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Background: Current clinical guidelines recommended primary human papillomavirus (HPV) screening for cervical cancer testing. Previous studies reported patient-level barriers (e.g., limited knowledge and attachment to Pap test) that may hinder wide adoption of primary HPV screening. We assessed these women-level factors following the implementation of primary HPV screening (July 2020) at Kaiser Permanente Southern California (KPSC). Methods: We administered a patient survey (mail and on-line) to female KPSC members aged 30–65 years who received primary HPV screening between October and December 2020. Those who preferred English vs. Spanish language were sampled separately. The survey included domains on knowledge about HPV and HPV screening, awareness of screening guidelines, and attitudes about HPV testing. Demographic data were collected using electronic health records. We used weighted multivariable logistic and modified Poisson regressions for associations between language preference and survey responses. Results: In total, 3,009 surveys were returned (38.0% response rate). Few women (7.0%) found HPV testing as an acceptable screening method. The majority of women (92.2%) remained unaware that HPV testing can replace Pap test for screening. The Pap test was the most preferred screening approach for 33.2% Spanish-speaking women vs. 19.9% English-speaking women. Only 20.6% knew that women aged 30–65 years can be screened every 5 years with cotest or primary HPV screening. Most women (96.4%) did not perceive stigma about taking the HPV test. Conclusion: Proactive patient education will help improve women's knowledge about primary HPV screening, which may facilitate its implementation in additional health care settings. [ABSTRACT FROM AUTHOR]

Purpose: Understanding emergency department (ED) use in adolescent and young adult (AYA) survivors could identify gaps in AYA survivorship. Methods: We conducted a cohort study of 7925 AYA survivors (aged 15–39 years at diagnosis) who were 2–5 years from diagnosis in 2006–2020 at Kaiser Permanente Southern California. We calculated ED utilization rates overall and by indication of the encounter (headache, cardiac issues, and suicide attempts). We estimated rate changes by survivorship year and patient factors associated with ED visit using a Poisson model. Results: Cohort was 65.4% women, 45.8% Hispanic, with mean age at diagnosis at 31.3 years. Overall, 38% of AYA survivors had ≥1 ED visit (95th percentile: 5 ED visits). Unadjusted ED rates declined from 374.2/1000 person-years (PY) in Y2 to 327.2 in Y5 (p change < 0.001). Unadjusted rates declined for headache, cardiac issues, and suicide attempts. Factors associated with increased ED use included: age 20–24 at diagnosis [relative risk (RR) = 1.30, 95% CI 1.09–1.56 vs. 35–39 years]; female (RR = 1.27, 95% CI 1.11–1.47 vs. male); non-Hispanic Black race/ethnicity (RR 1.64, 95% CI 1.38–1.95 vs. non-Hispanic white); comorbidity (RR = 1.34, 95% CI 1.16–1.55 for 1 and RR 1.80, 95% CI 1.40–2.30 for 2+ vs. none); and public insurance (RR = 1.99, 95% CI 1.70–2.32 vs. private). Compared with thyroid cancer, cancers associated with increased ED use were breast (RR = 1.45, 95% CI 1.24–1.70), cervical (RR = 2.18, 95% CI 1.76–2.71), colorectal (RR = 2.34, 95% CI 1.94–2.81), and sarcoma (RR = 1.39, 95% CI 1.03–1.88). Conclusion: ED utilization declined as time from diagnosis elapsed, but higher utilization was associated with social determinants of health and cancer types. [ABSTRACT FROM AUTHOR]

One hypothesis raised by Newport and Aslin to explain how speakers learn dependencies between nonadjacent phonemes is that speakers track bigram probabilities between two segments that are adjacent to each other within a tier of their own. The hypothesis predicts that a dependency between segments separated from each other at the tier level cannot be learned. Were this true, it could add psycholinguistic plausibility to phonological theories that limit possible nonadjacent dependencies to those between two tier-adjacent segments. Contrary to the prediction, the experiments in this paper show that adults can learn dependencies between two consonants that are nonadjacent to each other at the tier level as well as the segmental level. The results suggest that the range of learnable sound patterns may be wider than the range of attested sound patterns and that additional learning mechanisms should be considered to explain how speakers learn nonadjacent phonotactic dependencies. (Contains 3 tables.)

The purpose of this study was to describe the medication management and treatment provided in a specialty outpatient psychiatry clinic for 198 community-residing children and adults with intellectual disability and other developmental disabilities (IDD) referred to the clinic and discharged between 1999 and 2008. Using a descriptive design, data from a retrospective chart audit were examined to explain medication management from referral to discharge. The audit tool collected data on demographic variables, reasons for referral, admission date, clinic appointments, discharge date, diagnoses, and medications. Data on diagnoses and medications were grouped according to categories of the 2000 American Psychiatric Association's DSM-IV-TR: "Diagnostic and Statistical Manual of Mental Disorders," 4th Edition, Text Revision diagnoses and medication classes, respectively. Data were analyzed using descriptive statistics, paired sample t tests, and Wilcoxon signed-rank tests. Interrater reliability was examined with Kappa values and correlation statistics. The study found that psychiatric care in the clinic led to a simplification of medication regimens. For individuals taking prescribed psychiatric medications at referral, psychiatric medication polypharmacy and same-class psychiatric medication polypharmacy were reduced by discharge. Modifications in the profile of medications prescribed generally reflected expert consensus guidelines. The overall findings suggest that this model of provision of specialized psychiatric outpatient services for individuals with IDD may be one approach to improve the quality of mental health care for this underserved population. (Contains 5 tables.)

