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Background The US Supreme Court's 2022 ruling in Dobbs v Jackson Women's Health Organization overturned Roe v Wade, allowing individual states to determine abortion restrictions, significantly impacting graduate medical education (GME). While focus has been on states enacting restrictions, the impacts in states where abortion rights are safeguarded are equally important. Emergency medicine (EM) serves as a safety net within the health care system, making it ideal for understanding the broader implications of these legal changes on GME. Objective To explore the experiences and perspectives of EM residents regarding changing abortion legislation in California, an abortion-protective state. Methods We conducted a qualitative study using transcendental phenomenology. Thirteen postgraduate year 4 EM residents from a single large university-based program in California participated in semistructured interviews in 2023. Data were analyzed using thematic analysis. Results Four themes were identified: (1) impact of changing abortion legislation on practice; (2) personal and professional decisions influenced by legislation; (3) navigating legal uncertainties in practice; and (4) advocacy and engagement beyond clinical practice. Residents reported varying levels of awareness and concern about the implications of abortion laws on EM practice, the influence of these laws on their career decisions, the need for legal guidance, and a commitment to advocacy. These themes highlight a complex interplay between legal changes, personal values, and professional responsibilities. Conclusions This study highlights the significant impact of the Dobbs decision on EM residents in California, revealing that residents face unique ethical, legal, and advocacy challenges that may affect their professional identity formation. [ABSTRACT FROM AUTHOR]

In the US, racial disparities in hospital outcomes are well documented. We explored whether race was associated with all-cause in-hospital mortality and intensive care unit (ICU) admission among COVID-19 patients in California. This was a retrospective analysis of California State Inpatient Database during 2020. Hospitalizations ≥ 18 years of age for COVID-19 were included. Cox proportional hazards with mixed effects were used for associations between race and in-hospital mortality. Logistic regression was used for the association between race and ICU admission. Among 87,934 COVID-19 hospitalizations, majority were Hispanics (56.5%), followed by White (27.3%), Asian, Pacific Islander, Native American (9.9%), and Black (6.3%). Cox regression showed higher mortality risk among Hispanics, compared to Whites (hazard ratio, 0.91; 95% CI 0.87–0.96), Blacks (hazard ratio, 0.87; 95% CI 0.79–0.94), and Asian, Pacific Islander, Native American (hazard ratio, 0.89; 95% CI 0.83–0.95). Logistic regression showed that the odds of ICU admission were significantly higher among Hispanics, compared to Whites (OR, 1.70; 95% CI 1.67–1.74), Blacks (OR, 1.70; 95% CI 1.64–1.78), and Asian, Pacific Islander, Native American (OR, 1.82; 95% CI 1.76–1.89). We found significant disparities in mortality among COVID-19 hospitalizations in California. Hispanics were the worst affected with the highest mortality and ICU admission rates. [ABSTRACT FROM AUTHOR]

Using data from the 2008 University of California Undergraduate Experience Survey, we show that study time and academic conscientiousness were lower among students in humanities and social science majors than among students in science and engineering majors. Analytical and critical thinking experiences were no more evident among humanities and social sciences majors than among science and engineering majors. All three academically beneficial experiences were, however, strongly related to participation in class and interaction with instructors, and participation was more common among humanities and social sciences students than among science and engineering students. Bok's ("Our underachieving colleges: A candid look at how much students learn and why they should be learning more". Princeton and Oxford: Princeton University Press, "2006") influential discussion of "underachievement" in undergraduate education focused on institutional performance. Our findings indicate that future discussions should take into account differences among disciplinary categories and majors as well.

