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The benefits of undergraduate research experiences are well documented, yet few studies focus on programs designed to support students conducting research in the fields of humanities, arts, and social sciences. In this study, the authors examine learning experiences of students participating in the undergraduate research programs (URP) at UCLA, which support students conducting multiterm research or creative projects with faculty mentors. Drawing on data from students who participated in URP from 2015 to 2022 (N = 431), findings indicated that URP offered students structure, resources, mentorship, and peer networks to help them succeed. Further, students made significant gains in feeling connected to the research community and reported that undergraduate research was an important component of their academic career.

A modification in emphasis in an upper business course from a professor-centered approach to a student-centered focus demonstrated the use of possibilities to enrich a lecture course format to increase student engagement while also facilitating student readiness to enter the workforce. A proliferation of college teaching formats has emerged, including online learning, video teaching alternatives, and interactive learning outside the classroom. These rival formats offer new ways to engage students and ease them into future positions in organizations, yet the lecture format continues to be a choice preferred by many educational institutions. The transition to a course aligned with student needs and interests entailed numerous modifications in classroom conduct, curriculum, and student learning experiences. Certain changes appeared obvious along with other adjustments that, although profound, were subtle. This study identified factors associated with this transition along with their effects on students. Findings were based on input and evaluations by students. Three main factors were prominent in implementing the modifications: (a) augmenting the positioning of the professor as the unilateral classroom authority by adding the role of professor as agent of service to the students; (b) enriching content and assignments that immersed students in the course subjects, but often focused on the workplace environment; and (c) collecting initial input about student learning goals and requiring student feedback from each class meeting. Pre-post surveys completed by students assessed changes in their confidence on factors they associated with effectiveness in their careers.

We examined developmental trajectories of attention-deficit/hyperactivity disorder (ADHD) symptoms, standardized achievement, and school performance for adolescents with and without ADHD who did and did not enroll in postsecondary education (PSE; N = 749; 79% boys; 63% White, 17% non-Hispanic Black, 10% Hispanic, and 10% other ethnicities). In a multisite study (recruitment based in New York, North Carolina, Pennsylvania, California, and Quebec), participants were originally enrolled between 1994 and 1998 at ages 7 to 9.9 and followed up through 2012 (M[subscript age] = 25 at final follow-up). Adolescents who eventually enrolled in PSE had less severe symptoms, but differences were modest and trajectories were similar over time. For all adolescents, standardized achievement trajectories declined up to two thirds of a standard deviation from ages 9 to 17. By the end of high school, the average GPA of adolescents with ADHD was three quarters of a point higher for those who eventually enrolled in PSE compared to those who did not. Overall, school performance mattered more than academic achievement for understanding eventual enrollment of adolescents with ADHD.

This article traces the experience of university students in an upper division business course as they collectively authored an e-book as their course project. The professor designated the title of the book and the three themes that provided the structure of the book: service, leadership, and purpose. The 25 students at Pepperdine University in Malibu, California, executed the project following the leaderless organization model and its variations adopted by organizations with flattened hierarchies and fast-paced operations. The instructional approach was adapted to the values and preferences that typify millennials. The professor divided the students into five work teams, with each team focused on key tasks and composed of members with the proficiencies needed to complete the project. The article presents dynamics of the process including interactions among the teams and guidelines followed by the professor. The project culminated in a completed book presented to the students on the final day of class.

The article reviews challenges facing colleges including the need for actions to address new circumstances of educating college students and preparing them for productive roles following graduation. These challenges are balanced by resources colleges are developing to facilitate college-to-career transitioning to first destinations following graduation. In a review of support services offered by colleges the article identifies innovative programs that show potential for improved career support for students. Sources, including surveys of students and employers, published writing by leaders in education, and reported data from colleges, provide a present view of career support functions and suggest patterns of evolution. Colleges are strengthening their support to student's department by department, but programs and activities across-departments need to be integrated to improve services for students. Leveraging synergies among campus support functions improves services to students. The use of student support case managers may eliminate the silos among college support functions. Designing programs around students and bridging gaps among support services can deliver more relevant and timely results. The article introduces the voices of students expressed in an upper division business course Management Theory and Practice. The actual words of students were acquired as byproducts of class assignments and course evaluations. Collecting these indirectly rather that as the focal point of student input lends a candid perspective. The comments interject both students' requests for assistance and their appreciation for the support they received.

Despite its vital importance in our lives, chemistry is inadequately represented in most museums. Issues such as safety, replenishing and disposal of chemicals, supervision required, and cost are constraints that have limited the number and size of chemistry exhibits. Taking into account the constraints, a 21-station interactive and inexpensive chemistry exhibit has been designed, constructed, and installed in the Great Valley Museum on the Modesto Junior College West Campus. The exhibit is intended to stimulate interest in chemistry, demonstrate and emphasize the importance of chemistry in our lives, and provide a meaningful and enjoyable educational experience with chemistry. The centerpiece of the exhibit involves the identification of 11 elements from observations of relative density, electrical conductivity, magnetic properties, color, and luster. Descriptions of the 21 stations are included in this paper.