3 Background: Cancer care involves complex transitions across facilities, services and providers. Optimal TOAI is critical to ensuring safe transitions in care. In 2018, the Princess Margaret (PM) Cancer Centre, Division of Medical Oncology and Hematology (DMOH), Quality Program conducted a multi-incident analysis to identify trends in patient transfer-related events (TRE). Priority areas for quality improvement included (1) use of standardized verbal communication, (2) timeliness of handover and (3) documentation. The PM TOAI Working Group (WG) was established to tailor, standardize, implement and evaluate optimal TOAI practices across PM, with the objective of eliminating TRE by 2024. Methods: The WG was established with multi-disciplinary and inter-professional representation across PM services, and met monthly. A needs assessment and environmental scan were completed. Change initiatives were prioritized, and WG focused on developing standards of work (SOW), educational approaches, and evaluation. This work coincided with University Health Network (UHN)'s adoption of I-PASS as the institution's preferred handover tool, and I-PASS was embedded in all standards created. Change initiatives were: (1) An inter-/intra-facility TOAI SOW was developed (2) A nursing workflow mandating verbal/written handover with patient re-assessment within 1hr of transfer was created (3) Physician (MD) safety huddles with a focus on TOAI in acute oncology clinics and inpatient wards were established, and (4) Evening/weekend inpatient MD handovers were restructured and standardized. From Oct 2021 to Dec 2023, the TOAI WG completed eight cycles of PDSA change initiatives. Pre- and post-implementation surveys were conducted to identify and address barriers. Audits were used to evaluate consistency & quality of inpatient handover rounds. Results: PM reported a serious safety event rate per 10 000 adjusted patient days (SSER) of 1.24(2016); this has been reduced to 0.29 (2024). From 2013-2018, TRE occurred at PM with intervals ranging from 1 to 38 days. In the latter half of 2018, since establishing the TOAI WG, there was a gap of 123 days before the most recent event occurred. The current days between events is > 800 as of May 2024. Conclusions: Systematic implementation of TOAI initiatives at PM has improved the safety and effectiveness of patient care transitions through the adoption of tailored, standardized communication tools and targeted education, which has facilitated a sustained culture shift toward TOAI. These initiatives have reduced SSEs and fostered better communication and collaboration amongst healthcare providers. The sustained improvements highlight the significance of broad engagement of front-line staff and continuous evaluation in ensuring safe, high quality healthcare practices. [ABSTRACT FROM AUTHOR]

208 Background: From the moment cancer is suspected, patients and their caregivers may feel overwhelmed and not know where to seek help for non-medical questions. Social risks, including financial instability, housing and food insecurity can lead to poor cancer outcomes, and 39% of Kaiser Permanente (KP) cancer patients screened positive for at least one social risk. KP implemented the Cancer Support Line to provide patients and caregivers with a single point of contact to address non-medical concerns, including financial navigation, social health needs, and general cancer information. Methods: Kaiser Permanente partnered with patients, clinicians, and health plan functions supporting member services, social health, and quality to co-design and implement a phone number for cancer members in the KP Northwest market. The Cancer Support Line ('Line') is an inbound phone number staffed by Cancer Support Specialists ('Specialists'), a dedicated team of health plan member services, trained in cancer support skills. Specialists use four co-designed pathways to navigate callers to resources for financial questions, social needs, and general cancer information and support. If clinically appropriate questions arise, Specialists use existing operational channels to connect patients back to their care teams. Results: During the pilot, there were 1,057 interactions with members, patients, and caregivers from March 12th to May 17th. Financial questions about payment assistance and insurance benefits/eligibility emerged as the highest call driver. The top call outcomes by volume are shown in the included table. A high majority of calls (94%, n=992) were addressed by the Cancer Support Specialists themselves. Post-call survey results revealed that 96% of callers (n=26) rated their call experience high when asked "How would you rate your overall call experience today?" Conclusions: Effective collaboration across KP's project teams was a critical driver of the pilot's success. Workflows were built with all partner teams and departments, Specialist training was designed internally with consultation from the American Cancer Society, team communications were open and consistent, call reporting was robust and adaptable. Furthermore, the Line addresses a critical gap in the cancer patient experience: navigating non-medical needs that busy care teams are unable to address on their own. Though positive, these pilot results are preliminary and focused on one KP market. To evaluate the pilot for scalability, the team will assess process metrics and outcomes on caller, frontline staff, and Specialist experience on an ongoing basis to capture the Line's broader operational impact. Call transfer destination. Transfer Destination # of calls % No Transfer 992 93.9% KP Community Support Hub Transfer 45 4.3% Clinical Transfer 17 1.6% KP Community Support Hub + Clinic Transfer 3 0.3% [ABSTRACT FROM AUTHOR]

Background The current opioid epidemic across the United States has fueled a surge in the rate of new hepatitis C virus (HCV) infections among young persons who inject drugs (PWIDs). Paramount to interrupting transmission is targeting these high-risk populations and understanding the underlying network structures facilitating transmission within these communities. Methods Deep sequencing data were obtained for 52 participants from 32 injecting partnerships enrolled in the U-Find-Out (UFO) Partner Study, which is a prospective study of self-described injecting dyad partnerships from a large community-based study of HCV infection in young adult PWIDs from San Francisco. Phylogenetically linked transmission events were identified using traditional genetic-distance measures and viral deep sequence phylogenies reconstructed to determine the statistical support of inferences and the direction of transmission within partnerships. Results Using deep sequencing data, we found that 12 of 32 partnerships were genetically similar and clustered. Three additional phylogenetic clusters were found describing novel putative transmission links outside of the injecting relationship. Transmission direction was inferred correctly for 5 partnerships with the incorrect transmission direction inferred in more than 50% of cases. Notably, we observed that phylogenetic linkage was most often associated with a lower number of network partners and involvement in a sexual relationship. Conclusions Deep sequencing of HCV among self-described injecting partnerships demonstrates that the majority of transmission events originate from outside of the injecting partnership. Furthermore, these findings caution that phylogenetic methods may be unable to routinely infer the direction of transmission among PWIDs especially when transmission events occur in rapid succession within high-risk networks. [ABSTRACT FROM AUTHOR]

This article examines two independent schools as case studies for educating for sustainability, and shares what they have learned, what works, and best of all, what can be replicated elsewhere. Midland School--rigorous, rustic, and full of heart--is a small college preparatory boarding school on almost 3,000 acres in the Santa Ynez Valley in Southern California. Sustainability is in Midland's DNA, and has been since the school's founding in 1932. Midland was awarded a Governor's Award for Environmental and Economic Leadership, California's highest environmental honor. The Hotchkiss School--challenging, traditional, and well resourced--is a boarding school on 800 acres, including woods, lakes, and freshwater wetlands in Connecticut. Hotchkiss strengthened its commitment to environmental stewardship in 1996 in its Statement of Goals and Purposes, putting at the forefront of a Hotchkiss education the school's natural resources and student connection to these resources. Hotchkiss and Midland are two models of how schools can be regenerative in scope, adaptable to changing times, and resilient in the face of proven scientific limits.

