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Standardizing accessible test design and development to meet students' individual access needs is a complex task. The following study provides one approach to accessible test design and development using participatory design methods with school community members. Participatory research provides opportunities to empower collaborators by co-creating knowledge that is useful for assessment development. In this study, teachers of students who are visually impaired, students who are blind or are visually impaired, English language teachers, and test administrators provided feedback at critical stages of the development process to explore the construct validity of English language proficiency (ELP) assessments. Students who are blind or visually impaired need to be able to show what they know and can do without impact from construct-irrelevant variance like language acquisition or disability characteristics. Building on our iterative accessible test design, development, and delivery practices, and as part of a large project on English-learner proficiency test accessibility and usability, we collected rich observation and interview data from 17 students who were blind or visually impaired and were enrolled in grades kindergarten through Grade 12. We examined the ratings and item metadata, including assistive technology preferences and interactions, while we used grounded theory approaches to examine qualitative thematic findings. Implications for research and practice are discussed.

Implementing a randomized controlled trial design, the present study investigated the effects of two types of accommodations, linguistic modification and a glossary, for English learners (ELs) taking a computer-based mathematics assessment. Process data including response time and clicks on glossary words were also examined to better interpret students' interaction with the accommodations in the testing conditions. Regression and ANOVA analyses were performed with data from 513 students (189 ELs and 324 non-ELs) in Grade 9. No statistically significant accommodation effects were detected in this study. Process data revealed possible explanations (i.e., student engagement and glossary usage) for the nonsignificant results. Implications for future research on test accommodations for EL students are discussed.

Before the start of this past fall semester, a large Northern California community college, celebrated its 100th anniversary. One of the lead programs featured a panel of current faculty, staff, and students, in addition to a former Japanese American student who attended the college during World War II. Her story offered an opportunity for to contextualize the college's current role as a public institution of education. Instead, however, the panel and campus at large responded minimally to this conversation; it may have been startling or inspiring in the moment, but few actions or outcomes were attached. Most attendees returned to the normalcy of preparing for the upcoming semester and did not fully reflect on the relevancy of her story. Yet fast-forward to the middle of the fall semester, and the presidential election uncovered the beliefs and practices of the larger society, creating a crucial time for educational institutions and spaces to hold exactly these conversations about institutional history and responsibility. Within that discourse, many non-dominant communities and the educational institutions that served them would face uncertain futures depending on the outcome. The election included the soon-to-be victor, Donald Trump, who was campaigning on returning the glory days of America's past, featuring a more pronounced white idealism and blue-collar industry, while people of color and marginalized populations were more openly targeted by groups, proposed policies, and systems. The campus' student population is widely diverse; post-election anxiety and fear were evident and palpable throughout the halls, social spaces, and classrooms of the college. In this article, the authors reflect on the Trump election and the patterns of false response.

Adolescents in vulnerable living contexts (e.g., foster care, juvenile justice facilities, and experiencing homelessness) may be at increased risk of adolescent dating violence victimization (ADV) due to unstable environments and trauma exposure. They may also experience different protective factors. Yet, research is limited on ADV in these contexts. This study assessed differences in ADV experiences among adolescents (10–21 years) in vulnerable contexts compared to adolescents at home utilizing data from a sexual health education program serving communities facing health inequities in California. Descriptive analyses compared adolescents in vulnerable contexts (n = 1,951) with those living at home (n = 10,682). Multivariable logistic regression was used to estimate the odds of experiencing past year physical and/or sexual ADV by context, controlling for sociodemographic variables. We also examined two potential protective factors: meaningful communication with a parent/guardian and pro-social friendships. Significantly more adolescents in vulnerable contexts than at home identified as male (65.6% vs. 51.6%), 18 years or older (16.5% vs. 8.7%), non-Hispanic Black or African American (14.4% vs. 5%), and LGBTQ+ (15.3% vs. 10.8%). Among adolescents who dated in the past year, 21% in vulnerable contexts reported experiencing physical and/or sexual ADV, compared to 15% of those at home, and reported lower levels of protective factors. Adolescents experiencing homelessness/unstable housing and those in juvenile justice facilities had greater adjusted odds of ADV compared to adolescents at home (56% and 54% higher odds, respectively). It is critical to address systemic factors, which disproportionately impact the most marginalized and disadvantaged adolescents, in approaches for ADV prevention. [ABSTRACT FROM AUTHOR]

Background: Autumn and winter Santa Ana Winds (SAW) are responsible for the largest and most destructive wildfires in southern California. Aims: (1) To contrast fires ignited on SAW days vs non-SAW days, (2) evaluate the predictive ability of the Canadian Fire Weather Index (CFWI) for these two fire types, and (3) determine climate and weather factors responsible for the largest wildfires. Methods: CAL FIRE (California Department of Forestry and Fire Protection) FRAP (Fire and Resource Assessment Program) fire data were coupled with hourly climate data from four stations, and with regional indices of SAW wind speed, and with seasonal drought data from the Palmer Drought Severity Index. Key results: Fires on non-SAW days were more numerous and burned more area, and were substantial from May to October. CFWI indices were tied to fire occurrence and size for both non-SAW and SAW days, and in the days following ignition. Multiple regression models for months with the greatest area burned explained up to a quarter of variation in area burned. Conclusions: The drivers of fire size differ between non-SAW and SAW fires. The best predictor of fire size for non-SAW fires was drought during the prior 5 years, followed by a current year vapour pressure deficit. For SAW fires, wind speed followed by drought were most important. Fires ignited on Santa Ana Wind days are the largest and most destructive fires but other fires are more numerous and account for greater area burned. Fire indices on days after ignition are important predictors of fire size, but drought and wind speed are most closely tied to fire size. [ABSTRACT FROM AUTHOR]

Background Environmental contamination is suspected to play an important role in Candida auris transmission. Understanding speed and risks of contamination after room disinfection could inform environmental cleaning recommendations. Methods We conducted a prospective multicenter study of environmental contamination associated with C. auris colonization at 6 ventilator-capable skilled nursing facilities and 1 acute care hospital in Illinois and California. Known C. auris carriers were sampled at 5 body sites followed by sampling of nearby room surfaces before disinfection and at 0, 4, 8, and 12 hours after disinfection. Samples were cultured for C. auris and bacterial multidrug-resistant organisms (MDROs). Odds of surface contamination after disinfection were analyzed using multilevel generalized estimating equations. Results Among 41 known C. auris carriers, colonization was detected most frequently on palms/fingertips (76%) and nares (71%). C. auris contamination was detected on 32.2% (66/205) of room surfaces before disinfection and 20.5% (39/190) of room surfaces by 4 hours after disinfection. A higher number of C. auris –colonized body sites was associated with higher odds of environmental contamination at every time point following disinfection, adjusting for facility of residence. In the rooms of 38 (93%) C. auris carriers co-colonized with a bacterial MDRO, 2%–24% of surfaces were additionally contaminated with the same MDRO by 4 hours after disinfection. Conclusions C. auris can contaminate the healthcare environment rapidly after disinfection, highlighting the challenges associated with environmental disinfection. Future research should investigate long-acting disinfectants, antimicrobial surfaces, and more effective patient skin antisepsis to reduce the environmental reservoir of C. auris and bacterial MDROs in healthcare settings. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this cross‐sectional study was to determine the prevalence of long COVID and identify its clinical manifestations among farmworkers in California. Methods: We collected data on sociodemographic characteristics, anthropometrics, clinical chemistries and anti‐SARS‐CoV‐2 immunoglobulin G antibodies, self‐reported SARS‐CoV‐2 infection history, and standardized health tests and scales from 297 farmworkers in California between February and July 2022. Results: Most participants were born in Mexico or Central America, had less than a high school diploma, and were overweight or obese. The prevalence of long COVID (defined as self‐reported SARS‐CoV‐2 infection with symptoms >28 days) among farmworkers with a suspected or test‐confirmed infection was 61.8%. Participants with long COVID had higher mean [95% CI] body mass index (32.9 [31.6‐34.1]) and high‐sensitivity C‐reactive protein levels (4.8 [3.7, 6.0]) than those with no COVID‐19 history (30.5 [29.3‐31.7], and 3.3 [2.2, 4.3], respectively). Farmworkers with long COVID also reported greater fatigue, dyspnea, taste and smell problems, and overall poorer mental and physical health, than those with no COVID‐19 history. Farmworkers with long COVID had increased odds of functional limitations compared to those with a self‐reported SARS‐CoV‐2 infection with symptoms ≤28 days (OR [95% CI]: 7.46 [3.26, 17.09]). Conclusions: A significant proportion of farmworkers experience long COVID with persistent symptoms that limit their ability to perform their work. A comprehensive approach that addresses the unique needs and challenges of farmworkers is warranted given this population's high prevalence of long COVID and the essential nature of their work. [ABSTRACT FROM AUTHOR]

