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Overdiagnosis of Clostridioides difficile (C. difficile) is associated with increased hospital length of stay, antibiotic overuse, unnecessary infection prevention efforts and excess costs. This study evaluated a paper-based bedside C. difficile screening tool on the number of C. difficile laboratory tests performed and number of C. difficile infection (CDI) diagnoses. Nurses used the tool to determine whether stool should be sent for C. difficile testing. The tool provided indications for stool testing. We collected data on the number of C. difficile stool tests performed and CDI diagnoses for nine months before (PreT) and after (PostT) tool implementation in the hospital. We found a 31% reduction in the mean monthly number of C. difficile tests performed (37 PreT to 25 PostT) and a 56% reduction in CDI diagnoses (19 PreT to 8 PostT). This study demonstrates the success of using nurses and a bedside tool to decrease inappropriate C. difficile testing. This intervention has implications for patient management, infection prevention and cost containment. This low-cost paper-based tool may be helpful for the 25% of hospitals in the USA not using clinical decision support in their electronic health record (EHR), as well as for hospitals outside the United States who may not have access to EHRs. [ABSTRACT FROM AUTHOR]

While a growing body of research has examined immigrants' health generally, less is known specifically about the impact of immigration policy on the health of Chinese immigrants, the second-largest foreign-born population in the United States. This is due, in part, to the lack of methodologically well-trained, cross-cultural researchers who have both the cultural and linguistic expertise and health knowledge to engage with Chinese immigrant populations. This paper addresses this gap by examining Chinese cross-cultural researchers' roles in the qualitative phase of the Research on ImmiGrant HealTh and State policy (RIGHTS) project, which sought to assess how immigration policies shaped Chinese and other immigrants' experiences in healthcare and other related sectors in California. We used reflexivity to assess Chinese cross-cultural researchers' positionality of insiderness and outsiderness and its influence on the process of data collection (i.e., recruitment, conducting interviews, transcription, and translation). Our reflexivity guides the assessment of the opportunities (e.g., expanding the recruitment pool, engaging participants more effectively in interviews, ensuring data integrity, and discussing heterogeneity within the Chinese immigrant community) and challenges (e.g., the difficulty of recruiting low-income and undocumented immigrants, addressing participants' in-depth thoughts, the time-consuming nature of transcription and translation, and the assessment of power dynamics) in conducting immigrant health research with the Chinese community. These results highlight the need for cross-cultural researchers to help build trusting relationships with ethnic-minority communities, thus gaining new insights and advancing knowledge within the field of ethnic minority health research. These insights can guide future investigations of Chinese and other immigrant communities as research on immigration policy and health expands. [ABSTRACT FROM AUTHOR]

Presents an abstract of the paper ``Rockin' the Rock House' A Music Video to Prevent Syphillis in South Central Los Angeles,' by Juli Schmidt, a semifinalist paper in the contest for the 1989 Secretary's Award for Innovations in Health Promotion and Disease Prevention.

Background: Knowledge of patient characteristics, surgical fixation, graft choice, outcomes, and concurrent injuries of revision anterior cruciate ligament reconstruction (ACLR) is limited. Purpose: To describe the current cohort of revision ACLR captured by a community registry and the outcomes observed in the registered patients. Study Design: Case series; Level of evidence, 4. Methods: Patients who underwent revision ACLR registered between February 2005 and June 2014, by 200 surgeons in 46 hospitals, were evaluated. The Kaiser Permanente ACLR Registry (KPACLRR) collected data intraoperatively and postoperatively using paper forms, electronic medical records, administrative claims data, and patient-reported outcomes. The KPACLRR cohort was longitudinally followed, and outcomes were prospectively ascertained. Outcomes (ie, revisions, subsequent operative procedures, deep surgical site infections, and deep venous thrombosis) were adjudicated via a chart review. Descriptive statistics were employed. Results: Of 2019 patients who underwent revision ACLR, at a median follow-up of 2.2 years (interquartile range, 1.0-3.8 years), 212 (10.5%) required subsequent operative procedures, and 86 (4.3%) were revised a second time. At the time of revision, 55.1% of the patients had at least 1 concurrent meniscal injury, and 26% of those were repairable. Cartilage injuries were present in 42.0% of patients. Deep surgical site infections occurred in 12 patients (0.6%), deep venous thrombosis occurred in 5 patients (0.3%), and 1 patient (0.1%) had a pulmonary embolism. Conclusion: Revision ACLR can be performed with a low short-term revision rate and relatively few complications. At the time of revision, nearly half of these patients had an irreparable meniscal injury, and slightly less than half had a cartilage injury. A large community-based ACLR registry is useful in informing surgeons of current treatment practices, prevalence of concurrent injuries, and outcomes associated with the procedures, especially infrequent procedures such as revision ACLR. [ABSTRACT FROM AUTHOR]

Critics often mourn a loss of publicness in cities due to the increased presence of antiterror security zones and related behavioral and access controls, although recent work suggests that security landscapes have shifted from the hard, intense, militarized architecture of the late 1990s-early 2000s to a softer, less obtrusive approach more commonly seen today. Nonetheless, these studies are mostly anecdotal in nature: few studies attempt to back these claims with empirical evidence and even fewer connect this physical security imposition with the policies and plans governing its implementation and operation. In this paper I describe results of site visits to Civic Centers and Financial Districts in New York City, Los Angeles, and San Francisco. In each neighborhood I catalog security landscapes using a simple tool to assess the intensity, duration, and location of individual security zones. I find that the security landscape covers between 3.4% and 35.7% of publicly accessible space in the districts studied, and that this landscape is most prevalent and intense in New York City. I also find that security zones governed by multistakeholder networks are more intense and militarized than zones managed by a single entity. By understanding how the policies impact physical security, albeit in a relatively small sample of cities and districts, we can better predict what the future of urban security measures might hold. This paper provides empirical grounding to more common theoretical speculations regarding the future of the urban security landscape in the global West. [ABSTRACT FROM AUTHOR]