Endangered Sonoran (Antilocapra americana sonoriensis) and Peninsular (A. a. peninsularis) pronghorn persist largely because of captive breeding and reintroduction efforts. Recovery team managers want to re‐establish pronghorn in their native range, but there is currently uncertainty regarding the subspecies status of extinct pronghorn populations that historically inhabited southern California, USA, and northern Baja California, Mexico. To address this uncertainty, we genotyped museum specimens and conducted phylogenetic and population genetic analyses of historical data in the context of 3 contemporary pronghorn populations. The historical northern Baja California pronghorn share the most ancestry with contemporary Peninsular pronghorn, whereas pronghorn in southern California share more ancestry with contemporary American (A. a. americana) pronghorn. For reintroductions into northern Baja California, the Peninsular subspecies is more appropriate based on museum genetic data. For reintroductions into Southern California, ecological and genetic factors are both important, as the subspecies most genetically related to historical populations (American) may not be well‐adapted to the hot, low‐elevation deserts of the reintroduction area. © 2019 The Wildlife Society. Extinct pronghorn populations in northern Baja California, Mexico, share ancestry with the contemporary Peninsular subspecies, justifying the release of captive bred endangered Peninsular pronghorn at sites in this area. Ancestry of extinct populations in southern California, USA, is less certain; therefore, ecological data and conservation goals should be prioritized in determining which subspecies to release into this area. [ABSTRACT FROM AUTHOR]

Purpose: Limited understanding of factors affecting uptake and outcomes of different cancer survivorship care models hampers implementation of best practices. We conducted a formative evaluation of stakeholder-perceived acceptability and feasibility of an embedded primary care provider (PCP) survivorship care model.Methods: We identified clinical, operational, and patient stakeholders within Kaiser Permanente Southern California and conducted semi-structured interviews. Analyses were guided by the Consolidated Framework for Implementation Research (CFIR), an integrated framework from the field of implementation science. Deductive thematic categories were derived a priori from CFIR domains; thematic sub-categories were developed inductively.Results: We interviewed 12 stakeholders; multiple themes were identified. Acceptability: oncologists and operational leaders perceived that the model was an acceptable solution to issues of capacity and efficiency with the potential to improve quality; however, several oncologists perceived negative consequences including "[loss of] the joy of medicine." Patients were less enthusiastic, fearing the introduction of "[someone] who doesn't know me." Feasibility: confidence was high that this model can succeed, although there was concern about finding the right PCP and investment in training and staff support. Culture/climate: numerous system-level facilitators were identified, including encouragement of innovation and familiarity with developing new models.Conclusions: Formative evaluation is a critical pre-implementation process. Acceptability and feasibility for this model were high among oncologists and operational leaders but patients were ambivalent. Keys to successful implementation include training and support of engaged PCPs and a patient transition plan introduced early in the care trajectory. [ABSTRACT FROM AUTHOR]

We measured HIV incidence rate, trend and risk factors in 564 HIV-negative young people (< 30 years) who inject drugs (PWID) in San Francisco between 2000 and 2014. HIV incidence was 0.93/100 person-years (PY; 95% CI 0.50, 1.73). Incidence varied between 0.62/100 PY in 2000-2002 and 1.06/100 PY in 2012-2014 (P for trend = 1.0). HIV incidence varied significantly (P < 0.01) by race/ethnicity: among Hispanics it was 8.19/100 PY (95% CI 3.41, 19.68), African-Americans 4.59/100 PY (95% CI 1.15, 18.37), and Whites 0.26/100 PY (95% CI 0.06, 1.03). Male participants who reported sex with men (MSM) had higher HIV incidence (2.63/100 PY; 95% CI 1.31, 5.25) compared to males who did not report MSM (0.50/100 PY; 95% CI 0.12, 1.99) (P = 0.01). Despite an overall stable HIV incidence trend, incidence was elevated among African-American and Hispanic PWID, and men who have sex with men. Addressing prevention needs in these key populations is critical for the goal of eliminating HIV transmission. [ABSTRACT FROM AUTHOR]

This study investigated the demographic and clinical predictors of psychiatric hospitalization during the first 2 years of treatment for adults participating in the full-service partnership (FSP) program, based on Assertive Community Treatment, in a large county in northern California. Clinical and demographic characteristics, data on prior hospitalizations, length of enrollment, and living situation for 328 FSP participants were collected from the county's internal billing system and the California Department of Health Care Services. In univariate models, the probability of hospitalization varied by diagnosis, age, and hospitalization history. In the multivariate model, younger age and frequent hospitalization prior to enrollment predicted hospitalization during enrollment. Findings support prior research on hospital recidivism and may be beneficial in refining future strategies for meeting the needs of adults with serious mental illness. [ABSTRACT FROM AUTHOR]

Background: Advanced imaging and serum biomarkers are commonly used for surveillance in patients with early-stage breast cancer, despite recommendations against this practice. Incentives to perform such low-value testing may be less prominent in integrated health care delivery systems. The purpose of the current study was to evaluate and compare the use of these services within 2 integrated systems: Kaiser Permanente (KP) and Intermountain Healthcare (IH). The authors also sought to distinguish the indication for testing: diagnostic purposes or routine surveillance.Methods: Patients with American Joint Committee on Cancer stage 0 to II breast cancer diagnosed between 2009 and 2010 were identified and the use of imaging and biomarker tests over an 18-month period were quantified, starting at 1 year after diagnosis. Chart abstraction was performed on a random sample of patients who received testing to identify the indication for testing. Multivariate regression was used to explore associations with the use of nonrecommended care.Results: A total of 6585 patients were identified; 22% had stage 0 disease, 44% had stage I disease, and 34% had stage II disease. Overall, 24% of patients received at least 1 imaging test (25% at KP vs 22% at IH; P = .009) and 28% of patients received at least 1 biomarker (36% at KP vs 13% at IH; P<.001). Chart abstraction revealed that 84% of imaging tests were performed to evaluate symptoms or signs. Virtually all biomarkers were ordered for routine surveillance. Stage of disease, medical center that provided the services, and provider experience were found to be significantly associated with the use of biomarkers.Conclusions: Advanced imaging was most often performed for appropriate indications, but biomarkers were used for nonrecommended surveillance. Distinguishing between inappropriate use for surveillance and appropriate diagnostic testing is essential when evaluating adherence to recommendations. [ABSTRACT FROM AUTHOR]

In-home mental health services for older adults will likely become increasingly utilized as the population ages. Little is known about older adults with serious mental illness who receive in-home services through the public mental health system. This study examined the demographic and clinical characteristics of this population. A total of 148 clients were included. Mood disorders were present in 75.7% and schizophrenia spectrum disorders were present in 23.6%. A history of problematic substance use was documented in 47.3% of clients and 31.8% reported suicidal ideation prior to enrollment. A total of 25% of clients utilized psychiatric emergency services during the year prior to enrollment and 15.5% of clients were hospitalized for psychiatric treatment. Older adults who receive in-home mental health services are vulnerable and have complex treatment needs. [ABSTRACT FROM AUTHOR]