Many commonly employed performance validity tests (PVTs) are several decades old and vulnerable to compromise, leading to a need for novel instruments. Because implicit/non-declarative memory may be robust to brain damage, tasks that rely upon such memory may serve as an effective PVT. Using a simulation design, this experiment evaluated whether novel tasks that rely upon perceptual memory hold promise as PVTs. Sixty healthy participants were provided instructions to simulate symptoms of mild traumatic brain injury (TBI), and they were compared to a group of 20 honest responding individuals. Simulator groups received varying levels of information concerning TBI symptoms, resulting in naïve, sophisticated, and test-coached groups. The Word Memory Test, Test of Memory Malingering, and California Verbal Learning Test-II Forced Choice Recognition Test were administered. To assess perceptual memory, selected images from the Gollin Incomplete Figures and Mooney Closure Test were presented as visual perception tasks. After brief delays, memory for the images was assessed. No group differences emerged on the perception trials of the Gollin and Mooney figures, but simulators remembered fewer images than the honest responders. Simulator groups differed on the standard PVTs, but they performed equivalently on the Gollin and Mooney figures, implying robustness to coaching. Relying upon a criterion of 90% specificity, the Gollin and Mooney figures achieved at least 90% sensitivity, comparing favorably to the standard PVTs. The Gollin and Mooney figures hold promise as novel PVTs. As perceptual memory tests, they may be relatively robust to brain damage, but future research involving clinical samples is necessary to substantiate this assertion. [ABSTRACT FROM AUTHOR]

This study addresses public universities' policies and practices in the USA (United States of America) with a focus on public bilingual teacher preparation in Spanish-English programs (initial credential licensure and Masters of Education programs with, or without, endorsements). We questioned: "What do bilingual programs look like in public universities across the USA and particularly for the Spanish-speaking population?" With this purpose, we examined 78 bilingual programs in six states with high numbers of Spanish-speaking populations. We searched Websites and bilingual faculty postings, as well as randomly selected fifteen programs for phone interviews. The findings revealed inconsistencies in the implementation of bilingual teacher preparation programs in USA public universities and highlighted the need for further research on bilingual teacher preparation.

Open educational resources (OERs) provide a potential alternative to costly textbooks and can allow content to be edited and adapted to a variety of classroom environments. At the University of California, Davis, the OER "ChemWiki" project, as part of the greater STEMWiki Hyperlibrary, was developed to supplant traditional post-secondary chemistry textbooks. The effectiveness of using this OER was assessed by comparing two general chemistry classes, one using ChemWiki and one using a traditional textbook, during the spring quarter of 2014. Student performance was measured using common midterms, final, and a pre/post content exam. We also employed surveys, the Colorado Learning Attitudes about Science Survey (CLASS) for Chemistry, and a weekly time-on-task survey to quantify students' attitudes and study habits. The effectiveness of the ChemWiki compared to a traditional textbook was examined using multiple linear regression analysis with a standard non-inferiority testing framework. Results show that the performance of students who were assigned readings from the ChemWiki section was non-inferior to the performance of students in the section who were assigned readings from the traditional textbook, indicating that the ChemWiki does not substantially differ from the standard textbook in terms of student learning outcomes. The results from the surveys also suggest that the two classes were similar in their beliefs about chemistry and minimal overall study time. These results indicate that the ChemWiki is a viable cost-saving alternative to traditional textbooks.

Global surface temperatures are projected to increase in the future; this will modify regional precipitation regimes and increase global atmospheric drying. Despite many drought studies examining the consequences of reduced precipitation, there are few experimental studies exploring plant responses to atmospheric drying via relative humidity and vapor pressure deficit (VPD). We examined eight native California perennial grass species grown in pots in a greenhouse in Los Angeles, California for 34 weeks. All pots were well‐watered for 21 weeks, at which point we reduced watering to zero and recorded daily growth and dormancy for 3 weeks. We used this information to better understand the drought tolerance of our species in a larger soil drying × atmospheric drying experiment. In this larger experiment, we grew all eight species together in outdoor mesocosms and measured changes in community composition after 4 years of growth. Soil drying in our small pot experiment mirrored compositional shifts in the larger experiment. Namely, our most drought‐tolerant species in our pot experiment was Poa secunda, due to a summer dormancy strategy. Similarly, the grass community shifted toward P. secunda in the driest soils as P. secunda was mostly unaffected by either soil drying or atmospheric drying. We found that some species responded strongly to soil drying (Elymus glaucus, Festuca idahoensis, and Hordeum b. californicum), while others responded strongly to atmospheric drying (Bromus carinatus and Stipa cernua). As result, community composition shifted in different and interacting ways in response to soil drying, atmospheric drying, and their combination. Further study of community responses to increasing atmospheric aridity is an essential next step to predicting the future consequences of climate change. [ABSTRACT FROM AUTHOR]

We found that vittatalactone, specifically (3R,4R)-3-methyl-4-[(1S,3S,5S)-1,3,5,7-tetramethyloctyl]oxetan-2-one, is the male-produced aggregation pheromone of the western striped cucumber beetle, Acalymma trivittatum (Mannerheim), as was previously shown for the striped cucumber beetle, Acalymma vittatum (F.) (Coleoptera: Chrysomelidae). A synthetic mixture containing 9% of the authentic natural pheromone, is attractive to both sexes of both species in the field, as demonstrated by trapping using baited and unbaited sticky panels in California and earlier in Maryland. Females of both species do not produce detectable vittatalactone. This finding expands the usefulness of the synthetic vittatalactone mixture for pest management throughout the range of both A. vittatum and A. trivittatum. Development of vittatalactone time-release formulations combined with cucurbitacin feeding stimulants offer the potential for selective and environmentally-friendly cucurbit pest management tactics. [ABSTRACT FROM AUTHOR]

In this study, we explored whether the contribution of working memory (WM) to children's (N = 471) 2nd language (L2) reading and language acquisition was best accounted for by processing efficiency at a phonological level and/or by executive processes independent of phonological processing. Elementary school children (Grades 1, 2, & 3) whose 1st language (L1) was Spanish were administered a battery of cognitive (short-term memory [STM], working memory [WM], rapid naming, and random letter and number generation), vocabulary, and reading measures in both Spanish and English. Hierarchical regression analyses showed that in addition to phonological processing, naming speed, and inattention, both WM and STM contributed significant variance to L2 reading and language acquisition. Regression modeling showed no significant cross-language effects when L1 measures were entered into the analysis. The results showed that both STM and WM contributed unique variance to L2 reading and language acquisition beyond the contribution of L1 phonological processing skills. (Contains 6 tables and 1 footnote.)

