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Climate warming in recent decades has negatively impacted forest health in the western United States. Here, we report on potential early warning signals (EWS) for drought‐related mortality derived from measurements of tree‐ring growth (ring width index; RWI) and carbon isotope discrimination (∆13C), primarily focused on ponderosa pine (Pinus ponderosa). Sampling was conducted in the southern Sierra Nevada Mountains, near the epicenter of drought severity and mortality associated with the 2012–2015 California drought and concurrent outbreak of western pine beetle (Dendroctonus brevicomis). At this site, we found that widespread mortality was presaged by five decades of increasing sensitivity (i.e., increased explained variation) of both tree growth and ∆13C to Palmer Drought Severity Index (PDSI). We hypothesized that increasing sensitivity of tree growth and ∆13C to hydroclimate constitute EWS that indicate an increased likelihood of widespread forest mortality caused by direct and indirect effects of drought. We then tested these EWS in additional ponderosa pine‐dominated forests that experienced varying mortality rates associated with the same California drought event. In general, drier sites showed increasing sensitivity of RWI to PDSI over the last century, as well as higher mortality following the California drought event compared to wetter sites. Two sites displayed evidence that thinning or fire events that reduced stand basal area effectively reversed the trend of increasing hydroclimate sensitivity. These comparisons indicate that reducing competition for soil water and/or decreasing bark beetle host tree density via forest management—particularly in drier regions—may buffer these forests against drought stress and associated mortality risk. EWS such as these could provide land managers more time to mitigate the extent or severity of forest mortality in advance of droughts. Substantial efforts at deploying additional dendrochronological research in concert with remote sensing and forest modeling will aid in forecasting of forest responses to continued climate warming. [ABSTRACT FROM AUTHOR]

Forests in the western United States are being subject to more frequent and severe drought events as the climate warms. The 2012–2015 California drought is a recent example, whereby drought stress was exacerbated by a landscape-scale outbreak of western pine beetle (Dendroctonus brevicomis) and resulted in widespread mortality of dominant canopy species including ponderosa pine (Pinus ponderosa). In this study, we compared pairs of large surviving and beetle-killed ponderosa pines following the California drought in the southern Sierra Nevadas to evaluate physiological characteristics related to survival. Inter-annual growth rates and tree-ring stable isotopes (∆13C and δ18O) were utilized to compare severity of drought stress and climate sensitivity in ponderosa pines that survived and those that were killed by western pine beetle. Compared to beetle-killed trees, surviving trees had higher growth rates and grew in plots with lower ponderosa pine basal area. However, there were no detectable differences in tree-ring ∆13C, δ18O, or stable isotope sensitivity to drought-related meteorological variables. These results indicate that differences in severity of drought stress had little influence on local, inter-tree differences in growth rate and survival of large ponderosa pines during this drought event. Many previous studies have shown that large trees are more likely to be attacked and killed by bark beetles compared to small trees. Our results further suggest that among large ponderosa pines, those that were more resistant to drought stress and bark beetle attacks were in the upper echelon of growth rates among trees within a stand and across the landscape. [ABSTRACT FROM AUTHOR]

Two or more spatio-temporally co-located meteorological/climatological extremes (co-occurring extremes) place far greater stress on human and ecological systems than any single extreme could. This was observed during the California drought of 2011–2015 where multiple years of negative precipitation anomalies occurred simultaneously with positive temperature anomalies resulting in California's worst drought on observational record. The large-scale drivers which modulate the occurrence of extremes in two or more variables remains largely unexplored. Using California wintertime (November–April) temperature and precipitation as a case study, we apply a novel, nonparametric conditional probability distribution method that allows for evaluation of complex, multivariate, and nonlinear relationships that exist among temperature, precipitation, and various indicators of large-scale climate variability and change. We find that multivariate variability and statistics of temperature and precipitation exhibit strong spatial variation across scales that are often treated as being homogeneous. Further, we demonstrate that the multivariate statistics of temperature and precipitation are highly non-stationary and therefore require more robust and sophisticated statistical techniques for accurate characterization. Of all the indicators of the large-scale climate conditions we studied, the dipole index explains the greatest fraction of multivariate variability in the co-occurrence of California wintertime extremes in temperature and precipitation. [ABSTRACT FROM AUTHOR]

The article examines the extreme fire season in California in 2014. Topics covered include annual mean Keetch-Byram Drought index, wildfire simulations and projections, the findings that man-made global warming may exacerbate the frequency and areal extent of extreme fire risks and the influence of climate variability on future fire season.