BACKGROUND Quadrivalent recombinant influenza vaccines contain three times the amount of hemagglutinin protein as standard-dose egg-based vaccines, and the recombinant formulation is not susceptible to antigenic drift during manufacturing. Data are needed on the relative effectiveness of recombinant vaccines as compared with standard-dose vaccines against influenza-related outcomes in adults under the age of 65 years. METHODS In this cluster-randomized observational study, Kaiser Permanente Northern California facilities routinely administered either a high-dose recombinant influenza vaccine (Flublok Quadrivalent) or one of two standard-dose influenza vaccines during the 2018-2019 and 2019-2020 influenza seasons to adults 50 to 64 years of age (primary age group) and 18 to 49 years of age. Each facility alternated weekly between the two vaccine formulations. The primary outcome was influenza (A or B) confirmed by polymerase-chain-reaction (PCR) testing. Secondary outcomes included influenza A, influenza B, and influenza-related hospitalization outcomes. We used Cox regression analysis to estimate the hazard ratio of the recombinant vaccine as compared with the standard-dose vaccines against each outcome. We calculated the relative vaccine effectiveness as 1 minus the hazard ratio. RESULTS The study population included 1,630,328 vaccinées between the ages of 18 and 64 years (632,962 in the recombinant-vaccine group and 997,366 in the standard-dose group). During this study period, 1386 cases of PCR-confirmed influenza were diagnosed in the recombinant-vaccine group and 2435 cases in the standard-dose group. Among the participants who were 50 to 64 years of age, 559 participants (2.00 cases per 1000) tested positive for influenza in the recombinant-vaccine group as compared with 925 participants (2.34 cases per 1000) in the standarddose group (relative vaccine effectiveness, 15.3%; 95% confidence interval [CI], 5.9 to 23.8; P=0.002). In the same age group, the relative vaccine effectiveness against influenza A was 15.7% (95% CI, 6.0 to 24.5; P=0.002). The recombinant vaccine was not significantly more protective against influenza-related hospitalization than were the standard-dose vaccines. CONCLUSIONS The high-dose recombinant vaccine conferred more protection against PCR-confirmed influenza than an egg-based standard-dose vaccine among adults between the ages of 50 and 64 years. [ABSTRACT FROM AUTHOR]

High rates of anxiety and depression are reported among youth with autism spectrum disorders. These conditions are generally assessed using measures validated for typically developing youth. Few studies have investigated their validity for autism spectrum disorders, which is crucial for accurate assessment and the provision of proper treatment. The Revised Children's Anxiety and Depression Scale was evaluated with 67 youth with autism spectrum disorders to examine its utility in measuring anxiety and depression in this population. Parents and children (aged 11-15 years) referred to a multisite intervention study completed the Pediatric Anxiety Rating Scale, Multidimensional Anxiety Scale for Children, Anxiety Disorders Interview Schedule, Child Behavior Checklist, and Revised Children's Anxiety and Depression Scale. Results suggest acceptable internal consistency of the Revised Children's Anxiety and Depression Scale. Modest convergent validity was found among the Revised Children's Anxiety and Depression Scale and other standardized measures of anxiety and depression. There were stronger correlations between Revised Children's Anxiety and Depression Scale Total scores and subscales of measures expected to correlate significantly than those not expected to correlate. One exception was a significant association between the Revised Children's Anxiety and Depression Scale and Child Behavior Checklist Attention subscale, calling into question the divergent validity in separating anxiety from attention problems. Overall, results suggest preliminary support for the Revised Children's Anxiety and Depression Scale in youth with high-functioning autism spectrum disorders.

Telecommunication offers a cost-saving alternative to face-to-face vocational rehabilitation (VR) service delivery, yet little is known about the current use. This article describes findings from an exploratory survey of 1,187 counselors, representing 13 VR agencies across the United States. The online survey explored agency, counselor, and client facilitators and barriers to telecommunication use during the VR process. Staff with training in telecommunication strategies reported significantly higher rates of email telecommunication (p less than 0.01). Counselors with a higher rural caseload mix engaged in significantly less email telecommunication during the VR process, and rural clients as compared with urban clients were characterized as having less personal access to a computer with Internet. Although counselors use and rely on simple telecommunication methods such as phone and email to serve their clients, strategies to address barriers are needed to expand telecommunication use during the VR process. (Contains 1 figure and 3 tables.)

Does school choice enhance the ability of school districts to raise revenue? School districts use charter and magnet schools to attract and retain students, but does choice improve the odds for school districts seeking increased taxing authority at the polls? If those parents who choose schools are attentive to district policies, then increasing school choice should lead to more support of district spending. This work uses evidence from California, Colorado, Minnesota, and Wisconsin from 2000 to 2005 to suggest that school choice significantly improves a district's chances of winning revenue elections. (Contains 3 tables.)

The 2016 passage of California's Proposition 64, legalizing recreational (adult-use) cannabis, was justified ex ante in part for its potential to encourage restorative justice and positive local and state economic outcomes. But are the local institutions administering Proposition 64 achieving these aims? We address this question via a two-year case study of Mendocino County's polycentric cannabis governance system using a mixed methods approach including archival analysis, cannabis industry and governance system interviews, and participant observation. Evidence from our case study suggests that Mendocino's ability to achieve these goals is hampered by three quasi-market failures: interjurisdictional conflict, coproduction deficits, and devolution without adequate fiscal decentralization. A major driver in these quasi-market failures is the substantial regulatory and enforcement responsibility this governance system places on local government. We conclude by discussing some institutional structures that may address these failures. [ABSTRACT FROM AUTHOR]