Medical schools have reduced the time allotted to anatomy instruction. Consequently, schools engage students in more independent settings using information and communication technologies (ICT). There has been limited research in the use of video aids, a type of ICT, to enhance anatomy examination performance. The objective of this study is to describe the design, usage, and effect on examination performance of eight locally developed instructional anatomy videos. First-year UCSF medical students (n = 141) had access to the videos. They reported their video usage, reason for usage, and satisfaction. The prior year students (n = 141) served as a historical control group. Anatomy and radiology examination performance was compared between groups while controlling for prior performance. The students with and without access to the videos did not differ in examination performance. Sixty-one (43%) students in the experimental group responded to the survey. Of these, 79% reported using at least one video, viewing an average of 4.75 of the eight videos. They watched 3.27 (SD = 1.57, range 1-5) of the five anatomy videos and 1.48 (SD = 1.35; range 0-3) of the three radiology videos. In a regression analysis controlling for age and MCAT scores, using the anatomy videos at least once improved anatomy examination performance by 3.4% (P-value = 0.007). There was no relationship between radiology video usage and radiology exam score. Video resource availability did not enhance student performance in anatomy and radiology. However, when analyzing performance for those whom we knew level of video use, there was a statistically different and higher anatomy achievement. (Contains 5 tables and 1 figure.)

Simple Summary: All fields of healthcare were adversely affected by the COVID-19 pandemic. In this study, we sought to understand the effects of COVID-19 on hospitalizations for intracranial meningioma resection using a large database. We compared hospitalization rates as well as hospital outcomes such as Clavien–Dindo grade IV complications, in-hospital mortality, and prolonged length of stay for intracranial meningioma resection during 2019 and 2020. Our findings showed that though hospitalization rates decreased slightly during the COVID-19 pandemic, hospital outcomes were not adversely affected. The findings of our study show that with adequate planning and preparations, better hospital outcomes could be sustained even during healthcare emergencies such as COVID-19 pandemic. Our findings assure that neurosurgery practice in the US ensured the best quality of care to their patients even during COVID-19 pandemic. Purpose: To assess the effects of COVID-19 on hospitalizations for intracranial meningioma resection using a large database. Methods: We conducted a retrospective analysis of the California State Inpatient Database (SID) 2019 and 2020. All adult (18 years or older) hospitalizations were included for the analysis. The primary outcomes were trends in hospitalization for intracranial meningioma resection between 2019 and 2020. Secondary outcomes were Clavien–Dindo grade IV complications, in-hospital mortality, and prolonged length of stay, which was defined as length of stay ≥75 percentile. Results: There were 3,173,333 and 2,866,161 hospitalizations in 2019 and 2020, respectively (relative decrease, 9.7%), of which 921 and 788 underwent intracranial meningioma resection (relative decrease, 14.4%). In 2020, there were 94,114 admissions for COVID-19 treatment. Logistic regression analysis showed that year in which intracranial meningioma resection was performed did not show significant association with Clavien–Dindo grade IV complications and in-hospital mortality (OR, 1.23, 95% CI: 0.78–1.94) and prolonged length of stay (OR, 1.05, 95% CI: 0.84–1.32). Conclusion: Our findings show that neurosurgery practice in the US successfully adapted to the unforeseen challenges posed by COVD-19 and ensured the best quality of care to the patients. [ABSTRACT FROM AUTHOR]

The binding of influenza hemagglutinin (HA) to sialic acid (SA) receptors plays a well-defined role in shaping infection but the impact of such binding on vaccine responses has not yet been explored. We generated a virus-like particle (VLP) vaccine bearing the HA of H1N1 A/California/07/09 that is unable to bind to its α(2,6)-linked SA receptor (H1Y98F-VLP) and compared its immunogenicity and efficacy to a wild-type H1-VLP (H1WT-VLP) in mice. The H1Y98F-VLP elicited significantly stronger and more durable antibody responses (hemagglutination inhibition and microneutralization titers) and greater avidity maturation, likely attributable to improved germinal center formation. H1Y98F-VLP also resulted in a robust population of IL-2+TNFα+IFNγ− CD4+ T cells that correlated with antibody responses. Compared to H1WT-VLP vaccination, mice immunized with H1Y98F-VLP had 2.3-log lower lung viral loads and significantly lower pulmonary inflammatory cytokine levels 5 days post-challenge. These findings suggest that abrogation of HA-SA interactions may be a promising strategy to improve the quality and durability of influenza vaccine-induced humoral responses. [ABSTRACT FROM AUTHOR]