Background: To decrease tuberculosis case rates and cases due to recent infection (clustered cases) in San Francisco, California, tuberculosis control measures were intensified beginning in 1991 by focusing on prevention of Mycobacterium tuberculosis transmission and on the use of preventive therapy.Objective: To describe trends in rates of tuberculosis cases and clustered cases in San Francisco from 1991 through 1997.Design: Population-based study.Setting: San Francisco, California.Patients: Persons with tuberculosis diagnosed between 1 January 1991 and 31 December 1997.Measurements: DNA fingerprinting was performed. During sequential 1-year intervals, changes in annual case rates per 100,000 persons for all cases, clustered cases (cases with M. tuberculosis isolates having identical fingerprint patterns), and cases in specific subgroups with high rates of clustering (persons born in the United States and HIV-infected persons) were examined.Results: Annual tuberculosis case rates peaked at 51.2 cases per 100,000 persons in 1992 and decreased significantly thereafter to 29.8 cases per 100,000 persons in 1997 (P < 0.001). The rate of clustered cases decreased significantly over time in the entire study sample (from 10.4 cases per 100,000 persons in 1991 to 3.8 cases per 100,000 persons in 1997 [P < 0.001]), in persons born in the United States (P < 0.001), and in HIV-infected persons (P = 0.003).Conclusions: The rates of tuberculosis cases and clustered tuberculosis cases decreased both overall and among persons in high-risk groups. This occurred in a period during which tuberculosis control measures were intensified. [ABSTRACT FROM AUTHOR]

The article focuses on a biochemical comparison between the suture configuration techniques Krackow locking stitch and the nonlocking whipstitch, which are both the most commonly used for ligament and tendon grafts and repair. Topics discussed include the methodology observed for the comparison and the benefits and limitations associated with both suture configuration techniques based on gap formation, tendon elongation and end width.

Aims: To test the value of phosphatidylethanol (PEth) as a biomarker for alcohol consumption among injecting drug users (IDUs). Methods: As part of a longitudinal study of young IDUs, dried blood spots and self-reported alcohol by structured interview were collected at baseline. We compared self-reported alcohol use to detectable PEth (≥8 ng/ml) in the blood spots as well as the relationships between quantitative PEth results and quantity measures of alcohol consumption. Results: There were strong associations between PEth and self-reported categorical measures of alcohol consumption (all P < 0.01). There was high specificity for reporting abstaining from alcohol; 94% of those who reported not consuming alcohol in the prior month tested negative for PEth. PEth was well correlated with measures of alcohol use (e.g. with reported number of days drinking in the prior month: Spearman r = 0.70 (P < 0.001)). Conclusions: The positive correlation of PEth with reported alcohol consumption suggests that PEth may be a useful marker in settings where alcohol consumption is difficult to assess, or to corroborate or invalidate self-reported measures of alcohol consumption. [ABSTRACT FROM AUTHOR]

Abstract: Due to altriciality and the importance of embodied capital, children's fitness is contingent on parental investment. Injury suffered by a parent therefore degrades the parent's fitness both by constraining reproduction and by diminishing the fitness of existing offspring. Due to the latter added cost, compared to non-parents, parents should be more cautious in hazardous situations, including potentially agonistic interactions. Prior research indicates that relative formidability is conceptualized in terms of size and strength. As erroneous under-estimation of a foe's formidability heightens the risk of injury, parents should therefore conceptualize a potential antagonist as larger, stronger, and of more sinister intent than should non-parents; secondarily, the presence of one's vulnerable children should exacerbate this pattern. We tested these predictions in the U.S. using reactions to an evocative vignette, administered via the Internet (Study 1), and in-person assessments of the facial photograph of a purported criminal, collected on the streets of Southern California (Study 2). As predicted, parents envisioned a potential antagonist to be more formidable than did non-parents. Significant differences between parents with children and non-parents without children in the threat that the foe was thought to pose (Study 1) were fully mediated by increases in estimated physical formidability. [Copyright &y& Elsevier]

Objective An increased frequency of atherosclerosis (ATH) in systemic lupus erythematosus (SLE) is well-documented but not fully explained by the presence of traditional cardiac risk factors. Several nontraditional biomarkers, including proinflammatory high-density lipoprotein (piHDL) and leptin, have been individually associated with subclinical ATH in SLE. The aim of this study was to examine whether these and other biomarkers can be combined into a risk profile, the Predictors of Risk for Elevated Flares, Damage Progression, and Increased Cardiovascular Disease in Patients with SLE (PREDICTS), that could be used to better predict future progression of ATH. Methods In total, 210 patients with SLE and 100 age-matched healthy control subjects (all women) participated in this prospective cohort study. The longitudinal presence of carotid plaque and intima-media thickness (IMT) were measured at baseline and followup (mean ± SD 29.6 ± 9.7 months). Results At followup, carotid plaque was present in 29% of SLE patients. Factors significantly associated with plaque, determined using Salford Predictive Modeling and multivariate analysis, included age ≥48 years (odds ratio [OR] 4.1, P = 0.002), high piHDL function (OR 9.1, P < 0.001), leptin levels ≥34 ng/dl (OR 7.3, P = 0.001), plasma soluble TWEAK levels ≥373 pg/ml (OR 28.8, P = 0.004), and history of diabetes (OR 61.8, P < 0.001). Homocysteine levels ≥12 μmoles/liter were also a predictor. However, no single variable demonstrated an ideal combination of good negative predictive values (NPVs), positive predictive values (PPVs), sensitivity, and specificity. A high-risk PREDICTS profile was defined as ≥3 positive biomarkers or ≥1 positive biomarker plus a history of diabetes; for high-risk SLE patients, the PPV was 64%, NPV was 94%, sensitivity was 89%, and specificity was 79%. In multivariate analysis, SLE patients with the high-risk profile had 28-fold increased odds for the longitudinal presence of plaque ( P < 0.001) and increased progression of IMT ( P < 0.001). Conclusion A high-risk PREDICTS score confers 28-fold increased odds of the presence of any current, progressive, or acquired carotid plaque, both in patients with SLE and in control subjects, and is significantly associated with higher rates of IMT progression. [ABSTRACT FROM AUTHOR]

Mothers who breastfeed typically exhibit lower levels of depressive symptomatology than mothers who do not. However, very few studies have investigated the directionality of this relationship. Of the prospective studies published, all but one focus exclusively on whether maternal depression reduces rates of subsequent breastfeeding. This study again examines this relationship, but also the reverse-that breastfeeding might predict lower levels of later depression. Using multilevel modeling, we investigated the relationship between breastfeeding and self-reported depressive symptomatology in 205 women followed prenatally and at 3, 6, 12, and 24 months after birth. Consistent with previous research, women with prenatal depressive symptomatology weaned their infants 2.3 months earlier, on average, than women without such symptomatology. We also found, however, that women who breastfed more frequently at 3 months postpartum showed greater subsequent declines in depressive symptomatology over time compared to women who breastfed less frequently, resulting in lower absolute levels of depressive symptoms by 24 months postpartum, controlling for important confounds. In sum, these findings are consistent with a bidirectional association between breastfeeding and depression, with prenatal depression predicting less breastfeeding soon after birth and breastfeeding predicting declines in maternal depression up to 2 years after birth. We discuss mechanisms that could potentially explain these associations and avenues for future research. [ABSTRACT FROM AUTHOR]

