive, severe wildfires, and wildfire‐induced smoke occurred across the western and central United States since August 2020. Wildfires resulting in the loss of habitats and emission of particulate matter and volatile organic compounds pose serious threatens to wildlife and human populations, especially for avian species, the respiratory system of which are sensitive to air pollutions. At the same time, the extreme weather (e.g., snowstorms) in late summer may also impact bird migration by cutting off their food supply and promoting their migration before they were physiologically ready. In this study, we investigated the environmental drivers of massive bird die‐offs by combining socioecological earth observations data sets with citizen science observations. We employed the geographically weighted regression models to quantitatively evaluate the effects of different environmental and climatic drivers, including wildfire, air quality, extreme weather, drought, and land cover types, on the spatial pattern of migratory bird mortality across the western and central US during August‐September 2020. We found that these drivers affected the death of migratory birds in different ways, among which air quality and distance to wildfire were two major drivers. Additionally, there were more bird mortality events found in urban areas and close to wildfire in early August. However, fewer bird deaths were detected closer to wildfires in California in late August and September. Our findings highlight the important impact of extreme weather and natural disasters on bird biology, survival, and migration, which can provide significant insights into bird biodiversity, conservation, and ecosystem sustainability. Key Points: We investigated the environmental drivers of massive bird die‐offs by combining earth observations with citizen science observationsWe found distance to wildfire and air quality were the major factors that affect the birth mortality eventsOur findings highlight the important impact of extreme weather and natural disasters on bird biology, survival, and migration [ABSTRACT FROM AUTHOR]

American states have underinvested in public higher education for decades, spurring tuition increases that have in turn fueled an unprecedented rise in student debt. Most scholars have looked to ideology and partisanship to help explain this trend. However, existing studies have yet to provide a satisfactory account of why states led by both parties have exhibited the same spending patterns. This Article argues that to understand retrenchment, scholars must scrutinize the laws that shape legislators' budget choices. Through comparative histories of California and Virginia, interviews with eighteen state policymakers, and quantitative data, this analysis shows that decreased funding for public colleges and universities can be traced to three legal constructs: competing health, K-12 education, and prison expenditure mandates; outdated and inefficient tax systems; and campaign finance and lobbying rules that have allowed wealthy interests to overwhelm college advocates' voices. These findings should encourage scholars to examine the unintended consequences that legal frameworks governing one policy area can have on another. The results also have important implications for those wishing to revitalize public higher education: reformers should shift their focus from individual elections and budget battles to structural changes, beginning with revisions to state laws guiding appropriations, taxation, and political participation. [ABSTRACT FROM AUTHOR]

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Extreme droughts, heat waves, fires, hurricanes, floods, and landslides cause the largest losses in the United States, and globally, from natural hazards linked to weather and climate. There is evidence that the frequency of such extremes is increasing, particularly for heat waves, large fires, and intense precipitation, making better understanding of the probability and consequences of these events imperative. Further, these events are not isolated, but rather interact with each other and with other social and biophysical drivers and conditions, to amplify impacts. Less is known about the nature and strength of these interactions. Natural and social science subfields frame extreme events with different definitions and analytical approaches, often neglecting interactions and the subsequent novel extremes that can arise. Here we propose a framework for social‐environmental extremes, defined as extraordinary events that emerge from interactions among biophysical and social systems. We argue that this definition is critical because it constrains the focus to major events that are capturing societal and scientific attention because of their extreme biophysical drivers and/or the extreme social outcomes. We review how different fields approach extremes as interacting phenomena and propose a synthetic framework that allows analytical separation of the multiple drivers and responses that yield extreme events and extreme effects. We conclude with a future research agenda for understanding the extreme events that matter to society. This agenda will help to identify where, when, and why communities may have high exposure and vulnerability to social‐environmental extremes—informing future mitigation and adaptation strategies. Plain Language Summary: The frequency and magnitude of some extremes are increasing, for example, heavy downpours, heat waves, and wildfires, while vulnerabilities in ecosystems and human infrastructure and livelihoods are also changing. This review defines extremes across both their social and environmental dimensions, helping to establish the extremes that matter to society. In 2017, large portions of the western United States saw the wettest winter season, the hottest summer temperatures, and one of the driest falls ever recorded—leading to one of the largest and most devastating wildfire seasons in California, which were then followed by deadly mudslides that were partly a response to the burned landscape. This suite of events forces the questions: Are extremes increasing because of changes in natural events or social vulnerability, or both? Are extremes isolated events, or are they acting in concert or emergent from linked biophysical and social drivers? This review establishes a critical set of research questions that need to be addressed to better diagnose, predict, and mitigate extremes—one of the most pressing scientific challenges of our time. Key Points: Many extreme events have social and biophysical dimensions that are linkedThis review provides a definition and framework for understanding these events, termed social‐environmental extremesA proposed research agenda will help scientists better understand and predict the extremes that matter to society [ABSTRACT FROM AUTHOR]