Since the winter of 2013-2014, California has experienced its most severe drought in recorded history, causing statewide water stress, severe economic loss and an extraordinary increase in wildfires. Identifying the effects of global warming on regional water cycle extremes, such as the ongoing drought in California, remains a challenge. Here we analyse large-ensemble and multi-model simulations that project the future of water cycle extremes in California as well as to understand those associations that pertain to changing climate oscillations under global warming. Both intense drought and excessive flooding are projected to increase by at least 50% towards the end of the twenty-first century; this projected increase in water cycle extremes is associated with a strengthened relation to El Niño and the Southern Oscillation (ENSO)-in particular, extreme El Niño and La Niña events that modulate California's climate not only through its warm and cold phases but also its precursor patterns. [ABSTRACT FROM AUTHOR]

• Time-domain NMR analysis through CRAFT is an efficient untargeted metabolomics tool. • CRAFT-based analysis used with statistical methods generated reliable models. • The analysis is much faster than the traditional, Fourier transform-based approach. • The analysis generates better clustering in PCA plots than the traditional approach. • Biomarker analysis is feasible using the frequencies and amplitudes CRAFT provides. In NMR-based untargeted analysis, Fourier transformation is applied to the time-domain data to extract observables such as frequency and intensity. Despite its wide application, this approach has several limitations that can prevent NMR from reaching its highest potential. Here, we utilized Bayesian analysis through CRAFT as an alternative method, using California-style table olives as a model system. Our hypothesis was that the time-domain analysis through CRAFT will be as successful as the traditional approach. The results showed that CRAFT generated efficient unsupervised and supervised models in a robust, and rapid/automated manner. The duration of CRAFT analysis can be further reduced by using the first 14 k complex data points of the initial part of the FID, without affecting the performance of the untargeted analysis. For unsupervised analysis, CRAFT was generally more efficient, while for supervised analysis both approaches were effective. CRAFT can be also used for identifying marker compounds driving classifications. [ABSTRACT FROM AUTHOR]

Research on hooking up is rife with examinations of risky sexual health practices among LGBTQ+ young adults; yet, little has been written about the personal safety practices for this population. This omission is notable because safety practices can enhance the notable positive outcomes related to hooking up. Drawing on one-on-one interviews with 50 LGBTQ+ young adults (20 cismen, 20 ciswomen, two transmen, and eight others) in British Columbia, California, and Connecticut, we developed the safety spectrum theory, which used a spectral measurement to assess how LGBTQ+ young adults negotiate safety practices and implement safety rules. This spectrum was then applied to a three-step sequence of application (app)-based hookup rituals: online initiation, pre-meeting preparation, and in-person meetup. Results indicated that safety strategies may be dictated by situational factors, where individuals adapt to varying circumstances to be more in control of personal safety when hooking up. We further identified that participants move across the spectrum depending upon contextual factors, such as the gender of the potential hookup partner. This work suggests that LGBTQ+ young adults are mindful of their personal safety and deserve more credit than previously attributed in queer and sexual health research. From these findings, we provide evidence-based recommendations to make dating/hookup apps and public health campaigns more effective at mitigating hookup-related risks., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