Floods caused by atmospheric rivers and wildfires fanned by Santa Ana winds are common occurrences in California with devastating societal impacts. In this work, we show that winter weather variability in California, including the occurrence of extreme and impactful events, is linked to four atmospheric circulation regimes over the North Pacific Ocean previously named and identified as the "NP4 modes". These modes come in and out of phase with each other during the season, resulting in distinct weather patterns that recur throughout the historical record. Some phase combinations favor atmospheric river landfalls and extreme daily or multi-day precipitation, while other phase combinations favor anomalously hot weather and drying Santa Ana wind conditions over Southern California. This historical perspective of atmospheric circulation and impacts over 70 years reveals that weather patterns are changing in a way that enhances wildfire hazard in California, while the frequency of weather patterns linked to historical floods is not diminishing. These changes highlight the rising hazards of cascading weather extremes in California's present and future. [ABSTRACT FROM AUTHOR]

Background: California's South Coast has experienced peak burned area in autumn. Following typically dry, warm summers, precipitation events and Santa Ana winds (SAWs) each occur with increasing frequency from autumn to winter and may affect fire outcomes. Aims: We investigate historical records to understand how these counteracting influences have affected fires. Methods: We defined autumn precipitation onset as the first 3 days when precipitation ≥8.5 mm, and assessed how onset timing and SAWs were associated with frequency of ≥100 ha fires and area burned during 1948–2018. Key results: Timing of autumn precipitation onset had negligible trend but varied considerably from year to year. A total of 90% of area burned in autumn through winter occurred from fires started before onset. Early onset autumns experienced considerably fewer fires and area burned than late onset autumns. SAWs were involved in many of the large fires before onset and nearly all of the lesser number after onset. Conclusions: Risk of large fires is reduced after autumn precipitation onset, but may resurge during SAWs, which provide high risk weather required to generate a large fire. Implications: During autumn before onset, and particularly during late onset autumns, high levels of preparation and vigilance are needed to avoid great fire impacts. Autumn precipitation and Santa Ana winds are opposing determinants of fire outcomes in California's South Coast region. Most of the area burned in autumn through early winter during 1948–2018 occurred from fires started before the onset of precipitation, defined as the first autumn event with 8.5 mm or greater precipitation. [ABSTRACT FROM AUTHOR]

308 Background: In the US, 77.3% of women aged 21-65 years have had a Pap smear within the past three years and around 75.9% of women aged 50-74 years reported having a mammogram within the past two years as recommended according to the U.S. Preventive Services Task Force (USPSTF). In UTRGV Resident-led Clinic located in Hidalgo County, the quality metrics data demonstrated screening satisfactory rate for cervical and breast cancer to be 18% in August 2023. This Quality Improvement project is aimed at enhancing the screening satisfactory rate of breast and cervical cancer by 20% at UTRGV Knapp IM Clinic by December 2023. Methods: First, we focused on the education of the residents through noon conference and 1:1 education. This included comprehensive instruction on latest USPSTF guidelines and proper documentation on the electronic health record system, Athena. Second, we introduced a patient screening questionnaire, available in both English and Spanish. These efforts were evaluated through a pre-and-post-intervention survey designed to assess changes in residents' confidence, aligning with quality metrics data. We obtained and filtered the quality metrics raw data to include all the current residents in PGY1-3 and summed the number of patients who had records of breast and cervical cancer screening and divided the sum of all patients that required the record. The satisfaction rate was rounded to the 2nd decimal place. Results: The raw data from 8/2023 showed screening satisfactory rate for cervical and breast cancer to be 18%. With the initiation of intervention, the data from 9/2023 showed rate of 35%, finally reaching 39% on 12/2023, fulfilling our aim of 20% increase in the screening satisfactory rate. Survey data shows that there was an improvement of confidence observed in both breast and cervical cancer screening. Respectively, 27.5% and 30.9% increase in the residents who responded confident in breast cancer and cervical cancer screening were observed. 84.4% of residents responded that they are less forgetfulness in screening patients after the intervention. There was 22.9% increase in residents who know how to record the cancer screening result in Athena. 87.5% of the residents responded that they experienced improvement in implementing and documenting the breast and cervical cancer screening. Conclusions: Despite several limitations in acquiring and analyzing the data, this QI project positively impacted both subjective and objective data for the improvement of the breast and cervical cancer screening, fulfilling our aim of 20% increase in screening satisfactory rate by December 2023. Breast and cervical screening satisfactory Rate. Month/year Number of patients requiring breast and cervical cancer screening Number of patients with satisfaction in breast and cervical cancer screening Satisfactory rate (%) 08/2023 42 229 18 9/2023 999 2844 35 10/2023 454 1458 31 11/2023 649 1771 37 12/2023 113 287 39 [ABSTRACT FROM AUTHOR]

182 Background: Food insecurity disproportionately impacts immigrant, low-income, and racial and ethnic minorities with cancer. In our prior qualitative work, Latinx and multiethnic patients with food insecurity emphasized the importance of culturally-tailored food assistance interventions that could minimize stigma and maintain self-efficacy and autonomy. In collaboration with Latinx patients and community partners in Monterey County, California, we co-developed a culturally-tailored food voucher intervention. In this study, we conducted a pilot of the intervention among multiethnic and Latinx patients with cancer and tested the impact on food insecurity and health-related quality of life. Methods: We recruited low-income, racial and ethnic minority adults > 18 years of age who screened positive for food insecurity using the 2-item Hunger Vital Sign while receiving cancer treatment in a clinic in Monterey County, CA between July 2023 until August 2023. All participants who consented to participate received $40 monthly grocery store gift cards redeemable at a variety of local retailers for 6 months in addition to usual care provided by trained community health workers who assisted with other health-related social needs. We conducted validated surveys at baseline (time of enrollment) and 6-month follow-up (post-intervention) assessing demographics, food behaviors, food insecurity, and health-related quality of life, as well as feasibility and acceptability of the intervention. We compared pre- and post-intervention proportions with food insecurity using McNemars tests and change in health-related quality of life using paired t-tests. Results: Of the 30 study participants enrolled, 27 (90%) were Latinx; 24 (80%) spoke Spanish as their preferred language; 16 (53%) had advanced (stage 3 or 4) cancer; 12 (40%) were retired or unemployed; 10 (33%) were disabled; 20 (67%) reported a household income < $35,000 USD. Of the 26 (87%) participants who completed post-intervention surveys, the proportion with food insecurity decreased from 100% to 65% (95% CI 0.60-0.77; p = 0.01); 100% adhered to recommended treatment; and health-related quality of life scores increased by 8 points from 71.9 +/-16.1 to 79.5+/- 10.5 (p = 0.02) from baseline. All (100%) participants rated the program as feasible and acceptable in post-intervention surveys. Conclusions: This culturally-tailored food voucher intervention was associated with reductions in food insecurity and improvements in health-related quality of life among low-income Latinx patients with cancer. This intervention may represent an effective and acceptable approach to overcome food insecurity in Latinx and multiethnic patients with cancer. [ABSTRACT FROM AUTHOR]