People with type 1 diabetes may receive a significant portion of their care from primary care providers (PCPs). To understand the involvement of PCPs in delivering type 1 diabetes care, we performed surveys in California and Florida, two of the most populous and diverse states in the United States. PCPs fill insulin prescriptions but report low confidence in providing type 1 diabetes care and difficulty accessing specialty referrals to endocrinologists. [ABSTRACT FROM AUTHOR]

Groundwater depletion is a worldwide phenomenon that has prompted calls for improved policy and management. A prominent policy recommendation, especially among economists, is the establishment of well-defined transferable groundwater rights and the promotion of water transfers or markets. Modelled effects and actual results in limited sites show promising potential, but progress has been slow, even in areas of significant need and capacity such as the western United States. This article identifies some of the complexities associated with defining groundwater rights and with managing groundwater aquifers. Those complexities may account to some degree for the incremental and limited progress toward transferable rights. Recent groundwater policy developments in California and other western states are reviewed briefly in light of those complexities. [ABSTRACT FROM AUTHOR]

Objective: To estimate the impact of opting-out from Medicare supervision requirements for certified registered nurse anesthetists (CRNAs) on anesthesiologists' work patterns.Data Sources/study Setting: Secondary data from two national surveys of anesthesiologists and the Area Health Resource File.Study Design: We use a matching difference-in-difference regression which contrasts the change in work patterns for anesthesiologists in California, which dropped supervision requirements, to the change for similar anesthesiologists. Key outcome variables include the number of weekly hours worked, the type of work done, and type of care delivery teams.Data Collection/extraction Methods: Self-reported national survey data drawn from members of the American Society of Anesthesiologists.Principal Findings: Anesthesiologists in California saw no change in time spent working or time spent supervising CRNAs. There was a decrease in direct care clinical work hours along with a shift in working more in intraoperative care, a decrease in postoperative care, and an increase in the percentage of cases supervising residents.Conclusions: Anesthesiologists had small but real responses to California's decisions to opt-out of the physician supervision requirement for CRNAs, doing more work in intraoperative care and less outside of the operating room. Total hours worked saw no change. [ABSTRACT FROM AUTHOR]

Rising suppression cost and severity of wildfires in the United States have prompted debate over federal wildfire management policy. We estimate an econometric model of suppression resource allocation using a dynamic panel dataset on over 500 wildfires in the western United States. We find that more hand crews and engines are dispatched to fires that threaten homes, while more aircraft are dispatched to fires that start near higher-value homes. We combine our results with projected housing growth estimates in California to show that suppression expenditures may rise by nearly $24 million per year. (JEL Q23, Q28) [ABSTRACT FROM AUTHOR]