COVID-19 restrictions may prevent adults from achieving sufficient physical activity (PA) and may affect PA context. This study examined the early effects of COVID-19 on daily PA bouts and contexts during April-June 2020 using a daily diary approach. Adults (N = 390) completed daily diary surveys for 28 days assessing number of PA bouts and social (e.g., alone), locational (i.e., home, neighborhood, recreational space), and technology (e.g., using streaming videos) contexts of PA. Mixed-effects models examined the effects of days since the pandemic started (on 3/13/2020), state residence, and demographics on number of daily PA bouts. Models examined demographic and temporal effects on PA context. Participants were 18-77 years, 15% Hispanic/Latino, and 80% female. PA bouts per day decreased significantly over time among Californians versus Coloradans (bsimple = -0.01, p < .001) and Hispanics/Latinos (vs. non-Hispanic Latinos) did fewer PA bouts per day (b = -0.17, p = .04). Most PA bouts occurred while alone (56.7%), at home (43.4%), or in any neighborhood (40.5%). Older (60+ years) versus younger (<40 years) adults were less likely to do PA with others (odds ratio [OR] = 0.40, 95% confidence interval [CI]: 0.18-0.90). PA bouts in recreational spaces were more common on weekends versus weekdays (OR = 1.59, 95% CI: 1.32-1.92) and were less common among California versus Colorado residents (OR = 0.23, 95% CI: 0.12-0.42). PA bouts decreased from April to June 2020, and these changes disparately affected subgroups. Resources are needed to counteract the negative effects of COVID-19 restrictions intended to slow disease spread on PA., (© Society of Behavioral Medicine 2021. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Purpose: There is provocative, yet inconsistent, evidence that sleep deficiency may influence the development of breast cancer. The purpose of this study was to evaluate the risk of breast cancer associated with sleep deficiency among postmenopausal women in the California Teachers Study (CTS)., Methods: We conducted a case-control study of 2,856 invasive breast cancer cases and 38,649 cancer-free controls, nested within the CTS. Self-administered questionnaires were used to ascertain several components of sleep deficiency, including quality, latency, duration, disturbance and use of sleep medications. Additionally, a Global Sleep Index (GSI) was created by summing the individual sleep components and categorizing into quartiles. Multivariable logistic regression analyses were used to estimate odds ratios and 95% confidence intervals (OR, 95% CI)., Results: Increased breast cancer risks were associated with sleep deficiency. With the exception of duration, linear increases in risk were associated with all the other individual components of sleep deficiency (p-trend ≤ 0.002). The OR for the highest GSI quartile vs. lowest was 1.24, 95% CI 1.12-1.38; p-trend < 0.001)., Conclusions: Sleep deficiency may be a risk factor for breast cancer. Additional prospective studies and those aimed at elucidating underlying mechanism are warranted.

Carbazole and halogenated carbazoles have been widely detected throughout the environment in soil, river deposits, and lake sediments. Human exposure to these compounds may occur through inhalation, drinking water, dietary intake and/or skin contact, and exposure levels in the body may be evaluated by measuring them in serum or blood. This paper reports the method development and validation for the analysis of carbazole and 11 halogenated carbazoles in human blood and/or serum samples. A small sample size of 100 μL of blood or serum was employed for the analysis. The samples were prepared through salting-out liquid-liquid extraction (LLE) by using hexane/ethyl acetate (4:1, v/v) as the extraction solvent and aqueous MgSO 4 (37.5 wt%) as the salting-out regent, respectively. Sample analysis was performed using gas-chromatography (GC) coupled with a tandem mass spectrometer (MS/MS) in an electron impact (EI) mode. The developed method demonstrated low detection limits in the range of 0.02-0.27 ng/mL, intra-day accuracy ranging from 81.2% to 125%, and inter-day accuracy from 91.0% to 117%. The intra- and inter-day precisions, calculated by relative standard deviations (RSDs), were in the ranges of 1.0-16.0% and 1.8-16.4%, respectively. The developed method was applied to the analysis of 50 human serum samples collected from pregnant women in Southern California in 2012. Low concentrations of carbazole were measured in 18 samples, while halogenated carbazoles were not detected in any of the samples., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Chronotype is the behavioral manifestation of an individual's underlying circadian rhythm, generally characterized by one's propensity to sleep at a particular time during the 24 hour cycle. Evening chronotypes ("night owls") generally suffer from worse physical and mental health compared to morning chronotypes ("morning larks") - for reasons that have yet to be explained. One hypothesis is that evening chronotypes may be more susceptible to circadian disruption, a condition where the coordinated timing of biologic processes breaks down. The role of chronotype as an independent or modifying risk factor for cancer has not been widely explored. The objective of the current study was to evaluate the risk of breast cancer associated with chronotype in a case-control study nested within the California Teachers Study (CTS) cohort. The study population consisted of 39686 post-menopausal CTS participants who provided information on chronotype by completing a questionnaire in 2012-2013. 2719 cases of primary invasive breast cancer diagnosed from 1995/1996 through completion of the chronotype questionnaire were identified by linkage of the CTS to the California Cancer Registry. 36967 CTS participants who had remained cancer-free during this same time period served as controls. Chronotype was ascertained by responses to an abbreviated version of the Horne-Ostberg Morningness-Eveningness Questionnaire (MEQ) and was characterized into five categories: definite morning, more morning than evening, neither morning or evening, more evening than morning, definite evening. Multivariable unconditional logistic regression analyses were performed to estimate the odds ratios (ORs) and 95% confidence intervals (95% CIs) for each of the chronotypes, adjusted for established breast cancer risk factors. Compared to definite morning types, definite evening types had an increased risk of breast cancer with elevated ORs that were statistically significant in both the crude (OR = 1.24, 95% CI: 1.10-1.40) and fully-adjusted models (OR = 1.20, 95% CI: 1.06-1.35). The risk estimates in the fully-adjusted model for all other chronotypes did not significantly differ from one. These results suggest that evening chronotype may be an independent risk factor for breast cancer among a population of women who are not known to have engaged in any substantial night shift work. Further research in other populations of non-shift workers is warranted.