Objective. To evaluate the impact of comorbidities on achieving remission by examining changes in the clinical disease activity index (CDAI) in RA patients in the community-based Consortium of Rheumatology Researchers of North America (CORRONA) registry.Methods. A subcohort of 1548 RA subjects with varying disease duration met the following inclusion criteria: started a DMARD/biologic agent, continued therapy &geq;3 months, CDAI &geq;2.8 at study entry and followed longitudinally from baseline to follow-up (mean time 7.46 months). Patients reported comorbidities according to a standardized list of 33 conditions. Entry characteristics were compared across age categories using one-way analysis of variance. Linear and logistic regression models were constructed to assess characteristics [e.g. age, disease duration, number of previous DMARDs/biologics, baseline modified health assessment questionnaire (MHAQ), baseline CDAI and number of comorbidities] associated with primary outcomes: change in CDAI (baseline to follow-up) and CDAI remission (yes/no).Results. Although disease activity measures at entry were similar across age categories, older patients had more comorbidities, less improvement in CDAI/MHAQ and were less likely to attain remission at follow-up. However, after adjusting covariates an increasing number of patient-reported comorbidities and higher baseline CDAI (but not age) were consistently and independently associated with a lower likelihood of clinical improvement or remission (P < 0.001).Conclusion. In this observational cohort of community RA patients an increasing number of patients reported comorbidities, independently correlated with less CDAI improvement over time. These results reaffirm that comorbidities may be an important factor in consideration of treat-to-target recommendations and aid in understanding achievable RA therapeutic goals. [ABSTRACT FROM AUTHOR]

A retrospective observational study of 33 children hospitalized with coccidioidomycosis identified 31 with various pulmonary manifestations, 5 with osteomyelitis, and 2 with meningitis. Mediastinitis with purulence and abscessed/necrotic lymph nodes occurred in 21% of patients and resulted in longer hospitalizations.Background. Coccidioidomycosis, an endemic fungal infection seen throughout the southwestern United States, is not well described in children.Methods. We performed a retrospective observational study of all children admitted to Children's Hospital Central California with coccidioidomycosis from 1 January 2010 to 1 September 2011.Results. Thirty-three children, aged 6 months to 17 years, were hospitalized during the study period. These included patients with pneumonia (n = 28), pleural effusion (n = 13), pleural empyema (n = 4), lung abscess (n = 7), pericarditis (n = 2), osteomyelitis (n = 5), meningitis/cerebritis (n = 2), and vocal cord infection (n = 1). Mediastinitis, with radiographic evidence of purulence and necrotic/abscessed lymph nodes in the mediastinum, was present in 7 patients (21%) and tended to occur more often in younger children (median age, 3 years [range, 0.5–11 years] vs 7 years [range, 0.6–17 years] for non-mediastinitis patients; P = .10). Seven patients were admitted to the intensive care unit and 10 required surgical intervention. One patient died of meningitis. Hospitalizations were longer for patients with mediastinitis (median, 130 days [range, 58–200 days] vs 43 days [range, 3–273 days for non-mediastinitis patients]; P < .01) and those with maximum coccidioidal complement fixing antibody titers ≥1:128 (median, 174 days [range, 53–273 days] vs 33 days [range, 3–200 days] for those with maximum titers <1:128; P < .01).Conclusions. Coccidioidomycosis causes a substantial disease burden in the children of central California. Mediastinitis is common and tends to occur in younger children. Patients with mediastinitis or elevated coccidioidal complement fixation titers require longer hospitalizations. Further research is needed on the prevention and treatment of this disease. [ABSTRACT FROM AUTHOR]

The diet of the feral domestic cat consists of primarily birds and small mammals, but the nutritional composition is relatively unknown. Because of the increasing popularity of natural diets for cats and other wild captive carnivores, the purpose of this study was to describe the body composition and AA concentrations of select birds and small mammals in northern and central California: wild-caught mice (n = 7), Norway rats (n = 2), roof rats (n = 2), voles (n = 4), moles (n = 2), gophers (n = 3), and birds (n = 4). Body water, crude fat (CFa), CP, ash, and AA composition for each specimen were determined. Results are reported as mean ± SD. All results are reported on a DM basis except body water (as-is basis) and AA (g/16 g N). Combined, carcasses had this mean composition: 67.35 ± 3.19% water, 11.72 ± 6.17% CFa, 62.19 ± 7.28% CP, and 14.83 ± 2.66% ash. Concentrations of Arg, Tau, Cys, and Met were 5.63 ± 0.46, 0.92 ± 0.33, 1.91 ± 0.89, and 1.82 ± 0.19 g/16 g N, respectively. Using NRC physiologic fuel values for CP, CFa, and carbohydrate by difference, the combined average energy content of the carcasses was 3,929 kcal/kg DM, but the fiber content was not determined. With the exception of mice and rats, little historical data exist regarding the body and AA composition of many of the species analyzed in this study. Wild-caught mice and rats were composed of less fat but more ash compared with previously reported data in their puipose-bred counterparts. The CP content of mice in this study was similar to previous reports in puipose-bred mice. The CP content of rats was similar or slightly greater compared with historical findings in purpose-bred rats. The N content of rats and AA concentrations on a per-N basis for both rats and mice were similar to previously published data on purpose-bred rodents. The discrepancies in nutrient composition, especially fat concentration, indicate that using purpose-bred animals to represent the diet of the feral domestic cat may not be valid in many instances. When consumed to meet energy needs, the nutrient content of the species reported in the present study exceed the NRC (2006) recommended allowances (RA) for total fat, CP, and essential AA for felines at all life stages. [ABSTRACT FROM AUTHOR]