181 Background: Inequitable access to precision medicine limits its impact. To address disparities, we co-developed the Addressing Latinx Cancer Care Equity Study (NCT04843332), a multi-level intervention with community stakeholders. ALCANCE was designed for low-income and Latinx adults with cancer in rural Monterey County, California. We provided annual training for clinicians about testing guidelines and precision medicine disparities. Trained CHWs educated patients about precision medicine and encouraged them to raise the topic with their oncologist. We tested whether the intervention improved patient knowledge and receipt of precision medicine. Methods: Patients with newly diagnosed or recurrent cancer, age ≥ 18 years, able to consent in English or Spanish, and who self-identified as a racial and ethnic minority OR low-income status OR were insured by public or agricultural company insurance OR uninsured and receiving cancer care at Pacific Cancer Care, a rural community oncology practice in Monterey County, were randomized 1:1 to usual care (control group) or usual care augmented with the multi-level intervention for 12 months (intervention group). The primary outcome was whether the multilevel intervention could increase patient knowledge of precision medicine using a validated 6 question survey from time of enrollment (baseline) to 6-months post-enrollment between groups. A secondary outcome was receipt of precision medicine. CHWs and clinicians completed semi-structured interviews. Results: 110 participants were randomized; 70% (n = 67) reported Spanish as their primary language; 81% (n = 89) identified as Hispanic. Median age was 55 years (55.4 ± 14.3, mean± SD); majority had annual household incomes (USD) ≤ $34,999 (59.0%, n = 46); majority obtained a high school diploma/GED or less (67.3%, n = 74). Most had gastrointestinal (35.5%, n = 39) and breast (24.5%, n = 27) cancers and were diagnosed with stage 3 or 4 (64.5%, n = 71) disease. Precision medicine knowledge was low at baseline across both the control and intervention groups (23.5 ± 19.3 versus 23.0 ± 17.7, respectively). Intervention group participants had greater precision medicine knowledge at 6-months (39.2 ± 23.0) than control group participants (24.2 ± 20.0) with greater increase in knowledge overtime than control group participants (p < 0.001). More intervention group participants (n=46, 79.3%) received precision medicine testing than control (n=34, 60.7%). Across both groups, 26 of those tested had an actionable mutation. Of those 26, 66.7% (n=6 of 9) in the control group and 94.1% (n=16 of 17) in the intervention group received targeted therapy (p=0.065). Interviews with the care team indicated the model was acceptable and has been sustained as part of usual care. Conclusions: CHW-facilitated interventions may reduce disparities in precision medicine cancer care. Clinical trial information: NCT04843332 [ABSTRACT FROM AUTHOR]

151 Background: Addressing Latinx Cancer Care Equity - Program for Long-term United Skills Building (ALCANCE-PLUS) is an ongoing community-academic partnership between the Stanford University School of Medicine Partnerships to Advance Care and Pacific Cancer Care (PCC). The partnership began in 2019 and is comprised of several community-identified multi-level interventions to improve cancer health equity in an undeserved, rural migrant farm-working community. The intervention components are delivered by trained community health workers to low-income and racial and ethnic minoritized patients receiving active cancer treatment and include: 1) precision medicine education using literacy- and language-concordant educational tools; 2) food insecurity screening and intervention with plans to cross-train > 150 CHW's across the county to expand cancer screening and care delivery in the county. Here, we describe the characteristics of participants and the program's impact to date on metrics identified by the community. Methods: ALCANCE-PLUS eligibility includes: all patients with cancer actively receiving cancer-directed treatment at PCC who are ≥ 18 years old and speak English or Spanish. Community identified metrics of success include: % treatment adherence (completion), no-show rate, days from diagnosis to treatment, and % who received clinical trials education as compared to baseline (prior to program start). We used descriptive statistics and chi-squared tests to compare metrics of participants in the program to baseline. Results: At baseline, 62% of low-income and racial and ethnic minoritized patients in the county completed treatment, 35% had no-shows to clinic or infusion appointments with an average of 82.7 days from diagnosis to treatment and only 15% received clinical trial education. From July 2022 to May 2024, a total of 164 patients participated in the program. Mean ages were 60.88 ± 14.55, 68 (41.5%) identified as male, 104 (63.4%) as Hispanic or Latino, 2 (1.2%) African American or Black, 12 (7.3%) Asian American, 2 (1.2%) Native Hawaiian or Other Pacific Islanders, and 60 (36.6%) White. Insurance types included 63 (25.6%) patients with Medicaid, 56 (22.6) with Medicare, 13 (5.2%) with both, 72 (29%) with private insurance, and 7 (2.8%) with other insurance or uninsured. As of January 2024, treatment adherence was 100% for the 157 program participants, the average time from diagnosis to treatment dropped from 82.7 days county-wide pre-program to 30 days among enrolled participants, all participants received clinical trial education, and 38 (24.2%) were actively participating in a clinical trial. Conclusions: Community-academic partnerships to co-design and implement approaches to overcome community-identified needs for marginalized populations are essential to achieve cancer health equity. [ABSTRACT FROM AUTHOR]

Date Presented 03/21/24 Our qualitative study aimed to understand how families of autistic girls experienced the autism diagnostic odyssey, with a particular focus on families from minoritized racial and ethnic backgrounds. Primary Author and Speaker: Amber M. Angell Contributing Authors: Daniella Floríndez, Marshae Franklin, Jennifer Lopez, Alexis Rodriguez, Elinor Taylor, Jessica Rios, Melanie Guzman [ABSTRACT FROM AUTHOR]

Syphilis and congenital syphilis (CS) are increasing in California (CA). From 2015 through 2019, for example, CA cases of early syphilis among reproductive-age females (15–44) and CS each increased by >200%. Certain populations—including people experiencing homelessness, using drugs, and/or belonging to certain racial/ethnic groups—have been disproportionately impacted. We hypothesized that geospatial social determinants of health (SDH) contribute to such health inequities. To demonstrate this, we geospatially described syphilis in CA using the Healthy Places Index (HPI). The HPI is a composite index that assigns a score to each CA census tract based on eight socioeconomic characteristics associated with health (education, housing, transportation, neighborhood conditions, clean environment, and healthcare access as well as economic and social resources). We divided CA census tracts into four quartiles based on HPI scores (with the lowest quartile having the least healthy socioeconomic and environmental conditions), then used 2013–2020 CA sexually transmitted diseases surveillance data to compare overall syphilis (among adults and adolescents) and CS case counts, incidence rates (per 100,000 population or live births), and incidence rate ratios (IRRs) among these quartiles. From 2013 to 2020, across all stages of syphilis and CS, disease burden was greatest in the lowest HPI quartile and smallest in the highest quartile (8308 cases (representing 33.2% of all incidents) versus 3768 (15.1%) for primary and secondary (P&S) syphilis; 5724 (31.6%) versus 2936 (16.2%) for early non-primary non-secondary (NPNS) syphilis; 11,736 (41.9%) versus 3026 (10.8%) for late/unknown duration syphilis; and 849 (61.9%) versus 57 (4.2%) for CS; all with p < 0.001). Using the highest HPI quartile as a reference, the IRRs in the lowest quartile were 17 for CS, 4.5 for late/unknown duration syphilis, 2.6 for P&S syphilis, and 2.3 for early NPNS syphilis. We thus observed a direct relationship between less healthy conditions (per HPI) and syphilis/CS in California, supporting our hypothesis that SDH correlate with disparities in syphilis, especially CS. HPI could inform allocation of resources to: (1) support communities most in need of assistance in preventing syphilis/CS cases and (2) reduce health disparities. [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 homeless population is aging; older homeless adults may be at high risk of experiencing violent victimization. To examine whether homelessness is independently associated with experiencing physical and sexual abuse, we recruited 350 adults, aged 50 and older in Oakland, California, who met criteria for homelessness between July 2013 and June 2014. We interviewed participants at 6-month intervals for 3 years in Oakland about key variables, including housing status. Using generalized estimating equations, we examined whether persistent homelessness in each follow-up period was independently associated with having experienced physical or sexual victimization, after adjusting for known risk factors. The majority of the cohort was men (77.4%) and Black American (79.7%). At baseline, 10.6% had experienced either physical or sexual victimization in the prior 6 months. At 18-month follow-up, 42% of the cohort remained homeless. In adjusted models, persistent homelessness was associated with twice the odds of victimization (adjusted odds ratio [AOR] = 2.01; 95% confidence interval [CI]: [1.41, 2.87]). Older homeless adults experience high rates of victimization. Re-entering housing reduces this risk. Policymakers should recognize exposure to victimization as a negative consequence of homelessness that may be preventable by housing. [ABSTRACT FROM AUTHOR]