Background: People with HIV (PWH) are disproportionately vulnerable to the impacts of wildfires, given the need for frequent access to healthcare systems, higher burden of comorbidities, higher food insecurity, mental and behavioral health challenges, and challenges of living with HIV in a rural area. In this study, we aim to better understand the pathways through which wildfires impact health outcomes among PWH. Methods: From October 2021 through February 2022, we conducted individual semi-structured qualitative interviews with PWH impacted by the Northern California wildfires and clinicians of PWH who were impacted by wildfires. The study aims were to explore the influence of wildfires on the health of PWH and to discuss measures at the individual, clinic, and system levels that helped to mitigate these impacts. Results: We interviewed 15 PWH and 7 clinicians. While some PWH felt that surviving the HIV epidemic added to their resilience against wildfires, many felt that the wildfires compounded the HIV-related traumas that they have experienced. Participants outlined five main routes by which wildfires negatively impacted their health: (1) access to healthcare (medications, clinics, clinic staff), (2) mental health (trauma; anxiety, depression, or stress; sleep disturbances; coping strategies), (3) physical health (cardiopulmonary, other co-morbidities), (4) social/economic impacts (housing, finances, community), and (5) nutrition and exercise. The recommendations for future wildfire preparedness were at the (1) individual-level (what to have during evacuation), (2) pharmacy-level (procedural, staffing), and (3) clinic- or county-level (funds and vouchers; case management; mental health services; emergency response planning; other services such as telehealth, home visits, home laboratory testing). Conclusions: Based on our data and prior research, we devised a conceptual framework that acknowledges the impact of wildfires at the community-, household-, and individual-level with implications for physical and mental health outcomes among PWH. These findings and framework can help in developing future interventions, programs, and policies to mitigate the cumulative impacts of extreme weather events on the health of PWH, particularly among individuals living in rural areas. Further studies are needed to examine health system strengthening strategies, innovative methods to improve access to healthcare, and community resilience through disaster preparedness. Trial registration: N/A. [ABSTRACT FROM AUTHOR]

This article outlines the activities and recommendations of California's sustainable building task force, discusses sustainable building activities in California's higher education systems, and highlights key issues that California is grappling with in its implementation of sustainable building practices. (EV)

Introduction: During the COVID-19 pandemic, substance use disorder (SUD) treatment settings experienced several abrupt changes, including decreased admissions, reduction in services, and modified requirements for medication for substance use disorder. While these changes were implemented to facilitate the maintenance of important treatment options, the ethical consequences of such changes remained unknown. The current study aimed to explore ethical issues related to COVID-19-related changes reported by counselors in SUD treatment facilities. Method: From May to August 2020, we conducted 60 to 90 minutes in-depth interviews with 18 front-line staff in 1 residential and 1 outpatient treatment program, exploring issues drawn from the ethical principles of the national organization representing SUD counselors. Counselors volunteered to participate via phone or email, and participation was confidential. Interviews were conducted via videoconferencing. Topics included day-to-day experiences of ethical dilemmas in the workplace, particularly during the COVID-19 era. Interviews were recorded, transcribed, and checked for accuracy and a trained team of analysts then coded transcripts using thematic analysis. Results: As a result of the COVID-19 pandemic, SUD treatment programs quickly modified procedures to adhere to public health mandates while also continuing to offer care to clients. SUD counselors reported several ways their programs adapted new and creative procedures to reduce the risk of COVID-19 transmission. SUD counselors also identified several novel ethical dilemmas that occurred during the COVID-19 pandemic, often resulting from the counselor balancing the needs for responding to public health mandates with providing services to clients. There were several ways that COVID-19 related changes resulted in therapeutic challenges for some clients, and the SUD counselors highlighted ways that changes resulted in more flexible services for other clients. Conclusions: This study highlights the quick response to COVID-19 that occurred within SUD treatment. While these changes resulted in novel ethical dilemmas, they also offered more flexible and client-centered approaches to treatment. [ABSTRACT FROM AUTHOR]

Key Takeaways: Greenhouse gas mitigation and adaptation to climate change vulnerabilities should be incorporated into existing utility business and project management processes. A comprehensive climate action plan can meet and exceed legal requirements, reduce risk, achieve business process efficiencies, apply best available science, and demonstrate social responsibility. Focused internal workgroups, expert consultation, inspired management, feedback loops, breadth of application, and quantitative detail are critical to success. [ABSTRACT FROM AUTHOR]

HIV researchers use short messaging service (SMS)-based surveys to monitor health behaviors more closely than what would be possible with in-person assessment. Benefits are tempered by nonresponse to completing surveys. Understanding response patterns and their associated study participant characteristics would guide more tailored use of SMS-based surveys for HIV studies. We examined response to weekly 7-item SMS surveys administered as part of an HIV prevention trial. Using Mixture hidden Markov models (MHMM), we identified the underlying response patterns shared by subgroups of participants over time and quantified the association between these response patterns and participant characteristics. Three underlying response patterns were identified; responders, responders with phone-related errors, and non-responders. Non-responders versus responders were more likely to be younger, male, cis-gender, Black and Latinx participants with histories of homelessness, incarceration, and social support service utilization. Responders with phone-related errors compared to non-responders were more likely to be Black, Latinx, female, students, and have a history of incarceration and social support service utilization. More nuanced results from MHMM analyses better inform what strategies to use for increasing SMS response rates, including assisting in securing phone ownership/service for responders with phone-related errors and identifying alternative strategies for non-responders. Actively collecting and monitoring non-delivery notification data available from SMS gateway service companies offers another opportunity to identify and connect with participants when they are willing but unable to respond during follow-up. [ABSTRACT FROM AUTHOR]