Background: Despite positive outcomes associated with specialist palliative care (PC) in diverse medical populations, little research has investigated specialist PC in surgical ones. Although cancer surgery is predominantly safe, operations can be extensive and unpredictable perioperative morbidity and mortality persist, particularly for patients with upper gastrointestinal (GI) cancers. Objectives and Hypotheses: Our objective is to complete a multicenter, randomized controlled trial comparing surgeon-PC co-management with surgeon-alone management among patients pursuing curative-intent surgery for upper GI cancers. We hypothesize that perioperative PC will improve patient postsurgical quality of life. This study and design are based on >8 years of engagement and research with patients, family members, and clinicians surrounding major cancer surgery and advance care planning/PC for surgical patients. Methods: Randomized controlled superiority trial with two study arms (surgeon-PC team co-management and surgeon-alone management) and five data collection points over six months. The principal investigator and analysts are blinded to randomization. Setting: Four, geographically diverse, academic tertiary care hospitals. Data collection began December 20, 2018 and continues to December 2020. Participants: Patients recruited from surgical oncology clinics who are undergoing curative-intent surgery for an upper GI cancer. Interventions: In the intervention arm, patients receive care from both their surgical team and a specialist PC team; the PC is provided before surgery, immediately after surgery, and at least monthly until three months postsurgery. Patients randomized to the usual care arm receive care from only the surgical team. Main Outcomes and Measures: Primary outcome: patient quality of life. Secondary outcomes: patient: symptom experience, spiritual distress, prognostic awareness, health care utilization, and mortality. Caregiver: quality of life, caregiver burden, spiritual distress, and prognostic awareness. Intent-to-treat analysis will be used. Ethics and Dissemination: This study has been approved by the institutional review boards of all study sites and is registered on clinicaltrials.gov (NCT03611309, First received: August 2, 2018).

Because natural ecosystems are complex, it is difficult to predict how their variability scales across space and levels of organization. The species-insurance hypothesis predicts that asynchronous dynamics among species should reduce variability when biomass is aggregated either from local species populations to local multispecies communities, or from metapopulations to metacommunities. Similarly, the spatial-insurance hypothesis predicts that asynchronous spatial dynamics among either local populations or local communities should stabilize metapopulation biomass and metacommunity biomass, respectively. In combination, both species and spatial insurance reduce variation in metacommunity biomass over time, yet these insurances are rarely considered together in natural systems. We partitioned the extent that species insurance and spatial insurance reduced the annual variation in macroalgal biomass in a southern California kelp forest. We quantified variability and synchrony at two levels of organization (population and community) and two spatial scales (local plots and region) and quantified the strength of species and spatial insurance by comparing observed variability and synchrony in aggregate biomass to null models of independent species or spatial dynamics based on cyclic-shift permutation. Spatial insurance was weak, presumably because large-scale oceanographic processes in the study region led to high spatial synchrony at both population- and community-level biomass. Species insurance was stronger due to asynchronous dynamics among the metapopulations of a few common species. In particular, a regional decline in the dominant understory kelp species Pterygophora californica was compensated for by the rise of three subdominant species. These compensatory dynamics were associated with positive values of the Pacific Decadal Oscillation, indicating that differential species tolerances to warmer temperature and nutrient-poor conditions may underlie species insurance in this system. Our results illustrate how species insurance can stabilize aggregate community properties in natural ecosystems where environmental conditions vary over broad spatial scales., (© 2019 by the Ecological Society of America.)