PREMISE: The xylem tissue of plants performs three principal functions: transport of water, support of the plant body, and nutrient storage. Tradeoffs may arise because different structural requirements are associated with different functions or because suites of traits are under selection that relate to resource acquisition, use, and turnover. The structural and functional basis of xylem storage is not well established. We hypothesized that greater starch storage would be associated with greater sapwood parenchyma and reduced fibers, which would compromise resistance to xylem tensions during dehydration. METHODS: We measured cavitation resistance, minimum water potential, starch content, and sapwood parenchyma and fiber area in 30 species of southern California chaparral shrubs (evergreen and deciduous). RESULTS: We found that species storing greater starch within their xylem tended to avoid dehydration and were less cavitation resistant, and this was supported by phylogenetic independent contrasts. Greater sapwood starch was associated with greater parenchyma area and reduced fiber area. For species without living fibers, the associations with parenchyma were stronger, suggesting that living fibers may expand starch storage capacity while also contributing to the support function of the vascular tissue. Drought‐deciduous species were associated with greater dehydration avoidance than evergreens. CONCLUSIONS: Evolutionary forces have led to an association between starch storage and dehydration resistance as part of an adaptive suite of traits. We found evidence for a tradeoff between tissue mechanical traits and starch storage; moreover, the evolution of novel strategies, such as starch‐storing living fibers, may mitigate the strength of this tradeoff. [ABSTRACT FROM AUTHOR]

The aphid Chaetosiphon fragaefolii Cockerell, 1901 is an agricultural pest and known vector of strawberry viruses. To better understand its biology and systematics, we performed a genomic analysis on C. fragaefolii collected from Quinalt strawberry plants from Pacific Grove, Monterey county, California, USA using Oxford Nanopore and Illumina sequencing. The resulting data were used to assemble the aphids complete mitogenome. The mitogenome of C. fragaefolii is 16,108 bp in length and contains 2 rRNA, 13 protein-coding, and 22 tRNA genes (GenBank accession number LC590896). The mitogenome is similar in content and organization to other Aphididae. Phylogenetic analysis of the C. fragaefolii mitogenome resolved it in a fully supported clade in the tribe Macrosiphini. Analysis of the cox1 barcode sequence of C. fragaefolii from California found exact and nearly identical sequences to C. fragaefolii and Chaetosiphon thomasi Hille Ris Lambers, 1953, suggesting the two species are conspecific. [ABSTRACT FROM AUTHOR]

Relatively mesic environments within arid regions may be important conservation targets as 'climate change refugia' for species persistence in the face of worsening drought conditions. Semi-arid southern California and the relatively mesic environments of California's Channel Islands provide a model system for examining drought responses of plants in potential climate change refugia. Most methods for detecting refugia are focused on 'exposure' of organisms to certain abiotic conditions, which fail to assess how local adaptation or acclimation of plant traits (i.e. 'sensitivity') contribute to or offset the benefits of reduced exposure. Here, we use a comparative plant hydraulics approach to characterize the vulnerability of plants to drought, providing a framework for identifying the locations and trait patterns that underlie functioning climate change refugia. Seasonal water relations, xylem hydraulic traits and remotely sensed vegetation indices of matched island and mainland field sites were used to compare the response of native plants from contrasting island and mainland sites to hotter droughts in the early 21st century. Island plants experienced more favorable water relations and resilience to recent drought. However, island plants displayed low plasticity/adaptation of hydraulic traits to local conditions, which indicates that relatively conserved traits of island plants underlie greater hydraulic safety and localized buffering from regional drought conditions. Our results provide an explanation for how California's Channel Islands function as a regional climate refugia during past and current climate change and demonstrate a physiology-based approach for detecting potential climate change refugia in other systems. [ABSTRACT FROM AUTHOR]

Recent fire seasons have fueled intense speculation regarding the effect of anthropogenic climate change on wildfire in western North America and especially in California. During 1972–2018, California experienced a fivefold increase in annual burned area, mainly due to more than an eightfold increase in summer forest‐fire extent. Increased summer forest‐fire area very likely occurred due to increased atmospheric aridity caused by warming. Since the early 1970s, warm‐season days warmed by approximately 1.4 °C as part of a centennial warming trend, significantly increasing the atmospheric vapor pressure deficit (VPD). These trends are consistent with anthropogenic trends simulated by climate models. The response of summer forest‐fire area to VPD is exponential, meaning that warming has grown increasingly impactful. Robust interannual relationships between VPD and summer forest‐fire area strongly suggest that nearly all of the increase in summer forest‐fire area during 1972–2018 was driven by increased VPD. Climate change effects on summer wildfire were less evident in nonforested lands. In fall, wind events and delayed onset of winter precipitation are the dominant promoters of wildfire. While these variables did not change much over the past century, background warming and consequent fuel drying is increasingly enhancing the potential for large fall wildfires. Among the many processes important to California's diverse fire regimes, warming‐driven fuel drying is the clearest link between anthropogenic climate change and increased California wildfire activity to date. Plain Language Summary: Since the early 1970s, California's annual wildfire extent increased fivefold, punctuated by extremely large and destructive wildfires in 2017 and 2018. This trend was mainly due to an eightfold increase in summertime forest‐fire area and was very likely driven by drying of fuels promoted by human‐induced warming. Warming effects were also apparent in the fall by enhancing the odds that fuels are dry when strong fall wind events occur. The ability of dry fuels to promote large fires is nonlinear, which has allowed warming to become increasingly impactful. Human‐caused warming has already significantly enhanced wildfire activity in California, particularly in the forests of the Sierra Nevada and North Coast, and will likely continue to do so in the coming decades. Key Points: Annual burned area in California increased fivefold during 1972–2018, mainly due to summer forest fireAnthropogenic warming very likely increased summer forest fire by drying fuels; this trend is likely to continueLarge fall fires are likely to become increasingly frequent with continued warming and possibly gradual declines in fall precipitation [ABSTRACT FROM AUTHOR]

Background The US homeless population is aging. Older adults and those living in poverty are at a high risk of food insecurity. Methods We conducted a cross-sectional analysis of baseline data from a population-based study of 350 homeless adults aged ≥50. We assessed food security and receipt of food assistance. We used multivariable logistic regression to examine factors associated with very low food security. Results The majority of the cohort was male and African American. Over half (55.4%) met criteria for food insecurity, 24.3% reported very low food security. Half (51.7%) reported receiving monetary food assistance. In the multivariable model, those who were primarily sheltered in the prior 6 months, (multi-institution users [AOR = 0.44, 95% CI: 0.22–0.86]) had less than half the odds of very low food security compared with those who were unsheltered. Depressive symptoms (AOR = 3.01, 1.69–5.38), oral pain (AOR = 2.15, 1.24–3.74) and cognitive impairment (AOR = 2.21, 1.12–4.35) were associated with increased odds of very low food security. Conclusions Older homeless adults experience a high prevalence of food insecurity. To alleviate food insecurity in this population, targeted interventions must address specific risk groups. [ABSTRACT FROM AUTHOR]