Background: Obesity, race/ethnicity, and other correlated characteristics have emerged as high-profile risk factors for adverse coronavirus disease 2019 (COVID-19)-associated outcomes, yet studies have not adequately disentangled their effects.Objective: To determine the adjusted effect of body mass index (BMI), associated comorbidities, time, neighborhood-level sociodemographic factors, and other factors on risk for death due to COVID-19.Design: Retrospective cohort study.Setting: Kaiser Permanente Southern California, a large integrated health care organization.Patients: Kaiser Permanente Southern California members diagnosed with COVID-19 from 13 February to 2 May 2020.Measurements: Multivariable Poisson regression estimated the adjusted effect of BMI and other factors on risk for death at 21 days; models were also stratified by age and sex.Results: Among 6916 patients with COVID-19, there was a J-shaped association between BMI and risk for death, even after adjustment for obesity-related comorbidities. Compared with patients with a BMI of 18.5 to 24 kg/m2, those with BMIs of 40 to 44 kg/m2 and greater than 45 kg/m2 had relative risks of 2.68 (95% CI, 1.43 to 5.04) and 4.18 (CI, 2.12 to 8.26), respectively. This risk was most striking among those aged 60 years or younger and men. Increased risk for death associated with Black or Latino race/ethnicity or other sociodemographic characteristics was not detected.Limitation: Deaths occurring outside a health care setting and not captured in membership files may have been missed.Conclusion: Obesity plays a profound role in risk for death from COVID-19, particularly in male patients and younger populations. Our capitated system with more equalized health care access may explain the absence of effect of racial/ethnic and socioeconomic disparities on death. Our data highlight the leading role of severe obesity over correlated risk factors, providing a target for early intervention.Primary Funding Source: Roche-Genentech. [ABSTRACT FROM AUTHOR]

In order to evaluate mortality predictions based on boosted trees, this retrospective study uses electronic medical record data from three academic health centers for inpatients 18 years or older with at least one observation of each vital sign. Predictions were made 12, 24, and 48 hours before death. Models fit to training data from each institution were evaluated using hold-out test data from the same institution, and from the other institutions. Gradient-boosted trees (GBT) were compared to regularized logistic regression (LR) predictions, support vector machine (SVM) predictions, quick Sepsis-Related Organ Failure Assessment (qSOFA), and Modified Early Warning Score (MEWS) using area under the receiver operating characteristic curve (AUROC). For training and testing GBT on data from the same institution, the average AUROCs were 0.96, 0.95, and 0.94 across institutional test sets for 12-, 24-, and 48-hour predictions, respectively. When trained and tested on data from different hospitals, GBT AUROCs achieved up to 0.98, 0.96, and 0.96, for 12-, 24-, and 48-hour predictions, respectively. Average AUROC for 48-hour predictions for LR, SVM, MEWS, and qSOFA were 0.85, 0.79, 0.86 and 0.82, respectively. GBT predictions may help identify patients who would benefit from increased clinical care. [ABSTRACT FROM AUTHOR]

The article discusses the study that determined the role played by incentives in the promotion of HIV testing among parolees in community aftercare. Topics discussed include HIV testing received by larger proportion of those in the incentive group, based on bivariate comparisons, and multivariate logistic regression model to control covariates likely to influence HIV-testing behavior showed increased likelihood of HIV testing for those in the incentive group.