Background: There are several indications that malfunctions of the circadian clock contribute to depression. To search for particular circadian gene polymorphisms associated with depression, diverse polymorphisms were genotyped in two samples covering a range of depressed volunteers and participants with normal mood. Methods: Depression mood self-ratings and DNA were collected independently from a sample of patients presenting to a sleep disorders center (1086 of European origin) and from a separate sample consisting of 399 participants claiming delayed sleep phase symptoms and 406 partly-matched controls. A custom Illumina Golden Gate array of 768 selected single nucleotide polymorphisms (SNPs) was assayed in both samples, supplemented by additional SNPlex and Taqman assays, including assay of 41 ancestry-associated markers (AIMs) to control stratification. Results: In the Sleep Clinic sample, these assays yielded Bonferroni-significant association with depressed mood in three linked SNPs of the gene FMR1: rs25702 (nominal P=1.77E-05), rs25714 (P=1.83E-05), and rs28900 (P=5.24E-05). This FMR1 association was supported by 8 SNPs with nominal significance and a nominally-significant gene-wise set test. There was no association of depressed mood with FMR1 in the delayed sleep phase case-control sample or in downloaded GWAS data from the GenRED 2 sample contrasting an early-onset recurrent depression sample with controls. No replication was located in other GWAS studies of depression. Our data did weakly replicate a previously-reported association of depression with PPARGC1B rs7732671 (P=0.0235). Suggestive associations not meeting strict criteria for multiple testing and replication were found with GSK3B, NPAS2, RORA, PER3, CRY1, MTNR1A and NR1D1. Notably, 16 SNPs nominally associated with depressed mood (14 in GSK3B) were also nominally associated with delayed sleep phase syndrome (P=3E10-6). Conclusions: Considering the inconsistencies between samples and the likelihood that the significant three FMR1 SNPs might be linked to complex polymorphisms more functionally related to depression, large gene resequencing studies may be needed to clarify the import for depression of these circadian genes. [ABSTRACT FROM AUTHOR]

Background Up to 17 000 persons in the USA became infected with hepatitis C virus (HCV) in 2007, and many cases have unknown transmission routes. To date research on transmission of HCV via shared implements used to snort or smoke non-injection drugs has been inconclusive. Methods We tested stored sera for HCV antibodies (anti-HCV) in a large population-based study of homeless and marginally housed persons in San Francisco. We examined the association between sharing implements used for snorting and smoking drugs and anti-HCV while controlling for sociodemographic variables in those who denied everinjecting drugs (n = 430). We also examined the association of anti-HCV status with history of incarceration, tattoo and piercing history, sexual history and alcohol consumption. Results Seventeen percent of our sample was anti-HCV positive. We found no statistically significant associations with sharing implements used to smoke or snort drugs with anti-HCV status in our various multivariate models. There was a statistically significant negative association between ever snorting cocaine and anti-HCV status (adjusted odds ratio: 0.39; 95% confidence interval: 0.21–0.73). There were no other statistically significant associations with any other measured covariates in multivariate analyses. Conclusions Our findings suggest that sharing implements to snort or smoke drugs is not a significant risk factor for anti-HCV-positive status. [ABSTRACT FROM PUBLISHER]

This study examined associations between mortality and demographic and risk characteristics among young injection drug users in San Francisco, California, and compared the mortality rate with that of the population. A total of 644 young (<30 years) injection drug users completed a baseline interview and were enrolled in a prospective cohort study, known as the UFO (“U Find Out”) Study, from November 1997 to December 2007. Using the National Death Index, the authors identified 38 deaths over 4,167 person-years of follow-up, yielding a mortality rate of 9.1 (95% confidence interval: 6.6, 12.5) per 1,000 person-years. This mortality rate was 10 times that of the general population. The leading causes of death were overdose (57.9%), self-inflicted injury (13.2%), trauma/accidents (10.5%), and injection drug user-related medical conditions (13.1%). Mortality incidence was significantly higher among those who reported injecting heroin most days in the past month (adjusted hazard ratio = 5.8, 95% confidence interval: 1.4, 24.3). The leading cause of death in this group was overdose, and primary use of heroin was the only significant risk factor for death observed in the study. These findings highlight the continued need for public health interventions that address the risk of overdose in this population in order to reduce premature deaths. [ABSTRACT FROM PUBLISHER]

Objective Systemic sclerosis (SSc) is characterized by calcification, vasculopathy, and endothelial wall damage, all of which can increase the risk of developing atherosclerosis and cardiovascular disease. The aim of this study was to perform a systematic review and meta-analysis to determine whether the risk of atherosclerosis is increased in SSc patients compared to healthy individuals. Methods A systematic search was performed to identify studies published in PubMed and the Cochrane database up to May 2010, and recently published abstracts were also reviewed. Two reviewers independently screened articles to identify studies comparing the rate of atherosclerosis in SSc patients to that in healthy controls. The studies utilized one of the following methods: angiography, Doppler ultrasound to assess plaque and carotid intima-media thickness (IMT), computed tomography, magnetic resonance imaging, flow-mediated vasodilation (assessed as the FMD%), the ankle-brachial index, or autopsy. For carotid IMT and FMD% values, we computed a pooled estimate of the summary mean difference and explored predictors of carotid IMT using random-effects meta-regression. Results Of the 3,156 articles initially identified, 31 were selected for systematic review. The meta-analysis included 14 studies assessing carotid IMT and 7 assessing brachial artery FMD%. Compared to healthy controls, SSc patients had a higher prevalence of coronary atherosclerosis, peripheral vascular disease, and cerebrovascular calcification. Meta-analysis showed that SSc patients had increased carotid IMT (summary mean difference 0.11 mm, 95% confidence interval [95% CI] 0.05 mm, 0.17 mm; P = 0.0006) and lower FMD% (summary mean difference −3.07%, 95% CI −5.44%, −0.69%; P = 0.01) compared to controls. There was marked heterogeneity between the studies, which was mainly attributable to variations in disease duration and differences in the mean/median age between SSc patients and controls. Conclusion Patients with SSc have an increased risk of atherosclerosis compared to healthy subjects. Further studies should elucidate the mechanism of this increased risk. [ABSTRACT FROM AUTHOR]

The article discusses the presentation of collection of archival materials at the University of California, Los Angeles (UCLA) Library in California. The archival collections feature costumes from costume designers from theater, dance and film productions of the film and television industries and popular culture. The UCLA Library focus on building and making special collections in the performing arts that include works of costume designers Peggy Hamilton Adams, Hugo Ballin and Rudi Gernreich.