Older homeless‐experienced adults have low engagement in advance care planning (ACP) despite high morbidity and mortality. We conducted a cross‐sectional analysis of a cohort of 350 homeless‐experienced adults aged 50 and older in Oakland, California. We assessed the prevalence of potential surrogate decision‐makers, ACP contemplation, discussions, and ACP documentation (surrogate designation, advance directives). We used multivariable logistic regression to examine factors associated with ACP discussions and documentation. The median age of the cohort was 59 (range 52–82), 75.2% were male, and 82.1% were black. Sixty‐one percent reported a potential surrogate, 21.5% had discussed ACP, and 19.0% reported ACP documentation. In multivariable models, having 1 to 5 confidants versus none (adjusted odds ratio (aOR)=5.8, 95% confidence interval (CI)=1.7–20.0), 3 or more chronic conditions versus none (aOR=2.3, 95% CI=0.9–5.6), and a recent primary care visit (aOR=2.1, 95% CI=1.0–4.4) were associated with higher odds of ACP discussions and each additional 5 years of homelessness (aOR=0.7, 95% CI=0.5—0.9) with lower odds. Having 1 to 5 confidants (aOR=5.0, 95% CI=1.4–17.5), being black (aOR=5.5, 95% CI=1.5–19.5), and having adequate versus limited literacy (aOR=7.0, 95% CI=1.5–32.4) were associated with higher odds of ACP documentation and illicit drug use (aOR=0.3, 95% CI=0.1–0.9) with lower odds. Although the majority of older homeless‐experienced adults have a potential surrogate, few have discussed or documented their ACP wishes; the odds of both were greater with larger social networks. Future interventions must be customized for individuals with limited social networks and address the instability of homelessness, health literacy, and the constraints of safety‐net healthcare settings. [ABSTRACT FROM AUTHOR]

Objective: Out-of-network emergency department (ED) use, or use that occurs outside the contracted network, may lead to increased care fragmentation and cost. We examined factors associated with out-of-network ED use among Medicaid beneficiaries.Data Sources and Study Setting: Enrollment, claims, and encounter data for adult Medi-Cal health plan members with 1+ ED visits and complete Medicaid eligibility during the study period from 2013 to 2014.Study Design: We analyzed the data to identify factors associated with out-of-network ED use classified by mode of arrival (ambulance vs. nonambulance).Data Extraction Methods: We extracted encounter, ambulance, and ED census data and linked them together based on ED visit date.Principal Findings: Of 11,143 ED visits, 6,808 (61.1 percent) were out-of-network. The number of hours the study ED was on ambulance diversion increased the odds of out-of-network visits for the 3,365 (30.2 percent) ED visits arriving by ambulance. For all visit types, assignment to a primary care clinic at the in-network hospital and having had any primary care visit during the study period decreased the odds of out-of-network ED care. Individuals were more likely to go out-of-network for ED care if they lived in neighborhoods containing out-of-network EDs.Conclusions: There are a number of factors related to out-of-network ED use, including the proximity and density of out-of-network EDs, race and ethnicity, a prior history of out-of-network ED use, and individuals' connection to primary care. EDs that serve Medicaid beneficiaries may need to explore alternative sites and modalities of care as alternatives to the ED, and consider their ability to absorb large numbers of out-of-network visits given already limited capacity. [ABSTRACT FROM AUTHOR]

Purpose of the Study: Older homeless adults living in shelters have high rates of geriatric conditions, which may increase their risk for acute care use and nursing home placement. However, a minority of homeless adults stay in shelters and the prevalence of geriatric conditions among homeless adults living in other environments is unknown. We determined the prevalence of common geriatric conditions in a cohort of older homeless adults, and whether the prevalence of these conditions differs across living environments. Design and Methods: We interviewed 350 homeless adults, aged 50 and older, recruited via population-based sampling in Oakland, CA. We evaluated participants for common geriatric conditions. We assessed living environment using a 6-month follow-back residential calendar, and used cluster analysis to identify participants' primary living environment over the prior 6 months. Results: Participants stayed in 4 primary environments: unsheltered locations (n = 162), multiple locations including shelters and hotels (n = 88), intermittently with family/friends (n = 57), and, in a recently homeless group, rental housing (n = 43). Overall, 38.9% of participants reported difficulty performing 1 or more activities of daily living, 33.7% reported any falls in the past 6 months, 25.8% had cognitive impairment, 45.1% had vision impairment, and 48.0% screened positive for urinary incontinence. The prevalence of geriatric conditions did not differ significantly across living environments. Implications: Geriatric conditions were common among older homeless adults living in diverse environments, and the prevalence of these conditions was higher than that seen in housed adults 20 years older. Services that address geriatric conditions are needed for older homeless adults living across varied environments. [ABSTRACT FROM AUTHOR]

Objective The median age of single homeless adults is over 50, yet little is known about their emergency department ( ED) use. We describe use of and factors associated with ED use in a sample of homeless adults 50 and older. Methods We recruited 350 participants who were homeless and 50 or older in Oakland, California. We interviewed participants about residential history in the prior 6 months, health status, health-related behaviors, and health services use and assessed cognition and mobility. Our primary outcome was the number of ED visits in the prior 6 months based on medical record review. We used negative binomial regression to examine factors associated with ED use. Results In the 6 months prior to enrollment, 46.3% of participants spent the majority of their time unsheltered; 25.1% cycled through multiple institutions including shelters, hospitals, and jails; 16.3% primarily stayed with family or friends; and 12.3% had become homeless recently after spending much of the prior 6 months housed. Half (49.7%) of participants made at least one ED visit in the past 6 months; 6.6% of participants accounted for 49.9% of all visits. Most (71.8%) identified a regular non- ED source of healthcare; 7.3% of visits resulted in hospitalization. In multivariate models, study participants who used multiple institutions (incidence rate ratio [ IRR] = 2.27; 95% confidence interval [ CI] = 1.08 to 4.77) and who were unsheltered ( IRR = 2.29; 95% CI = 1.17 to 4.48) had higher ED use rates than participants who had been housed for most of the prior 6 months. In addition, having health insurance/coverage ( IRR = 2.6; CI = 1.5 to 4.4), a history of psychiatric hospitalization ( IRR = 1.80; 95% CI = 1.09 to 2.99), and severe pain ( IRR = 1.72; 95% CI = 1.07 to 2.76) were associated with higher ED visit rates. Conclusions A sample of adults aged 50 and older who were homeless at study entry had higher rates of ED use in the prior 6 months than the general U.S. age-matched population. Within the sample, ED use rates varied based on individuals' residential histories, suggesting that individuals' ED use is related to exposure to homelessness. [ABSTRACT FROM AUTHOR]