To determine if asthma control was more difficult to achieve in obese versus non-obese asthmatic children, retrospective analysis was performed on obese and non-obese Los Angeles inner-city children (2 to 18 years of age) with persistent asthma. No difference in time required to achieve control of asthma, ability to maintain control of asthma, baseline pulmonary functions, and number of controllers prescribed was found between the two groups. We conclude that in a Los Angeles inner-city pediatric population, obesity is not a factor in the ability to control asthma. [ABSTRACT FROM AUTHOR]

BACKGROUND: Mandated HCV 2.0 lookback significantly challenged the human and financial resources available to the six Los Angeles County Department of Health Services (DHS) hospital blood banks. To comply with FDA requirements, DHS developed a centralized process that utilized the services of a contract vendor for performing HCV lookback. STUDY DESIGN AND METHOD: A DHS public health nurse acted as HCV lookback coordinator and as liaison with the vendor. Cases were electronically forwarded to the vendor, who then reviewed the patient's chart to obtain information necessary for tracking the patient through commercial databases. The vendor was responsible for notifying the recipient for pretest counseling and for providing documentation of all efforts. RESULTS: In total, 411 recipients were identified, of which, 168 cases were completed by the hospitals, 243 were forwarded to the vendor, 50 percent were deceased, 21 percent were contacted, and 28 percent could not be contacted, and 1 percent could not be located on any databases. The vendor contacted 35 of 66 cases that the hospitals had unsuccessfully attempted to contact. Of the cases forwarded to the vendor, 82 percent were completed on time. Delays were attributable to the vendor in less than 2 percent of cases. The cost per case forwarded to the vendor was $322. CONCLUSION: Utilizing a professional service to conduct HCV recipient notifications is an effective strategy for meeting FDA deadlines and for freeing transfusion service staff to perform critical functions. It remains to be seen whether such strategies offer a cost savings. [ABSTRACT FROM AUTHOR]

Objectives: Many epidemiological studies have shown that coronavirus disease 2019 (COVID-19) disproportionately affects males, compared with females, although other studies show that there were no such differences. The aim of the present study was to assess differences in the prevalence of hospitalizations and in-hospital outcomes between the sexes, using a larger administrative database. Methods: We used the 2020 California State Inpatient Database for this retrospective analysis. International Classification of Diseases, Tenth Revision, Clinical Modification diagnosis code U07.1 was used to identify COVID-19 hospitalizations. These hospitalizations were subsequently stratified by male and female sex. Diagnosis and procedures were identified using the International Classification of Diseases, Tenth Revision, Clinical Modification codes. The primary outcome of the study was hospitalization rate, and secondary outcomes were in-hospital mortality, prolonged length of stay, vasopressor use, mechanical ventilation, and intensive care unit (ICU) admission. Results: There were 95,180 COVID-19 hospitalizations among patients 18 years and older, 52,465 (55.1%) of which were among men and 42,715 (44.9%) were among women. In-hospital mortality (12.4% vs 10.1%), prolonged length of hospital stays (30.6% vs 25.8%), vasopressor use (2.6% vs 1.6%), mechanical ventilation (11.8% vs 8.0%), and ICU admission rates (11.4% versus 7.8%) were significantly higher among male compared with female hospitalizations. Conditional logistic regression analysis showed that the odds of mortality (odds ratio [OR] 1.38, 95% confidence interval [CI] 1.38–1.44), hospital lengths of stay (OR 1.35, 95% CI 1.31–1.39), vasopressor use (OR 1.59, 95% CI 1.51–1.66), mechanical ventilation (OR 1.62, 95% CI 1.47–1.78), and ICU admission rates (OR 1.58, 95% CI 1.51–1.66) were significantly higher among male hospitalizations. Conclusion: Our findings show that male sex is an independent and strong risk factor associated with COVID-19 severity. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented in response to the article "A critical role of Cyr61 in interleukin-17–dependent proliferation of fibroblastlike synoviocytes in rheumatoid arthritis," by Zhang Q and colleagues in the May 2011 issue.