The evaluation of water systems based on historical statistics is problematic when shifts in the hydrologic system occur due to a changing climate. An explicit link to thermodynamic and dynamic pathways in the climate system that may control water system performance is missing from current operational policies prescribed by regulation manuals within the US. In response, this study contributes an extended version of an existing weather regime (WR)–based stochastic weather generator (SWG) that allows (1) hourly simulation, (2) over the entire year, and (3) with a corrected representation of extremes. A range of climate scenarios is developed to demonstrate the insights that can be gained from linking the impacts of climate change to their thermodynamic and dynamic causal mechanisms, in this case for inflows to the Don Pedro Reservoir within the Tuolumne River Watershed of California. Application of the WR-SWG and water system modeling chain shows that the magnitude of flood events can be heavily influenced by antecedent hydrologic factors such as snow water equivalent (SWE) and soil moisture. Our results suggest that, under all climate change scenarios, SWE decreases as temperature increases and contributes more (sometimes up to 2.5 times more than the baseline) inflow as part of rain-on-snow events. The monthly reservoir inflows show the potential to cause extreme floods as the average rate of inflow increases by up to 80% with temperature increases, whereas SWE tends to increase by 50%, adding water to the stream during the high flow season. In addition to the temperature increase, if the water-holding capacity of the atmosphere increases with Clausius-Clapeyron scaling, reservoir inflows are projected to increase. This provides insight for risk-hedging policies: winter storm and spring snowmelt release and storage decisions that drive flood and drought risk, respectively. [ABSTRACT FROM AUTHOR]

Frequent and prolonged droughts challenge groundwater sustainability in California but managing aquifer recharge can help to partially offset groundwater overdraft. Here, we use managed aquifer recharge (MAR) to examine potential benefits of adding an artificial recharge facility downstream from California's Lower American River Basin, in part to prepare for drought. We use a statewide hydroeconomic model, CALVIN, which integrates hydrology, the economics of water scarcity cost and operations, environmental flow requirements, and other operational constraints, and allocates water monthly to minimize total scarcity and operating costs. This study considers a recharge facility with unconstrained and constrained flows. The results show that adding a recharge facility increases groundwater storage, reduces groundwater overdraft, and increases hydropower without substantially impacting environmental flows. Further, artificial recharge adds economic benefits by (1) reducing the combined costs of water shortage and surface water storage and (2) by increasing hydropower revenue. This study provides a benchmark tool to evaluate the economic feasibility and water supply reliability impacts of artificial recharge in California. [ABSTRACT FROM AUTHOR]

The extent to which rising atmospheric CO2 concentration has already influenced food production and quality is uncertain. Here, we analyzed annual field trials of autumn-planted common wheat in California from 1985 to 2019, a period during which the global atmospheric CO2 concentration increased 19%. Even after accounting for other major factors (cultivar, location, degree-days, soil temperature, total water applied, nitrogen fertilization, and pathogen infestation), wheat grain yield and protein yield declined 13% over this period, but grain protein content did not change. These results suggest that exposure to gradual CO2 enrichment over the past 35 years has adversely affected wheat grain and protein yield, but not grain protein content. [ABSTRACT FROM AUTHOR]

We measured the effectiveness of a city-wide school-located influenza vaccination (SLIV) program implemented in over 102 elementary schools in Oakland, California. We conducted a retrospective cohort study among Kaiser Permanente Northern California (KPNC) members of all ages residing in either the intervention or a multivariate-matched comparison site from September 2011 - August 2017. Outcomes included medically attended acute respiratory illness (MAARI), influenza hospitalization, and Oseltamivir prescriptions. We estimated difference-in-differences (DIDs) in 2014–15, 2015–16, and 2016–17 using generalized linear models and adjusted for race, ethnicity, age, sex, health plan, and language. Pre-intervention member characteristics were similar between sites. The proportion of KPNC members vaccinated for influenza by KPNC or the SLIV program was 8–11% higher in the intervention site than the comparison site during the intervention period. Among school-aged children, SLIV was associated with lower Oseltamivir prescriptions per 1,000 (DIDs: −3.5 (95% CI −5.5, −1.5) in 2015–16; −4.0 (95% CI −6.5, −1.6) in 2016–17) but not with other outcomes. SLIV was associated with lower MAARI per 1,000 in adults 65 + years (2014–15: −13.2, 95% CI –23.2, −3.2; 2015–16: −21.5, 95% CI −31.1, −11.9; 2016–17: −13.0, 95% CI –23.2, −2.9). There were few significant associations with other outcomes among adults. A city-wide SLIV intervention was associated with higher influenza vaccination coverage, lower Oseltamivir prescriptions in school-aged children, and lower MAARI among people over 65 years, suggesting possible indirect effects of SLIV among older adults. [ABSTRACT FROM AUTHOR]