Aims Young injection drug users (IDU) are at high risk for hepatitis C virus (HCV). We sought to determine whether perceiving one's injecting partner to be HCV positive was associated with decreased odds of engaging in receptive needle/syringe sharing (RNS) or ancillary equipment sharing (AES) with that partner. Design Cross sectional study. Setting 2003 to 2007 in San Francisco. Participants 212 young (under age 30) IDU who were HCV antibody negative reported on 492 injecting partnerships. Measurements Self-reported RNS and AES within injecting partnerships. Findings RNS and AES (in the absence of RNS) occurred in 23% and 64% of injecting partnerships in the prior month. The odds of engaging in RNS were significantly lower for relationships in which the participant reported that his/her partner was HCV positive (odds ratio [OR] 0.49; 95% confidence interval [CI] 0.25–0.95). This association was attenuated when adjusted for reusing one's own needle/syringe (adjusted OR 0.57; 95% CI 0.28–1.15). The odds of engaging in AES were lower for participants who did not know the HCV status of their partner, only among non-sexual partnerships (OR 0.47; 95% CI 0.29–0.76). Conclusions Because perceiving one's partner to be HCV positive was associated with decreased RNS, increased HCV testing and partner disclosure may be warranted. AES was common and was decreased only among non-sexual partnerships in which the HCV status of the partner was not known. This suggests that interventions to reduce AES in young IDU must be widespread. [ABSTRACT FROM AUTHOR]

Objectives. To determine the association between multiple drug use and nonfatal overdose among young people (younger than 30 years) who inject drugs. Methods. We completed a longitudinal study of 173 injection drug users younger than 30 years living in San Francisco, California, between April 2012 and February 2014. Results. The odds of nonfatal overdose increased significantly as heroin and benzodiazepine pill-taking days increased and when alcohol consumption exceeded 10 drinks per day compared with 0 drinks per day. Conclusions. Heroin, benzodiazepine, and alcohol use were independently associated with nonfatal overdose over time among young people who inject drugs. Efforts to address multiple central nervous system depressant use remain an important component of a comprehensive approach to overdose, particularly among young people. [ABSTRACT FROM AUTHOR]

Aims. To describe temporal trends in methamphetamine use among young injection drug users (IDU) in San Francisco. Design and Methods. Secondary analysis of cross-sectional baseline data collected for a longitudinal study of young IDU from 1998 to 2004. Participants were 1445 young IDU (<30 years old) who reported injection in the previous month, English-speaking, and recruited by street outreach methods. We examined trends for: lifetime (ever) and recent (30-day) methamphetamine use, including injected and non-injected, and by age group and sexual risk behaviour [men who have sex with men injecting drug users (MSM-IDU), male IDU (non-MSM) and female IDU]. Results. In 1998, 1999, 2000, 2001, 2003 and 2004 we interviewed 237, 276, 431, 310, 147 and 44 participants, respectively. Overall, median age was 22 years [interquartile range (IQR) 20 - 25], 30.3% were women and median duration of injecting was 4.4 years (IQR 2 - 7). Prevalence of methamphetamine use was high, with 50.1% reporting recent injection, but overall there were no temporal increases in reported 'ever' injected use. Recent methamphetamine injection (past 30 days) increased significantly, and peaked at 60% in 2003. MSM-IDU had higher methamphetamine injection ever (92.3%) and recently (59.5%) compared to heterosexual male (non-MSM) IDU (81.6% and 47.3%, respectively) and to female IDU (78.4% and 46.1%, respectively). Conclusions. Despite reports of ubiquitous increases in methamphetamine use, there were no significant increases in 6 years in ever injecting methamphetamine overall among young IDU. MSM-IDU who reported the highest methamphetamine use overall reported some increases in recent injected use. The methamphetamine 'epidemic' was probably under way among young IDU earlier than other populations. [Inglez-Dias A, Hahn JA, Lum PJ, Evans J, Davidson P, Page-Shafer K. Trends in methamphetamine use in young injection drug users in San Francisco from 1998 to 2004: the UFO Study. Drug Alcohol Rev 2008;27:286-291] [ABSTRACT FROM AUTHOR]

Background: Most studies that have identified variables associated with the health-related quality of life (HRQL) of patients with colorectal cancer have been cross-sectional or included patients with other diagnoses. The objectives of this study were to identify predictors of HRQL in patients with colorectal cancer and interpret the clinical importance of the results. Methods: We conducted a population-based longitudinal study of patients identified through three regions of the California Cancer Registry. Surveys were completed by 568 patients approximately 9 and 19 months post-diagnosis. Three HRQL outcomes from the Functional Assessment of Cancer Therapy - Colorectal (FACT-C) were evaluated: social/family well-being (SWB), emotional well-being (EWB) and the Trial Outcome Index (TOI), which is a colorectal cancer-specific summary measure of physical function and well-being. Sociodemographic, cancer/health, and healthcare variables were assessed in multivariable regression models. We computed the difference in predicted HRQL scores corresponding to a large difference in a predictor variable, defined as a 1 standard deviation difference for interval variables or the difference relative to the reference category for nominal variables. The effect of an explanatory variable on HRQL was considered clinically meaningful if the predicted score difference was at least as large as the minimally important difference. Results: Common predictors of better TOI, SWB and EWB were better general health and factors related to better perceived quality of cancer care. Predictor variables in addition to general health and perceived quality of care were identified only for SWB. Being married/living as married was associated with better SWB, whereas being male or of Hispanic ethnicity was associated with worse SWB. Among the sociodemographic, cancer/health, and healthcare variables evaluated, only Hispanic ethnicity had a clinically meaningful effect on an HRQL outcome. Conclusion: Our findings, particularly the information on the clinical importance of predictor variables, can help clinicians identify patients who may be at risk for poor future HRQL. Potentially modifiable factors were related to perceived quality of cancer care; thus, future research should evaluate whether improving these factors improves HRQL. [ABSTRACT FROM AUTHOR]

Background : We describe incarceration history (jail or prison) among a community‐based sample of young injection drug users (IDU) (age Methods : Cross‐sectional baseline data from study of street‐recruited young IDU in San Francisco were analyzed. Results : In a sample of 839 young IDU, median age was 22 years, 70% were male, 86% had a lifetime history of incarceration, and 56% had been incarcerated in the prior year. Serologic markers of HBV and HCV infections were significantly higher among those with any history of incarceration (29% and 42% respectively) compared with those with no incarceration history. Variables independently associated with recent incarceration were gender (male), homelessness, increased years of injecting, and a history of having ever borrowed previously used needles for injecting. Variables independently associated with any lifetime history of incarceration included: gender (males), educational level, homelessness, increased years of injecting, and anti‐HCV status. Conclusions : Interventions to increase geographic and social stability, such as safe transitional housing, and clean and safe injecting spaces, may also contribute greatly to reducing both incarceration and bloodborne infection in this young high‐risk population. [ABSTRACT FROM AUTHOR]

Background: Homelessness is associated with high rates of health and substance use problems.Objective: To examine trends in the age, housing, health status, health service utilization, and drug use of the homeless population over a 14-year period.Design: Serial cross-sectional.Participants: We studied 3,534 literally homeless adults recruited at service providers in San Francisco in 4 waves: 1990-1994, 1996-1998, 1999-2000, and 2003.Measurements: Age, time homeless, self-reported chronic conditions, hospital and emergency department utilization, and drug and alcohol use.Results: The median age of the homeless increased from 37 to 46 over the study waves, at a rate of 0.66 years per calendar year (P<.01). The median total time homeless increased from 12 to 39.5 months (P<.01). Emergency department visits, hospital admissions, and chronic health conditions increased.Conclusions: The homeless population is aging by about two thirds of a year every calendar year, consistent with trends in several other cities. It is likely that the homeless are static, aging population cohort. The aging trends suggest that chronic conditions will become increasingly prominent for homeless health services. This will present challenges to traditional approaches to screening, prevention, and treatment of chronic diseases in an aging homeless population. [ABSTRACT FROM AUTHOR]

Estimates the HIV seroconversion rate among the homeless and marginally housed in San Francisco, California. Epidemiology; Person-time incidence rates of HIV infection and hazard ratios; Analysis of confidence intervals.