This paper describes a project that was undertaken using naturalistic driving data collected via Global Positioning System (GPS) devices to demonstrate a proof-of-concept for proactive safety assessments of crash-prone locations. The main hypothesis for the study is that the segments where drivers have to apply hard braking (higher jerks) more frequently might be the “unsafe” segments with more crashes over a long-term. The linear referencing methodology in ArcMap was used to link the GPS data with roadway characteristic data of US Highway 101 northbound (NB) and southbound (SB) in San Luis Obispo, California. The process used to merge GPS data with quarter-mile freeway segments for traditional crash frequency analysis is also discussed in the paper. A negative binomial regression analyses showed that proportion of high magnitude jerks while decelerating on freeway segments (from the driving data) was significantly related with the long-term crash frequency of those segments. A random parameter negative binomial model with uniformly distributed parameter for ADT and a fixed parameter for jerk provided a statistically significant estimate for quarter-mile segments. The results also indicated that roadway curvature and the presence of auxiliary lane are not significantly related with crash frequency for the highway segments under consideration. The results from this exploration are promising since the data used to derive the explanatory variable(s) can be collected using most off-the-shelf GPS devices, including many smartphones. [ABSTRACT FROM AUTHOR]

Telomere length (TL) is an indicator of cellular aging associated with longevity and psychosocial stress. We examine here the relationship between religious involvement and TL in 251 stressed female family caregivers recruited into a 2-site study. Religious involvement, perceived stress, caregiver burden, depressive symptoms, and social support were measured and correlated with TL in whole blood leukocytes. Results indicated a U-shaped relationship between religiosity and TL. Those scoring in the lowest 10% on religiosity tended to have the longest telomeres (5743 bp ± 367 vs. 5595 ± 383, p = 0.069). However, among the 90% of caregivers who were at least somewhat religious, religiosity was significantly and positively related to TL after controlling for covariates (B = 1.74, SE = 0.82, p = 0.034). Whereas nonreligious caregivers have relatively long telomeres, we found a positive relationship between religiosity and TL among those who are at least somewhat religious. [ABSTRACT FROM AUTHOR]

• Simulated hydrogen (H 2) demand from 2030 California fuel cell vehicle deployment. • Simulated electrolysis H 2 production using PLEXOS power system model of Western US. • Flexible electrolysis operation can reduce system costs, carbon dioxide emissions. Hydrogen fuel cell electric vehicles (FCEVs) have been proposed as an option for lowering carbon dioxide (CO 2) and pollutants emissions from the transportation sector, when implemented in combination with green hydrogen production methods such as water electrolysis powered by renewable electricity. FCEVs also have the added advantages of high specific energy density and rapid refueling, two important challenges that battery electric vehicles have not yet fully overcome. Moreover, flexible operation of electrolysis could support the grid and lower electricity costs. In this paper, we simulate time-varying FCEV hydrogen refueling demand for light, medium- and heavy-duty vehicles met using electrolysis systems distributed throughout the Western U.S. power system. We find that by oversizing electrolyzers the resulting load flexibility results in different hydrogen generation temporal profiles, average electricity costs, renewable curtailment levels, and CO 2 emissions. Our results indicate that increasing hydrogen production flexibility lowers hydrogen and electricity generation cost and CO 2 emissions, but there is a tradeoff between lowering operational cost and increasing electrolyzer capital cost, yielding a minimum total system cost at a size corresponding to between 80% and 90% annual capacity factor assuming a future electrolyzer cost of $300/kW. [ABSTRACT FROM AUTHOR]