For California water resource planning in the face of climate change, hydrological and water distribution models require inputs of high spatial– and temporal–resolution temperature and precipitation projections. We used a quantile delta mapping (QDM) procedure along with bias correction and localized constructed analogs (LOCA) downscaling to produce 6-km temperature and precipitation fields that preserve the relative changes in these quantities from climate model projections. We developed a wetter moderate warming (WMW) case from the Representative Concentration Pathway (RCP) 4.5 emissions scenario and a dry extreme warming (DEW) case from the RCP8.5 scenario to establish a range of projected hydroclimatological conditions. In both cases, we found that extreme precipitation becomes more extreme, but the sign of changes in moderate precipitation events differs between the two cases. The precipitation estimate range is most broad in southern California, where it varies by a factor of 2 and is 50% across the Sierra Nevada. This approach, adopted by the California Department of Water Resources, balances a host of practical water resource planning considerations with the evolving state of the science for future hydroclimatological projections. [ABSTRACT FROM AUTHOR]

Water is a fundamental resource in freshwater ecosystems, and streamflow plays a pivotal role in driving riverine ecology and biodiversity. Ecologically functional flows, managed hydrographs that are meant to reproduce the primary components of the natural hydrograph, are touted as a potential way forward to restore ecological functions of highly modified rivers, while also balancing human water needs. A major challenge in implementing functional flows will be establishing the shape of the managed hydrograph so as to optimize improvements to the ecosystem given the limited resources. Identifying the shape of the flow–biology relationship is thus critical for determining the environmental consequences of flow regulation. In California's Central Valley, studies have found that increased streamflow can improve survival of imperiled juvenile salmon populations during their oceanward migration. These studies have not explored the potential nonlinearities between flow and survival, giving resource managers the difficult task of designing flows intended to help salmon without clear guidance on flow targets. We used an information theoretic approach to analyze migration survival data from 2436 acoustic‐tagged juvenile Chinook salmon from studies spanning differing water years (2013–2019) to extract actionable information on the flow–survival relationship. This relationship was best described by a step function, with three flow thresholds that we defined as minimum (4259 cfs), historic mean (10,712 cfs), and high (22,872 cfs). Survival varied by flow threshold: 3.0% below minimum, 18.9% between minimum and historic mean, 50.8% between historic mean and high, and 35.3% above high. We used these thresholds to design alternative hydrographs over the same years that included an important component of functional flows: spring pulse flows. We compared predicted cohort migration survival between actual and alternative hydrographs. Managed hydrographs with pulse flows that targeted high survival thresholds were predicted to increase annual cohort migration survival by 55–132% without any additions to the water budget and by 79–330% with a modest addition to the water budget. These quantitative estimates of the biological consequences of different flow thresholds provide resource managers with critical information for designing functional flow regimes that benefit salmon in California's highly constrained water management arena. [ABSTRACT FROM AUTHOR]

Objective: Increasing access to human immunodeficiency virus (HIV) pre-exposure prophylaxis (PrEP) and postexposure prophylaxis (PEP) is a high priority for the Ending the HIV Epidemic Initiative. Expanding access to PrEP and PEP through a variety of health care settings, including community pharmacies, may increase access in communities most in need. California is the first state to allow community pharmacists to furnish PrEP and PEP directly to consumers. Our objective was to assess attitudes among key stakeholders about a California policy to allow community pharmacists to furnish HIV PrEP and PEP.Methods: We conducted a qualitative case study with key pharmacy stakeholders. Semistructured phone interviews were audio-recorded and transcribed verbatim. We generated analytical memos for each interview and working with these analytical memos, we conducted a constant comparison across cases to identify commonalities and differences.Results: We launched the study in October 2018 and interviewed pharmacists (n = 7) working in a variety of settings, including retail-, clinic-, and community-based pharmacies. We also interviewed medical providers (n = 2) working in high-volume PrEP clinics and sought input from representatives of large retail chain pharmacies (n = 2). Overall, pharmacists and medical provider informants shared similar opinions about the central benefits as well as the key challenges related to pharmacist-delivered PrEP and PEP services. Benefits included: community pharmacists are widely accessible, PrEP and PEP protocols are similar to other preventative medications, policy may lead to efficiencies in the health care workforce, and community pharmacists are authorities on medication adherence. Challenges included: implementation issues may limit pharmacist involvement, and missed opportunities to diagnose and treat other health conditions.Conclusion: This study characterizes the types of benefits and challenges that can be expected when PrEP and PEP prescribing privileges are extended to community pharmacists. This information may be useful to policymakers and other stakeholders considering legislation to permit direct prescription of PrEP and PEP by pharmacists. [ABSTRACT FROM AUTHOR]