Adults aged 50 and older make up half of individuals experiencing homelessness and have high rates of morbidity and mortality. They may have different life trajectories and reside in different environments than do younger homeless adults. Although the environmental risks associated with homelessness are substantial, the environments in which older homeless individuals live have not been well characterized. We classified living environments and identified associated factors in a sample of older homeless adults. From July 2013 to June 2014, we recruited a community-based sample of 350 homeless men and women aged fifty and older in Oakland, California. We administered structured interviews including assessments of health, history of homelessness, social support, and life course. Participants used a recall procedure to describe where they stayed in the prior six months. We performed cluster analysis to classify residential venues and used multinomial logistic regression to identify individual factors prior to the onset of homelessness as well as the duration of unstable housing associated with living in them. We generated four residential groups describing those who were unsheltered (n = 162), cohabited unstably with friends and family (n = 57), resided in multiple institutional settings (shelters, jails, transitional housing) (n = 88), or lived primarily in rental housing (recently homeless) (n = 43). Compared to those who were unsheltered, having social support when last stably housed was significantly associated with cohabiting and institution use. Cohabiters and renters were significantly more likely to be women and have experienced a shorter duration of homelessness. Cohabiters were significantly more likely than unsheltered participants to have experienced abuse prior to losing stable housing. Pre-homeless social support appears to protect against street homelessness while low levels of social support may increase the risk for becoming homeless immediately after losing rental housing. Our findings may enable targeted interventions for those with different manifestations of homelessness. [ABSTRACT FROM AUTHOR]

Background: Little is known about hospitalization-associated disability (HAD) in older adults who receive care in safety-net hospitals.Objectives: To describe HAD and to examine its association with age in adults aged 55 and older hospitalized in a safety-net hospital.Design: Secondary post hoc analysis of a prospective cohort from a discharge intervention trial, the Support from Hospital to Home for Elders.Setting: Medicine, cardiology, and neurology inpatient services of San Francisco General Hospital, a safety-net hospital.Participants: A total of 583 participants 55 and older who spoke English, Spanish, or Chinese. We determined the incidence of HAD 30 days post-hospitalization and ORs for HAD by age group.Measurements: The outcome measure was death or HAD at 30 days after hospital discharge. HAD is defined as a new or additional disability in one or more activities of daily living (ADL) that is present at hospital discharge compared to baseline. Participants' functional status at baseline (2 weeks prior to admission) and 30 days post-discharge was ascertained by self-report of ADL function.Results: Many participants (75.3 %) were functionally independent at baseline. By age group, HAD occurred as follows: 27.4 % in ages 55-59, 22.2 % in ages 60-64, 17.4 % in ages 65-69, 30.3 % in ages 70-79, and 61.7 % in ages 80 or older. Compared to the youngest group, only the adjusted OR for HAD in adults over 80 was significant, at 2.45 (95 % CI 1.17, 5.15).Conclusions: In adults at a safety-net hospital, HAD occurred in similar proportions among adults aged 55-59 and those aged 70-79, and was highest in the oldest adults, aged ≥ 80. In safety-net hospitals, interventions to reduce HAD among patients 70 years and older should consider expanding age criteria to adults as young as 55. [ABSTRACT FROM AUTHOR]

Latino adults between ages 50 and 60 yr are at high risk for developing chronic conditions that can lead to early disability. We conducted a qualitative pilot study with 11 Latinos in this demographic group to develop a foundational schema for the design of health promotion programs that could be implemented by occupational therapy practitioners in primary care settings for this population. One-on-one interviews addressing routines and activities, health management, and health care utilization were conducted, audiotaped, and transcribed. Results of a content analysis of the qualitative data revealed the following six domains of most concern: Weight Management; Disease Management; Mental Health and Well-Being; Personal Finances; Family, Friends, and Community; and Stress Management. A typology of perceived health-actualizing strategies was derived for each domain. This schema can be used by occupational therapy practitioners to inform the development of health-promotion lifestyle interventions designed specifically for late-middle-aged Latinos. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate the compliance with and tolerability of daily cranberry capsule ingestion for asymptomatic bacteriuria (ASB) prevention in pregnancy. Design: A total of 49 pregnant women from two sites were randomly assigned to cranberry or matching placebo, two doses daily, at gestational ages less than 16 weeks. Patients were followed monthly for urinary tract infection until delivery. Up to seven monthly visits were scheduled for each patient. Delivery data were evaluated. Results: Of 38 evaluable patients, the mean compliance rate over the study period was 82% (range, 20%-100%). This compliance rate and the 74% of patients achieving good (≥75%) compliance were similar between those who received cranberry capsules and placebo. Compliance evaluation revealed that most patients stopped capsule consumption after 34-38 weeks of participation. Multivariate logistic regression and longitudinal analysis showed a significant interaction time effect with cranberry treatment. However, cranberry consumption was not a significant predictor of gastrointestinal intolerance or study withdrawal. Although 30% of patients withdrew for various reasons, only 1 withdrew because of intolerance to the cranberry capsules. Loss to follow-up was mostly due to provider change (9 of 49 [18%]) and therapy disinterest (4 of 49 [8%]). Seven cases of ASB occurred in 5 patients: 2 of 24 (8%) in the cranberry group and 3 of 25 (12%) in the placebo group. No cases of cystitis or pyelonephritis were observed. Conclusion: One third of pregnant women could not complete the study protocol for various reasons. Compliance with and tolerability of cranberry capsule ingestion appear good; these capsules provide a potentially effective means to prevent ASB in pregnancy. Further studies with large samples are necessary to confirm the findings. [ABSTRACT FROM AUTHOR]

Background: Latino children experience more prevalent and severe tooth decay than non-Hispanic white and non-Hispanic black children. Few theory-based, evaluated and culturally appropriate interventions target parents of this vulnerable population. To fill this gap, the Contra Caries Oral Health Education Program, a theory-based, promotora-led education program for low-income, Spanish-speaking parents of children aged 1-5 years, was developed. This article describes qualitative findings of the acceptability of curriculum content and activities, presents the process of refinement of the curriculum through engaging the target population and promotoras, and presents results from the evaluation assessing the acceptability of the curriculum once implemented. Methods: Focus groups were conducted with low-income Spanish-speaking parents of children 1-5 years living in a city in an agricultural area of California. Interviews were digitally recorded, translated and transcribed, checked for accuracy and the resulting data was thematically coded and analyzed using a social constructionist approach. The Contra Caries Oral Health Education Program was then implemented with a separate but similar sample, and after completing the program, participants were administered surveys asking about acceptability and favorite activities of the education program. Data were entered into a database, checked for accuracy, open-ended questions were categorized, and responses to close-ended questions counted. Results: Twelve focus groups were conducted (N=51), 105 parents attended the Contra Caries Oral Health Education Program, and 83 parents filled out surveys. Complete attendance and retention was high (89 % and 90 %, respectively). This study found that their children's oral health is a high priority. Parents were not only interested in, but actually attended classes focused on increasing their knowledge and skills with respect to early childhood oral health. The Contra Caries content and format was perceived as acceptable by parents. Strong opinions about curriculum content were expressed for including information on how caries starts and progresses, weaning from the bottle, oral health care for children and adults, motivational strategies for children's tooth brushing, dental visits and cavity restorations. Conclusions: The Contra Caries Oral Health Education Program was acceptable to low-income, Spanish-speaking parents of children 1-5 years. Participating in the curriculum development and revision process likely played an important role in the parents' high acceptability of the program. [ABSTRACT FROM AUTHOR]