Background. We examined adherence to highly active antiretroviral therapy (HAART) in the homeless population, a population thought to be at high risk for poor adherence to therapy and for development of drug- resistant strains of human immunodeficiency virus (HIV). Methods. We performed a 12-month prospective study of 148 persons receiving HAART who were identified in a stratified screening of the homeless and marginally housed. We sampled in lunch lines, shelters, and hotels in 3 neighborhoods of San Francisco, California. We used pill counts at unannounced home visits as the primary measure of adherence. Results. Of 148 individuals sampled, 46 (3 1%) discontinued HAART during the study. Average adherence in the group of those who discontinued HAART was 51%, and 9% of these subjects had undetectable virus loads (i.e., <400 copies/mL) at the last follow-up visit. Predictors of discontinuation of therapy were depressive symptoms, injection drug use, African American ethnicity, and early poor adherence. Of 148 subjects, 102 (69%) continued to receive HAART throughout the study period. Average adherence in the group of those who continued to receive HAART was 74%, and 55% of these subjects had undetectable virus loads at the last follow-up visit. Predictors of lower average adherence in this group were African American ethnicity and use of crack cocaine; men who had sex with men had higher adherence. Conclusions. One-third of homeless and marginally housed persons receiving HAART discontinued therapy during the follow-up period and would benefit from adherence interventions directed at sustaining therapy', two- thirds continued to receive therapy at adherence levels comparable to those found with other clinical populations. [ABSTRACT FROM AUTHOR]

Objective: To measure Hepatitis C Virus (HCV) prevalence, incidence, and initiation of HCV therapy in a representative HIV-infected cohort of the urban poor.Design: Cohort analysis.Setting: The Research and Access to Care for the Homeless (REACH) Cohort is a systematic sample of HIV-infected marginally housed individuals identified from single-room occupancy hotels, homeless shelters, and free lunch programs in San Francisco.Participants: Two hundred forty-nine participants with 28.9 months (median) of follow-up were studied. Mean age was 44 (range 24 to 75, standard deviation 8.4) years. Eighty-two percent were male, 43% were African-American, 64% were lifetime injection drug users, and 24% had been on the street or in a shelter in the prior month.Interventions: We measured HCV testing and treatment history with structured interviews; additionally, participants were tested for HCV antibodies (EIA-2) with RNA viral load confirmation.Main Results: At baseline, 172 (69.1%) were HCV-positive and 182 (73.1%) were HCV-positive at follow-up, including 155 (62.2%) with viremia. HCV-positive status was associated with having injected drugs, elevated serum alanine aminotransferase, homelessness in the last 1 year, and more severe depressive symptoms. The incidence of new HCV infection was 4.63% per person-year (ppy; 95% confidence interval, 2.31 to 8.13) in the entire cohort and 16.77% ppy among injection drug users. The prevalence of HCV antibody-negative HCV-viremia was 13.2% (10/76). Nonwhites were less likely to receive HCV testing and subspecialty referral, controlled for drug use and other confounders. Sixty-eight percent (123/182) were aware treatment was available; however, only 3.8% (7/182) or 1.16% ppy received HCV treatment.Conclusions: While HCV infection is common, HCV treatment is rare in the HIV-HCV coinfected urban poor. Urban poor, nonwhite individuals are less likely to receive HCV testing and subspecialty referral than their white counterparts. Antibody-negative infection may complicate screening and diagnosis in HIV-infected persons. J [ABSTRACT FROM AUTHOR]

Presents a case study on key issues and design details for challenging, extreme HP/HT wells in California. Equipment/perforating limitations; Qualification tests; tubular stress and loading analyses; High-density completion-brine usage; Actual field operational experiences; Production casing selection; General completion and testing philosophy.

The article presents a study which examined factors associated with hepatitis B virus (HBV) vaccine completion and observed postvaccination antibody responses in completers. The study combined cash incentives and street outreach with flexible immunization schedules to improve HBV vaccine completion among young injection drug users in San Francisco, California. The participants who have completed their HBV immunization were more likely to have lived in San Francisco for three or more months to have received prior HIV testing and to have anti-hepatitis C virus positive test results.

Assesses the prevalence of HIV infection and associated risk behaviors among street-recruited young injection drug users in San Francisco, California. Factors independently associated with HIV infection in males; Use of multiple logistic regression model; Social demographic characteristics.

Recounts the activities of the History of Science Dinner Club at the University of California, Berkeley, California. Agenda for the meetings; Speakers that attended; Alterations made on its practices.

Acknowledges the contributions of Walter David Knight, a physicist from Berkeley, California. Investigations on electronics and magnets; Influence on the nuclear magnetic resonance; Impact of his work on metal cluster physics and other scientific disciplines.

Presents the results of a study which examined the use of the San Francisco needle exchange program (NEP), by injection drug users (IDUs) recruited in methadone maintenance and out-patient detoxification programs. Percentage of IDUs who had ever used the NEP; Classes of IDUs who were more likely to use the NEP.

Indicates how science and social science can be combined to assess the range and effectiveness of policy alternatives available to environmental decision-makers. Cost-effective regulatory alternatives to the Los Angeles, California particulate sulfate problem; Application of both sciences to the relationship of emissions to pollution levels and environmental quality; Rejection of notion that a simple reduction in emissions leads to a commensurate reduction in pollution levels; Problem of applying licenses and emissions.

The appeal of using markets as a means of allocating scarce resources stems in large part from the assumption that a market will approximate the competitive ideal. When competition is not a foregone conclusion, the question naturally arises as to how a firm might manipulate the market to its own advantage. This paper analyzes the issue of market power in the context of markets for transferable property rights. First, a model is developed that explains how a single firm with market power might exercise its influence. This is followed by an examination of the model in the context of a particular policy problem--the control of particulate sulfates in the Los Angeles region. [ABSTRACT FROM AUTHOR]