Background: It is estimated that vaccinating 50%-70% of school-aged children for influenza can produce population-wide indirect effects. We evaluated a city-wide school-located influenza vaccination (SLIV) intervention that aimed to increase influenza vaccination coverage. The intervention was implemented in ≥95 preschools and elementary schools in northern California from 2014 to 2018. Using a matched cohort design, we estimated intervention impacts on student influenza vaccination coverage, school absenteeism, and community-wide indirect effects on laboratory-confirmed influenza hospitalizations.Methods and Findings: We used a multivariate matching algorithm to identify a nearby comparison school district with pre-intervention characteristics similar to those of the intervention school district and matched schools in each district. To measure student influenza vaccination, we conducted cross-sectional surveys of student caregivers in 22 school pairs (2017 survey, N = 6,070; 2018 survey, N = 6,507). We estimated the incidence of laboratory-confirmed influenza hospitalization from 2011 to 2018 using surveillance data from school district zip codes. We analyzed student absenteeism data from 2011 to 2018 from each district (N = 42,487,816 student-days). To account for pre-intervention differences between districts, we estimated difference-in-differences (DID) in influenza hospitalization incidence and absenteeism rates using generalized linear and log-linear models with a population offset for incidence outcomes. Prior to the SLIV intervention, the median household income was $51,849 in the intervention site and $61,596 in the comparison site. The population in each site was predominately white (41% in the intervention site, 48% in the comparison site) and/or of Hispanic or Latino ethnicity (26% in the intervention site, 33% in the comparison site). The number of students vaccinated by the SLIV intervention ranged from 7,502 to 10,106 (22%-28% of eligible students) each year. During the intervention, influenza vaccination coverage among elementary students was 53%-66% in the comparison district. Coverage was similar between the intervention and comparison districts in influenza seasons 2014-2015 and 2015-2016 and was significantly higher in the intervention site in seasons 2016-2017 (7%; 95% CI 4, 11; p < 0.001) and 2017-2018 (11%; 95% CI 7, 15; p < 0.001). During seasons when vaccination coverage was higher among intervention schools and the vaccine was moderately effective, there was evidence of statistically significant indirect effects: The DID in the incidence of influenza hospitalization per 100,000 in the intervention versus comparison site was -17 (95% CI -30, -4; p = 0.008) in 2016-2017 and -37 (95% CI -54, -19; p < 0.001) in 2017-2018 among non-elementary-school-aged individuals and -73 (95% CI -147, 1; p = 0.054) in 2016-2017 and -160 (95% CI -267, -53; p = 0.004) in 2017-2018 among adults 65 years or older. The DID in illness-related school absences per 100 school days during the influenza season was -0.63 (95% CI -1.14, -0.13; p = 0.014) in 2016-2017 and -0.80 (95% CI -1.28, -0.31; p = 0.001) in 2017-2018. Limitations of this study include the use of an observational design, which may be subject to unmeasured confounding, and caregiver-reported vaccination status, which is subject to poor recall and low response rates.Conclusions: A city-wide SLIV intervention in a large, diverse urban population was associated with a decrease in the incidence of laboratory-confirmed influenza hospitalization in all age groups and a decrease in illness-specific school absence rate among students in 2016-2017 and 2017-2018, seasons when the vaccine was moderately effective, suggesting that the intervention produced indirect effects. Our findings suggest that in populations with moderately high background levels of influenza vaccination coverage, SLIV programs are associated with further increases in coverage and reduced influenza across the community. [ABSTRACT FROM AUTHOR]

Background: There are a limited number of studies investigating the relationship between primary care physician (PCP) characteristics and the quality of care they deliver.Objective: To examine the association between PCP performance and physician age, solo versus group affiliation, training, and participation in California's Affordable Care Act (ACA) exchange.Design: Observational study of 2013-2014 data from Healthcare Effectiveness Data and Information Set (HEDIS) measures and select physician characteristics.Participants: PCPs in California HMO and PPO practices (n = 5053) with part of their patient panel covered by a large commercial health insurance company.Main Measures: Hemoglobin A1c testing; medical attention nephropathy; appropriate treatment hypertension (ACE/ARB); breast cancer screening; proportion days covered by statins; monitoring ACE/ARBs; monitoring diuretics. A composite performance measure also was constructed.Key Results: For the average 35- versus 75-year-old PCP, regression-adjusted mean composite relative performance scores were at the 60th versus 47th percentile (89% vs. 86% composite absolute HEDIS scores; p < .001). For group versus solo PCPs, scores were at the 55th versus 50th percentiles (88% vs. 87% composite absolute HEDIS scores; p < .001). The effect of age on performance was greater for group versus solo PCPs. There was no association between scores and participation in ACA exchanges.Conclusions: The associations between population-based care performance measures and PCP age, solo versus group affiliation, training, and participation in ACA exchanges, while statistically significant in some cases, were small. Understanding how to help older PCPs excel equally well in group practice compared with younger PCPs may be a fruitful avenue of future research. [ABSTRACT FROM AUTHOR]

Riverine ecosystems around the world have undergone extensive anthropogenic alterations, often to the detriment of native aquatic biodiversity. Migratory fishes are particularly vulnerable to habitat fragmentation and degradation. For example, Chinook Salmon populations in the Sacramento River, CA have been declining for nearly a century. Its Mediterranean climate, position in a landscape dominated by urban and agricultural land use, and the presence of an inland delta that serves as the hub of California's vast water conveyance system, makes this a particularly perilous region for migrating juvenile salmon. This study used acoustic telemetry to investigate survival and routing of juvenile fall and spring-run Chinook Salmon through their riverine and estuarine migratory phases during the historic California drought of 2012–2016. Survival to the ocean in this river system is already lower relative to Chinook Salmon populations in North American. Survival to the Pacific Ocean ranged from 0.0–9.1% over the course of this three-year study. Use of four migratory routes through the Delta was variable, both within and between years. We documented extensive use and relatively high survival in Steamboat Slough (up to 41.5% routing through and up to 39.8% survival), part of the Sacramento River's distributary network. Migration through this pathway precludes juvenile salmon from encountering junctions leading to low survival routes. Results from this modeling effort provide valuable information and highlight opportunities for directing management actions to benefit these ecologically and economically valuable runs of Chinook Salmon. [ABSTRACT FROM AUTHOR]