Objective: Atrial fibrillation (AF) is a common arrhythmia in patients at high cardiovascular risk. COVID-19 patients with underlying cardiovascular disease are at increased risk of poor clinical outcomes. In this study, we aimed to determine hospital outcomes among patients admitted with AF and COVID-19 infection., Methods: We conducted a retrospective analysis using the 2020 California State Inpatient data, including all COVID-19 hospitalizations of individuals aged ≥18. Primary outcomes were in-hospital mortality, prolonged length of stay (above the 75th percentile), vasopressor use, mechanical ventilation, and ICU admission. We compared adverse hospital outcomes between those with and without AF and used multivariable logistic regression to adjust for confounders., Results: This analysis included 94,114 COVID-19 hospitalizations, of which 9391 (10.0%) had AF. Patients with COVID-19 and AF had higher rates of adverse outcomes, including mortality (27.2% vs. 9.6%, p  < .001), prolonged length of stay (40.0% vs. 27.1%, p  < .001), vasopressor use (4.4% vs. 1.9%, p  < .001), mechanical ventilation (19.0% vs. 9.1%, p  < .001), and ICU admission (18.4% vs. 8.8%, p  < .001) After multivariable adjustment, the odds of adverse outcomes remained significantly higher, including mortality adjusted odds ratio [OR], 2.04, 95% CI: 1.92-2.16), prolonged length of stay (aOR, 1.37, 95% CI: 1.31-1.44), vasopressor use (aOR, 1.98, 95% CI: 1.86-2.11), mechanical ventilation (aOR, 1.95, 95% CI: 1.72-2.20), and ICU admission (aOR, 2.01, 95% CI: 1.88-2.15)., Conclusion: COVID-19 hospitalized patients frequently have underlying AF, which confers a higher risk of adverse hospital outcomes and mortality, even after adjusting for baseline comorbidities. Heightened awareness is needed in the treatment of hospitalized COVID-19 patients with AF.

Background: Coronavirus disease 2019 (COVID-19) outbreak has negatively impacted routine cardiovascular care. In this study, we assessed the impact of COVID-19 pandemic on percutaneous coronary artery intervention (PCI) and coronary artery bypass grafting (CABG) hospitalizations and outcomes using a large database., Methods: The current study was a retrospective analysis of California State Inpatient Database (SID) during March-December of 2019 and 2020. All adult hospitalizations for coronary artery revascularization were included for the analysis. ICD-10-CM diagnosis and procedure codes were used for identifying hospitalizations and procedures. The primary outcome was inhospital mortality, and secondary outcomes were hospital length of stay, stroke, acute kidney injury, and mechanical ventilation. Propensity score match analysis was done to compare adverse clinical outcomes., Results: PCI hospitalizations (relative decrease, 15.0%, P for trend <0.001) and CABG hospitalizations (relative decrease, 16.4%, P for trend <0.001) decreased from 2019 to 2020, while viral pneumonia hospitalizations increased (relative increase, 1751.6%, P for trend <0.001). Monthly PCI and CABG hospitalization showed decreasing trends from January 2019 to December 2020. Propensity score match analysis showed that the odds of inhospital mortality (OR, 1.12; 95% CI, 1.01-1.24), acute kidney injury (OR, 1.12; 95% CI, 1.06-1.17), and ARDS (OR, 1.89; 95% CI, 1.18-3.01) were higher among patients who received PCI in 2020., Conclusion: Results of our study indicate that initiatives such as encouraging patients to receive treatments and controlling the spread of COVID-19 should be instituted to improve PCI and CABG hospitalizations., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)

Background: Twin pregnancies are associated with increased perinatal morbidity and mortality. No consensus exists whether vaginal twin delivery should take place in the labor room or operating room, or whether anesthesiologists should be present. We surveyed members of the California Society of Anesthesiologists (CSA) to review management of vaginal twin delivery, and examined anesthetic intervention retrospectively at our institution., Methods: 230 CSA members were asked to complete an online survey on location of vaginal twin delivery in their institution and whether they were required to be present throughout. We then retrospectively reviewed charts of vaginal twin deliveries at our institution over a 36-month period to analyze frequency and type of anesthetic intervention., Results: The online survey response rate was 58%; 64% of responders reported that vaginal twin deliveries were performed in the operating room and 55% that an anesthesiologist was present. There was a strong association between anesthesiologist's presence and delivery in the operating room (OR 7; 95% CI 3-20). We reviewed 81 charts of women who underwent vaginal twin delivery. The median (range) time that the anesthesiologist was present for each delivery was 60 (20-380) min. Of women undergoing vaginal twin delivery, 27% required anesthetic intervention during the second stage of labor with 6% having emergency cesarean delivery., Conclusion: There is a lack of consensus regarding the appropriate location for vaginal twin delivery and the role of anesthesiologists. A significant percentage of women undergoing vaginal twin delivery in our institution received anesthetic intervention in the immediate delivery period.