Objectives To determine the prevalence of preadmission functional disability in late-middle-aged and older safety-net inpatients and to identify characteristics associated with functional disability by age. Design Cross-sectional analysis. Setting Safety-net hospital in San Francisco, California. Participants English-, Spanish-, and Chinese-speaking community-dwelling individuals aged 55 and older admitted to a safety-net hospital with anticipated return to the community (N = 699). Measurements At hospital admission, participants reported their need for help performing five activities of daily living ( ADLs) and seven instrumental activities of daily living ( IADLs) 2 weeks before admission. ADL disability was defined as needing help performing one or more ADLs and IADL disability as needing help performing two or more IADLs. Participant characteristics were assessed, including sociodemographic characteristics, health status, health-related behaviors, and health-seeking behaviors. Results Overall, 28.3% of participants reported that they had an ADL disability 2 weeks before admission, and 40.4% reported an IADL disability. The prevalence of preadmission ADL disability was 28.9% of those aged 55 to 59, 20.7% of those aged 60 to 69, and 41.2% of those aged 70 and older ( P < .001). The prevalence of IADL disability had a similar distribution. The characteristics associated with functional disability differed according to age; in participants aged 55 to 59, African Americans had a higher odds of ADL and IADL disability, whereas in participants aged 60 to 69 and aged 70 and older, inadequate health literacy was associated with functional disability. Conclusion Preadmission functional disability is common in individuals aged 55 and older admitted to a safety-net hospital. Late-middle-aged individuals admitted to safety-net hospitals may benefit from models of acute care currently used for older adults that prevent adverse outcomes associated with functional disability. [ABSTRACT FROM AUTHOR]

Background: Hospitals are implementing discharge support programs to reduce readmissions, and these programs have had mixed success. Objective: To examine whether a peridischarge, nurse-led intervention decreased emergency department (ED) visits or readmissions among ethnically and linguistically diverse older patients admitted to a safety-net hospital. Design: Randomized, controlled trial using computer-generated randomization with 1:1 allocation, stratified by language. (Clinical Trials.gov: NCT01221532) Setting: Publicly funded urban hospital in Northern California. Patients: Hospitalized adults aged 55 years or older with anticipated discharge to the community who spoke English, Spanish, or Chinese (Mandarin or Cantonese). Intervention: Usual care versus in-hospital, one-on-one, self-management education given by a dedicated language-concordant registered nurse combined with a telephone follow-up after discharge from a nurse practitioner. Measurements: Staff blinded to the study groups determined ED visits or readmissions to any facility at 30, 90, and 180 days after initial hospital discharge using administrative data from several hospitals. Results: There were 700 low-income, ethnically and linguistically diverse patients with a mean age of 66.2 years (SD, 9.0). The primary outcome of ED visits or readmissions did not differ between the intervention and usual care groups (hazard ratio, 1.26 [95% Cl, 0.89 to 1.78] at 30 days, 1.21 [Cl, 0.91 to 1.62] at 90 days, and 1.11 [Cl, 0.86 to 1.43] at 180 days). Limitations: This study was done at a single acute-care hospital. There were fewer outcomes than expected, which may have caused the study to be underpowered. Conclusion: A nurse-led, in-hospital discharge support intervention did not show a reduction in readmissions or ED visits among diverse, low-income older adults at a safety-net hospital. Although wide CIs preclude firm conclusions, the intervention may have increased ED visits. Alternative readmission prevention strategies should be tested in this population. [ABSTRACT FROM AUTHOR]

There is little or no data examining the association between either pain or the use or misuse of opioid analgesic with adherence to antiretroviral medications (ARVs) among HIV-infected adults. We interviewed a community-based cohort of HIV-infected indigent adults prescribed antiretroviral medications (ARVs) quarterly to examine the association between (1) pain, (2) receipt of opioid analgesics, and (3) opioid analgesic misuse with self-reported ARV adherence. Of 281 participants, most (82.5 %) reported severe or moderate pain, half (52.4 %) received a prescription for opioids, and one quarter (24.6 %) misused opioid analgesics. Most (71.9 %) reported >90 % ARV adherence. In a GEE model, neither pain (unadjusted OR 1.14, CI 0.90-1.45) nor prescription of opioid analgesics (unadjusted OR 1.11, CI 0.84-1.49) were significantly associated with ARV adherence. Misuse of opioid analgesics was associated with incomplete adherence (AOR 1.42, CI 1.09-1.86). Individuals who misuse opioid analgesics, like those who use illicit substances, may have difficulty adhering to medication regimens. [ABSTRACT FROM AUTHOR]

Urban policymakers and sustainable food activists have identified urban agriculture as an important strategy for confronting a host of urban problems, including food insecurity, health disparities, access to urban green space and community economic revitalisation. Much recent work on urban agriculture has examined community and school gardens, but little research has been undertaken on home gardens as a solution to urban problems. This article examines a home-gardening programme in San Jose, California, La Mesa Verde, asking whether some of the benefits found in community gardens can be found in home gardens. Specifically, we look at financial, health and community benefits, examining the potential of home gardens to become forces for broader social change. We ask whether gardens can become agents of cultural preservation, self-determination, particularly for recent immigrants who use these spaces to build identities and work towards collective action and self-determination. [ABSTRACT FROM PUBLISHER]

Background: Consumption of sugar-sweetened beverage (SSB) has risen over the past two decades, with over 10 million Californians drinking one or more SSB per day. High SSB intake is associated with risk of type 2 diabetes, obesity, hypertension, and coronary heart disease (CHD). Reduction of SSB intake and the potential impact on health outcomes in California and among racial, ethnic, and low-income sub-groups has not been quantified. Methods: We projected the impact of reduced SSB consumption on health outcomes among all Californians and California subpopulations from 2013 to 2022. We used the CVD Policy Model – CA, an established computer simulation of diabetes and heart disease adapted to California. We modeled a reduction in SSB intake by 10–20% as has been projected to result from proposed penny-per-ounce excise tax on SSB and modeled varying effects of this reduction on health parameters including body mass index, blood pressure, and diabetes risk. We projected avoided cases of diabetes and CHD, and associated health care cost savings in 2012 US dollars. Results: Over the next decade, a 10–20% SSB consumption reduction is projected to result in a 1.8–3.4% decline in the new cases of diabetes and an additional drop of 0.5–1% in incident CHD cases and 0.5–0.9% in total myocardial infarctions. The greatest reductions are expected in African Americans, Mexican Americans, and those with limited income regardless of race and ethnicity. This reduction in SSB consumption is projected to yield $320–620 million in medical cost savings associated with diabetes cases averted and an additional savings of $14–27 million in diabetes-related CHD costs avoided. Conclusions: A reduction of SSB consumption could yield substantial population health benefits and cost savings for California. In particular, racial, ethnic, and low-income subgroups of California could reap the greatest health benefits. [ABSTRACT FROM AUTHOR]

Purpose: An association between hospital volume and postoperative mortality has been identified for several oncologic surgical procedures. Our objective was to analyze differences in surgical outcomes for patients with rectal cancer according to hospital volume in the state of California. Methods: A cross-sectional study from 2000 to 2005 was performed using the state of California Office of Statewide Health Planning and Development database. Hospitals were categorized into low (≤30)-, medium (31-60)-, and high (>60)-volume groups based on the total number of rectal cancer operations performed during the study period. Results: Overall, 7,187 rectal cancer operations were performed. Of the 321 hospitals in the study cohort, 72 % ( n = 232), 20 % ( n = 65), and 8 % ( n = 24) were low-, medium-, and high-volume hospitals, respectively. Postoperative mortality was significantly lower- in high-volume hospitals (0.9 %) when compared to medium- (1.1 %) and low-volume hospitals (2.1 %; p < 0.001). High-volume hospitals also performed more sphincter-preserving procedures (64 %) when compared to medium- (55 %) and low-volume hospitals (51 %; p < 0.001). Conclusions: These data indicate that hospital volume correlates with improved outcomes in rectal cancer surgery. Rectal cancer patients may benefit from lower mortality and increased sphincter preservation in higher-volume centers. [ABSTRACT FROM AUTHOR]