Hatchery production of Pacific salmon for release into the environment is a common tool for conservation and supplementation of depleted stocks. Hatchery conditions are controlled to support high survival rates; however, once released into the environment, managers have little control over conditions experienced by juveniles. Thus, release timing is a critical decision in hatchery operations. This 3-year study used acoustic telemetry to estimate release timing effects on migration survival of fall run Chinook Salmon from the largest hatchery in California: the Coleman National Fish Hatchery. Juvenile Chinook Salmon implanted with JSATS transmitters were released in two or more groups each year, concomitant with the regular hatchery production. Arrays of acoustic monitors were deployed at six locations within the 517 km migration route to estimate reach-specific survival of each release. Mark-recapture models identified both year and release timing effects on reach-specific survival. In years when release effects were well-supported, survival was higher in the earlier release group. Survival in subsequent releases was similar or significantly lower indicating that conditions in the river may decline or stay the same but improvement was not observed. Survival was consistently high in the first 92 km of the migration route and may be related to predator swamping from the release of millions of hatchery fish. Survival declined, and became more variable, within the lower 425 km of the river with the lowest rates observed in the tidal bay-delta. These results indicate that both year and release timing can strongly influence survival and that time between releases likely influences the magnitude of the effect. [ABSTRACT FROM AUTHOR]

The United States (US) has experienced a surge of anti-immigrant policies and rhetoric, raising concerns about the influence on health outcomes for immigrants living in the US. We conducted qualitative interviews (n = 20) with health care and social service providers, attorneys, and legal/policy experts in California to understand how agencies were maintaining access to HIV care and prevention for immigrant clients. We conducted a thematic analysis to describe the role of medical–legal partnerships (MLPs) and document best practices. Informants reported high demand for legal services. Referrals were facilitated by case managers, medical providers, and pre-existing relationships between clinics and legal agencies. Informants identified a need for additional funding and further guidance on screening for and supporting patients with legal needs. MLPs have the capacity to create sustainable, efficient, comprehensive structural changes that minimize barriers to HIV prevention and treatment and improve health outcomes among immigrant populations. [ABSTRACT FROM AUTHOR]

Discusses evidence for social stratification and aristocracy among northwestern California Indians, particularly the Yurok tribe. Examines the place of ritual and ceremony in the concept of aristocracy, the great houses, the role of great house priests, and the elaborate speech of the Yurok aristocracy. Contains 47 references. (DHP)

Atmospheric inverse modelling has become an increasingly useful tool for evaluating emissions of greenhouse gases including methane, nitrous oxide, and synthetic gases such as hydrofluorocarbons (HFCs). Atmospheric inversions for emissions of CO2 from fossil fuel combustion (ff CO2) are currently being developed. The aim of this paper is to investigate potential errors and uncertainties related to the spatial and temporal prior representation of emissions and modelled atmospheric transport for the inversion of ff CO2 emissions in the US state of California. We perform simulation experiments based on a network of ground-based observations of CO2 concentration and radiocarbon in CO2 (a tracer of ff CO2), combining prior (bottom-up) emission models and transport models currently used in many atmospheric studies. The potential effect of errors in the spatial and temporal distribution of prior emission estimates is investigated in experiments by using perturbed versions of the emission estimates used to create the pseudo-data. The potential effect of transport error was investigated by using three different atmospheric transport models for the prior and pseudo-data simulations. We find that the magnitude of biases in posterior total state emissions arising from errors in the spatial and temporal distribution in prior emissions in these experiments are 1 %–15 % of posterior total state emissions and are generally smaller than the 2 σ uncertainty in posterior emissions. Transport error in these experiments introduces biases of -10 % to +6 % into posterior total state emissions. Our results indicate that uncertainties in posterior total state ff CO2 estimates arising from the choice of prior emissions or atmospheric transport model are on the order of 15 % or less for the ground-based network in California we consider. We highlight the need for temporal variations to be included in prior emissions and for continuing efforts to evaluate and improve the representation of atmospheric transport for regional ff CO2 inversions. [ABSTRACT FROM AUTHOR]

The US population aged 90 years or more is growing rapidly, and there are limited data on their health. The Cardiovascular Health Study is a prospective study of black and white adults aged ≥65 years recruited in 2 waves (1989–1990 and 1992–1993) from Medicare eligibility lists in Forsyth County, North Carolina; Sacramento County, California; Washington County, Maryland; and Pittsburgh, Pennsylvania. We created a synthetic cohort of the 1,889 participants who had reached age 90 years at baseline or during follow-up through July 16, 2015. Participants entered the cohort at 90 years of age, and we evaluated their changes in health after age 90 years (median duration of follow-up, 3 years (interquartile range, 1.3–5)). Measures of health included cardiovascular events, cognitive function, depressive symptoms, prescription medications, self-rated health, and functional status. The mortality rate was high: 19.0 per 100 person-years (95% confidence interval : 17.8, 20.3) in women and 20.9 per 100 person-years (95% confidence interval: 19.2, 22.8) in men. Cognitive function and all measures of functional status declined with age; these changes were similar by sex. When we isolated period effects, we found that medication use increased over time. These estimates can help inform future research and can help health-care systems meet the needs of this growing population. [ABSTRACT FROM AUTHOR]

While Medicaid eligibility expansion created health care access for millions in California, its impact on people living with HIV has been more nuanced. Newly covered people living with HIV who have behavioral health care needs now must navigate separate mental health and substance use care systems, instead of receiving them in integrated care settings as they had under the Ryan White HIV/AIDS Program. We conducted forty-seven interviews in the period April 2015-June 2016 to examine the impact of Medicaid expansion on people living with HIV in California who had behavioral health care needs. California's historical division in its Medicaid funding streams created challenges in determining which payer should cover clients' behavioral health care. Compounding these challenges were a perceived lack of cultural competence for serving this population, insufficient infrastructure to facilitate continuity of care, and unmet need for nonmedical supportive services. The multipayer model under health reform has compromised the administrative simplicity and integrated delivery of HIV and behavioral health services previously available to uninsured patients through the Ryan White HIV/AIDS Program. [ABSTRACT FROM AUTHOR]