Atmospheric mercury (Hg) poses human health and ecological risks once deposited and bio-accumulated through food chains. Source contribution analysis of Hg deposition is essential to formulating emission control strategies to alleviate the adverse impact of Hg release from anthropogenic sources. In this study, a Hg version of California Puff Dispersion Modeling (denoted as CALPUFF-Hg) system with added Hg environmental processes was implemented to simulate the Hg concentration and deposition in the central region of the Pearl River Delta (cPRD) at 1 km × 1 km resolution. The contributions of eight source sectors to Hg deposition were evaluated. Model results indicated that the emission from cement production was the largest contributor to Hg deposition, accounting for 13.0%, followed by coal-fired power plants (6.5%), non-ferrous metal smelting (5.4%), iron and steel production (3.5%), and municipal solid waste incineration (3.4%). The point sources that released a higher fraction of gaseous oxidized mercury, such as cement production and municipal solid waste incineration, were the most significant contributors to local deposition. In this intensive industrialized region, large point sources contributed 67-94% of total Hg deposition of 6 receptors which were the nearest grid-cells from top five Hg emitters of the domain and the largest municipal solid waste incinerator in Guangzhou. Based on the source apportionment results, cement production and the rapidly growing municipal solid waste incineration are identified as priority sectors for Hg emission control in the cPRD region., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Nitrogen (N) is a limiting nutrient in vast regions of the world's oceans, yet the sources of N available to various phytoplankton groups remain poorly understood. In this study, we investigated inorganic carbon (C) fixation rates and nitrate (NO 3 - ), ammonium (NH 4 + C-labeled incubation assays coupled to flow cytometry cell sorting and nanoSIMS analysis on samples collected in the North Pacific Subtropical Gyre (NPSG) and in the California Current System (CCS). Based on these analyses, we found that photosynthetic growth rates (based on C fixation) of PPE were higher in the CCS than in the NSPG, while the opposite was observed for Prochlorococcus. Reduced forms of N (NH 15 N and 13 C-labeled incubation assays coupled to flow cytometry cell sorting and nanoSIMS analysis on samples collected in the North Pacific Subtropical Gyre (NPSG) and in the California Current System (CCS). Based on these analyses, we found that photosynthetic growth rates (based on C fixation) of PPE were higher in the CCS than in the NSPG, while the opposite was observed for Prochlorococcus. Reduced forms of N (NH 4 + and urea) accounted for the majority of N acquisition for all the groups studied. NO 3 - represented a reduced fraction of total N uptake in all groups but was higher in PPE (17.4 ± 11.2% on average) than in Prochlorococcus and Synechococcus (4.5 ± 6.5 and 2.9 ± 2.1% on average, respectively). This may in part explain the contrasting biogeography of these picoplankton groups. Moreover, single cell analyses reveal that cell-to-cell heterogeneity within picoplankton groups was significantly greater for NO 3 - uptake than for C fixation and NH 4 + uptake. We hypothesize that cellular heterogeneity in NO 3 - uptake within groups facilitates adaptation to the fluctuating availability of NO 3 - in the environment.

Background: Opportunistic infections, while well studied in the AIDS population, continue to have variable and surprising presentations. Here, we present a case of disseminated histoplasmosis with disseminated nontuberculous mycobacterial infection in a 50 year old man with long standing AIDS living in a non-endemic area., Case Presentation: Patient presented with a constellation of symptoms, and imaging of the chest showed a pulmonary mass with cavitation, multiple nodules, and ground glass opacities. Further investigations revealed granulomatous lung nodules and fungemia consistent with Histoplasma capsulatum, and coinfection with disseminated nontuberculous mycobateria in a nonendemic area., Conclusions: Immunocompromised patients risk co-inhabitation by multiple infectious organisms. Some of these organisms may preside in the host for years prior to reactivation. Clinicians in non endemic areas should therefore be careful to not overlook specific organisms based on a lack of a recent travel history. Physicians in nonendemic areas should become more familiar with the clinical findings and diagnostic approach of infectious such as Histoplasmosis, to ensure earlier recognition and treatment in immunocompromised individuals.