BACKGROUND: Environmental health (EH) professionals, one of the largest segments of the public health workforce, are responsible for delivery of essential environmental public health services. The challenges facing these professionals and research needs to improve EH practice are not fully understood, but 26% of EH professionals working in health departments of the United States plan to retire in 5 y, while only 6% of public health students are currently pursuing EH concentrations. OBJECTIVES: A groundbreaking initiative was recently launched to understand EH practice in health departments of the United States. This commentary article aims to identify priority EH practice challenges and related research needs for health departments. METHODS: A horizon scanning approach was conducted in which challenges facing EH professionals were provided by 1,736 respondents working at health departments who responded to a web-based survey fielded in November 2017. Thematic analyses of the responses and determining the frequency at which respondents reported specific issues and opportunities identified primary EH topic areas. These topic areas and related issues informed focus group discussions at an in-person workshop held in Anaheim, California. The purpose of the in-person workshop was to engage each of the topic areas and issues, through facilitated focus groups, leading to the formation of four to five related problem statements for each EH topic. DISCUSSION: EH professionals are strategically positioned to diagnose, intervene, and prevent public health threats. Focus group engagement resulted in 29 priority problem statements partitioned among 6 EH topic areas: a) drinking water quality, b) wastewater management, c) healthy homes, d) food safety, e) vectors and public health pests, and f) emerging issues. This commentary article identifies priority challenges and related research needs to catalyze effective delivery of essential environmental public health services for common EH program areas in health departments. An unprecedented initiative to revitalize EH practice with timely and strategic recommendations for student and professional training, nontraditional partnerships, and basic and translational research activities is recommended. [ABSTRACT FROM AUTHOR]

Objectives: Repeat visits (revisits) to emergency departments (EDs) for psychiatric care reflect poor continuity of care and impose a high financial cost. We test whether rapid expansion of community health centers (CHCs)—which provide regional, low‐cost primary care—correspond with fewer repeat psychiatric‐related ED visits (PREDVs). Methods: We obtained repeated cross‐sectional time‐series data for 7.8 million PREDVs from the State Emergency Department Database for four populous U.S. states (California, Florida, North Carolina, and New York) from 2006 to 2011. We specified as the outcome variable the count of repeat visits per ED visitor with a psychiatric diagnosis. We retrieved aggregate‐level mental health visits at CHCs from the Uniform Data System. Negative binomial regression methods controlled for individual‐level confounders, county health system and sociodemographic attributes, year fixed effects, and county fixed effects. Results: The risk of a repeat PREDV decreased with a county‐level increase in mental health patients seen at CHCs (incidence rate ratio = 0.986, 95% confidence interval = 0.98 to 0.99). Conversion of this rate ratio to the number of revisits averted indicated 34,000 fewer repeat PREDVs in these four states statistically associated with a 1% expansion in CHC mental health visits. Exploratory analyses found that revisits decline for relatively mild/moderate illnesses (e.g., mood, anxiety disorders) but not for severe illnesses (e.g., schizophrenia/psychoses). Conclusion: An increase in mental health services at CHCs corresponds with a modest decline in repeat PREDVs. This decline concentrates among those with less severe mental illnesses. [ABSTRACT FROM AUTHOR]

Objectives: Racial differences in mortality in the United States have narrowed and vary by time and place. The objectives of our study were to (1) examine the gap in life expectancy between white and black persons (hereinafter, racial gap in life expectancy) in 4 states (California, Georgia, Illinois, and New York) and (2) estimate trends in the contribution of major causes of death (CODs) to the racial gap in life expectancy by age group. Methods: We extracted data on the number of deaths and population sizes for 1969-2013 by state, sex, race, age group, and 6 major CODs. We used a Bayesian time-series model to smooth and impute mortality rates and decomposition methods to estimate trends in sex- and age-specific contributions of CODs to the racial gap in life expectancy. Results: The racial gap in life expectancy at birth decreased in all 4 states, especially among men in New York (from 8.8 to 1.1 years) and women in Georgia (from 8.0 to 1.7 years). Although few deaths occurred among persons aged 1-39, racial differences in mortality at these ages (mostly from injuries and infant mortality) contributed to the racial gap in life expectancy, especially among men in California (1.0 year of the 4.3-year difference in 2013) and Illinois (1.9 years of the 6.7-year difference in 2013). Cardiovascular deaths contributed most to the racial gap in life expectancy for adults aged 40-64, but contributions decreased among women aged 40-64, especially in Georgia (from 2.8 to 0.5 years). The contribution of cancer deaths to inequality increased in California and Illinois, whereas New York had the greatest reductions in inequality attributable to cancer deaths (from 0.6 to 0.2 years among men and from 0.2 to 0 years among women). Conclusions: Future research should identify policy innovations and economic changes at the state level to better understand New York's success, which may help other states emulate its performance. [ABSTRACT FROM AUTHOR]