California has heavily concentrated hospital, physician, and health insurance markets, but their current structure and functioning is not well understood. We assessed consolidation trends and performed an analysis of "hot spots"--markets that potentially warrant concern and scrutiny by regulators in terms of both horizontal concentration (such as hospital-hospital mergers) and vertical integration (hospitals' acquisition of physician practices). In 2016, seven counties were high on all six measures used in our hot-spot analysis (four horizontal concentration and two vertical integration measures), and five counties were high on five. The percentage of physicians in practices owned by a hospital increased from about 25 percent in 2010 to more than 40 percent in 2016. The estimated impact of the increase in vertical integration from 2013 to 2016 in highly concentrated hospital markets was found to be associated with a 12 percent increase in Marketplace premiums. For physician outpatient services, the increase in vertical integration was also associated with a 9 percent increase in specialist prices and a 5 percent increase in primary care prices. Legislative proposals, actions by the state's attorney general, and other regulatory changes are suggested. [ABSTRACT FROM AUTHOR]

The House Ball Community (HBC) is an understudied network of African American men who have sex with men and transgender women, who join family-like houses that compete in elaborate balls in cities across the United States. From 2011 to 2012, we surveyed 274 recent attendees of balls in the San Francisco Bay Area, focusing on social networks, social support, and HIV-related behaviours. Participants with a high percentage of alters who were supportive of HIV testing were significantly more likely to have tested in the past six months (p = .02), and less likely to have engaged in unprotected anal intercourse (UAI) in the past three months (p = .003). Multivariate regression analyses of social network characteristics, and social support, revealed that testing in the past six months was significantly associated with social support for safer sex, instrumental social support, and age. Similarly, UAI in the past three months was significantly associated with social support for safer sex, homophily based on sexual identity and HIV status. HIV-related social support provided through the HBC networks was correlated with recent HIV testing and reduced UAI. Approaches utilising networks within alternative kinship systems, may increase HIV-related social support and improve HIV-related outcomes. [ABSTRACT FROM PUBLISHER]

Rainstorms increase levels of fecal indicator bacteria in urban coastal waters, but it is unknown whether exposure to seawater after rainstorms increases rates of acute illness. Our objective was to provide the first estimates of rates of acute illness after seawater exposure during both dry- and wet-weather periods and to determine the relationship between levels of indicator bacteria and illness among surfers, a population with a high potential for exposure after rain. We enrolled 654 surfers in San Diego, California, and followed them longitudinally during the 2013--2014 and 2014--2015 winters (33,377 days of observation, 10,081 surf sessions). We measured daily surf activities and illness symptoms (gastrointestinal illness, sinus infections, ear infections, infected wounds). Compared with no exposure, exposure to seawater during dry weather increased incidence rates of all outcomes (e.g., for earache or infection, adjusted incidence rate ratio (IRR) = 1.86, 95% confidence interval (CI): 1.27, 2.71; for infected wounds, IRR = 3.04, 95% CI: 1.54, 5.98); exposure during wet weather further increased rates (e.g., for earache or infection, IRR = 3.28, 95% CI: 1.95, 5.51; for infected wounds, IRR = 4.96, 95% CI: 2.18, 11.29). Fecal indicator bacteria measured in seawater (Enterococcus species, fecal coliforms, total coliforms) were strongly associated with incident illness only during wet weather. Urban coastal seawater exposure increases the incidence rates of many acute illnesses among surfers, with higher incidence rates after rainstorms. [ABSTRACT FROM AUTHOR]

Background: Coliphages have been proposed as indicators of fecal contamination in recreational waters because they better mimic the persistence of pathogenic viruses in the environment and wastewater treatment than fecal indicator bacteria. We estimated the association between coliphages and gastrointestinal illness and compared it with the association with culturable enterococci.Methods: We pooled data from six prospective cohort studies that enrolled coastal beachgoers in California, Alabama, and Rhode Island. Water samples were collected and gastrointestinal illness within 10 days of the beach visit was recorded. Samples were tested for enterococci and male-specific and somatic coliphages. We estimated cumulative incidence ratios (CIR) for the association between swimming in water with detectable coliphage and gastrointestinal illness when human fecal pollution was likely present, not likely present, and under all conditions combined. The reference group was unexposed swimmers. We defined continuous and threshold-based exposures (coliphage present/absent, enterococci >35 vs. ≤35 CFU/100 ml).Results: Under all conditions combined, there was no association between gastrointestinal illness and swimming in water with detectable coliphage or enterococci. When human fecal pollution was likely present, coliphage and enterococci were associated with increased gastrointestinal illness, and there was an association between male-specific coliphage level and illness that was somewhat stronger than the association between enterococci and illness. There were no substantial differences between male-specific and somatic coliphage.Conclusions: Somatic coliphage and enterococci had similar associations with gastrointestinal illness; there was some evidence that male-specific coliphage had a stronger association with illness than enterococci in marine waters with human fecal contamination. [ABSTRACT FROM AUTHOR]