Background: Seizures are a known complication of encephalitis. We sought to determine the incidence of seizures and the relative utility of routine and continuous electroencephalography in children with suspected encephalitis., Methods: Records from all 217 children (ages 0-20 years, enrolled 2004-2011) from our institution who had diagnostic samples sent to the California Encephalitis Project were reviewed., Results: One hundred children (46%) had at least one seizure observed clinically or recorded on electroencephalography. Diffuse abnormalities (e.g., generalized slowing) were more common than focal or epileptiform abnormalities (88.9% vs 63.2% and 57.3%, respectively; P < 0.0001), but focal and epileptiform abnormalities were more correlated with seizures (91.0% [P = 0.04] and 89.2% [P = 0.05], respectively vs 76.9%). Fifty-four patients (25%) had at least 1 day of continuous electroencephalography. When used, continuous electroencephalography recorded a seizure in more than half of patients. Six children had no recognized seizure (clinical or electrographic) before continuous electroencephalography was performed. Twenty-two children (10%) had a seizure recorded by continuous electroencephalography after routine electroencephalography did not record a seizure. Overall, continuous electroencephalography was more likely to capture a seizure, capture a subclinical seizure, or rule out a concerning event as a seizure than routine electroencephalography (all comparisons P < 0.0001)., Conclusions: Children with suspected encephalitis are at high risk for seizures. Continuous electroencephalography is better able than routine electroencephalography to determine whether seizures are present. Further, continuous electroencephalography can guide treatment by classifying a clinical event as seizure or seizure-mimic. Our findings support the expanded use of continuous electroencephalography in children with suspected encephalitis., (Copyright © 2014 Elsevier Inc. All rights reserved.)

Introduction: Lung cancer incidence is associated with markers of lower socioeconomic status (SES) in whites, blacks, and Asians but with markers of higher SES in Hispanics. The magnitude and etiology of this positive gradient in Hispanics remain undefined. We examined non-small-cell lung cancer (NSCLC) incidence and ever-smoking rates among California Hispanics according to measures of SES., Methods: We computed neighborhood (n)SES-specific incidence rates by sex and race or ethnicity for 74,179 NSCLC cases in the California Cancer Registry, 1998-2002. Associations between nSES and NSCLC incidence were examined, using incidence rate ratios and linear trend tests, and stratified by age, stage, and histology. Ever-smoking rates among Hispanics were obtained from California Health Interview Survey 2001 data, and odds ratios for ever-smoking were calculated for measures of SES and acculturation., Results: Compared with the lowest nSES quintile, the NSCLC incidence in the highest quintile was 1.86 and 1.18 times higher for Hispanic women and men, respectively. The positive nSES gradients remained significant for all ages, stages, and nonsquamous histologies in women, and only for older age, local or regional stages, and adenocarcinoma histology in men. Ever-smoking rates were associated with English-speaking households and U.S.-born status for Hispanic women and low education and U.S.-born status for Hispanic men., Conclusions: For California Hispanics, higher nSES was strongly associated with increased NSCLC incidence in women, but weakly associated in men, and ever-smoking rates were strongly correlated with increased acculturation. This finding may portend an increasing burden of NSCLC in Hispanic women, given future trends in acculturation and SES.

Prior studies comparing US-born and foreign-born Asian Americans have shown that birth in the US conveys greater risk of obesity. Our study investigates whether retention of Asian culture might be protective for obesity despite acculturation to US lifestyle. We classified self-identified Asian American respondents of the California Health Interview Survey as traditional, bicultural, and acculturated using nativity and language proficiency in English and Asian language. We then examined the association of acculturation with overweight/obesity (BMI ≥ 25 kg/m²) in a multivariate regression model. Acculturated respondents had higher adjusted odds of being overweight/obese than bicultural respondents (2.13 [1.40-3.23] for men, 3.28 [2.14-5.04] for women), but bicultural respondents had similar odds of being overweight/obese as traditional respondents (.98 [.69-1.41] for men, .72 [.50-1.05] for women). Among the bicultural, second and first generation respondents were equally likely to be overweight/obese. Biculturalism in Asian Americans as measured by Asian language retention appears protective against obesity. Further research is needed to understand the mechanisms underlying this association.

Objective: We investigated the initial outbreak of fluoroquinolone-resistant Neisseria gonorrhoeae (QRNG) in southern California with analysis of transmission using strain typing., Methods: Surveillance for QRNG was conducted between 2000 and 2002 in southern California, including epidemiology and strain typing by a combination of antibiogram, auxotype, serovar, Lip type and amino acid alteration patterns in the quinolone-resistance determining region of GyrA and ParC. Combining epidemiological data with strain typing, we describe the emergence of QRNG outbreak strains using risk factor analysis and transmission networks., Results: Two outbreak strains accounted for 82% of isolates. Both strains required proline, were Lip type 17c, had amino acid alterations 91> Phe in GyrA and 87> Arg in ParC, but they differed by their serovar, IB-3C8 versus IB-2H7, 2G2. Outbreak strains were positively associated with men who have sex with men (MSM), adjusted odds ratio (AOR) 23.9 (95% confidence interval (CI) 2.2 to 261) and negatively associated with travel history: AOR 0.05, (95% CI 0.0 to 0.6). Network analysis demonstrated that 17 cases were connected by sexual contacts and/or public venues including bars, bathhouses/sex clubs, and internet sites., Conclusions: QRNG may have become established among Californian MSM through an identified transmission network of southern Californian bars, bathhouses and internet sites.

Objective: To demonstrate that open bedside tracheotomy is an efficient, safe, and cost-effective procedure., Study Design: Retrospective review of more than 200 open bedside tracheotomies performed at UCLA Medical Center, Harbor-UCLA Medical Center, and West Los Angeles VA Medical Center from 1995 to 1998., Methods: The only personnel required for the procedure were an attending or senior resident and a junior resident or intern, as well as the respiratory therapist to withdraw the endotracheal tube. No anesthetist or scrub nurse was present for any of the procedures. The procedure took an average of 15 to 25 minutes. Patients were followed for 30 days after surgery to determine the incidence of complications., Results: The incidence of major complications related to the procedure, including hemorrhage and myocardial infarction, was less than 1%. The incidence of minor complications, including moderate bleeding at the tracheotomy site, was 4%. Overall mortality within 30 days was 8%, but was not related to the tracheotomy for any patients in this series. The charge for the procedure was $233 for the tracheotomy tube supplies and instruments. This cost compares favorably with an average charge of more than $3000 for the procedure in the operating room and about $1000 for a percutaneous tracheotomy kit., Conclusion: Review of our experience demonstrates that open bedside tracheotomies can be performed more efficiently and economically than operating room tracheotomies. The safety of this procedure is comparable to percutaneous tracheotomy but at a decreased cost.

Examines the extent to which academic achievement and work habits of first and second graders are predicted by classroom social status over the kindergarten, first-, and second-grade period. Three hundred and forty five children (163 boys and 182 girls) from a southern California community comprised the sample. The ethnic distribution of the sample was approximately 45% Caucasian, 42% Latino, 9% African American, and 5% Asian or other ethnicity. Findings suggest that peer rejection assessed as early as kindergarten and social rejection that is stable across 2 years (kindergarten-first grade or first-second grade) are associated with deficits in first-grade work habits and second-grade academic achievement and work habits. In contrast, stable social acceptance appears to buffer children from early academic difficulty. The pattern of findings remain significant after controlling for initial kindergarten academic competence. The implications for clinical and educational intervention programs are discussed.

Recent changes in the etiology, topography, and bacteriology of subphrenic abscess are identified in 93 patients treated between 1955 and 1975. Gastric and biliary tract operation account for 52% of abscesses. Appendicitis is now responsible for only 8% of subphrenic infections, in contrast with the 40% of previous reports. Colonic surgery (19%) and trauma (8%) are increasing in importance. Left-sided abscesses occur in 40%, and multiple space abscesses in 20% of patients. The bacterial flora consists of multiple strains of aerobic and anaerobic organisms. Since 1970, the aerobes have been Escherichia coli (96%), Klebsiella (21%), and Proteus (38%); anaerobes include Bacteroides (83%), cocci (50%), and clostridia (50%). The mean interval from the preceding operation until drainage of the subphrenic abscess was 5.5 weeks. Overall mortality was 31%, with higher mortalities for multiple space involvement (39%) and for abscesses developing after emergency procedures (35%). Recommendations based on this data are: (1) antibiotics selected should be effective against anaerobes, and (2) transperitoneal drainage is frequently indicated because of the increase in multiple abscesses and the need to evaluate the first operation.