This paper examines the geographies of justice movements in Rotterdam in The Netherlands and Los Angeles in the United States. In their wider national and international frameworks movements in both countries continue to contest unjust forms of urbanization characterized by neoliberal initiatives that undermine the socioeconomic status of low-income residents. These movements are constituted by relations that stretch across several geographical levels. There remain, however, significant differences in their spatial organizational form: Rotterdam is characterized by loose networks of local associations which relate to constellations of nationally based Christian churches, unions, and humanist organizations, whereas networks between associations, unions, and university activists in Los Angeles have undergone institutionalization at the urban level. We show that movement territorialization is particularly evident at the urban level in Los Angeles while embedded at the national level in the shadow of state - corporatist institutional legacies and power relations in Rotterdam. By drawing upon important insights from several economic geographers, we develop a conceptual framework for explaining the spatialities of contention and contribute to contemporary controversies over relationality, territoriality, and political action at a variety of scales. A normative implication of the paper concerns the learning capacities of contesting actors to forge alliances and achieve their ambitions within path-dependent institutional frameworks. [ABSTRACT FROM AUTHOR]

This paper explores drug use in the lives of female gang members. Gang researchers have traditionally neglected the roles that females play in street gangs. More recent efforts have begun to examine the social life of young women and to uncover the extent to which the women develop a subculture within a male-dominated environment. In analyzing the culture of drug use in gang life, we uncover the extent to which women use illicit drugs in a highly gendered way. We focus on the ways in which female gang members use drugs in a recreational manner, in a social setting where drug taking is normative behavior. Data for this paper are drawn from an ongoing study of street gangs in the San Francisco Bay area in which 168 female gang members were interviewed using both a quantitative and a qualitative interview schedule. [ABSTRACT FROM AUTHOR]

An awareness of the growing importance of the Chinese overseas was recognized in convening the major conference Luodi-shenggen: The Legal Political and Economic Status of Chinese in Diaspora, which was held in San Francisco, California in November 1992. The organizing committee had designated five major themes around which participants could write their papers. Panels were created around these themes, with additional panels developed around topics that emerged as being of concern as planning for the conference progressed. Concern tended to center around the general issues of overseas Chinese communities and, in particular, the origin and structure of new Chinatowns. In total, over 140 papers were presented encompassing these themes during the three days of the conference. Just under half of the papers were presented in Chinese and the rest in English. The sessions on business relations devoted much attention to the strategies of Chinese entrepreneurs within both local and regional contexts. The sessions on migration covered the gamut from theoretical, global aspects of the Chinese diaspora to local dimensions of the Chinese migrant and criminal law. Particular attention was focused on two of the main destinations of migration such as Australia and Canada.

Background/Context: Across the United States, secondary school curricula are intensifying as a growing proportion of students enroll in high-level academic math courses. In many districts, this intensification process occurs as early as eighth grade, where schools are effectively constraining their mathematics curricula by restricting course offerings and placing more students into Algebra I. This paper provides a quantitative single-case research study of policy-driven curricular intensification in one California school district. Research Questions: (1a) What effect did 8th eighth grade curricular intensification have on mathematics course enrollment patterns in Towering Pines Unified schools? (2b) How did the distribution of prior achievement in Towering Pines math classrooms change as the district constrained the curriculum by universalizing 8th eighth grade Algebra? (3c) Did 8th eighth grade curricular intensification improve students' mathematics achievement? Setting: Towering Pines is an immigrant enclave in the inner-ring suburbs of a major metropolitan area. The district's 10 middle schools together enroll approximately 4,000 eighth graders each year. The districts' students are ethnically diverse and largely economically disadvantaged. The study draws upon administrative data describing 8th eighth graders in the district in the 2004-20-05 through 2007-20-08 school years. Intervention/Program/Practice: During the study period, Towering Pines dramatically intensified middle school students' math curricula: In the 2004-20-05 school year 32 % of the district's 8th eighth graders enrolled in Algebra or a higher- level mathematics course; by the 2007-20-08 school year that proportion had increased to 84%. Research Design: We use an interrupted time-series design, comparing students' 8th eighth grade math course enrollments, 10th grade math course enrollments, and 10th grade math test scores across the four cohorts, controlling for demographics and prior achievement. Findings/Results: We find that students' odds of taking higher level mathematics courses increased as this district implemented the state's Algebra mandate. However, even as the district implemented a constrained curriculum strategy, mathematics achievement growth between 6th sixth and 10th grade slowed and the achievement advantages associated with 8th eighth grade Algebra declined. Conclusions/Recommendations: Our analyses suggest that curricular intensification increased the inclusiveness and decreased the selectivity of the mathematics tracking regime in Towering Pines middle schools. However, the findings suggest that this constrained curriculum strategy may have may have unintended negative consequences for student achievement. [ABSTRACT FROM AUTHOR]

Background: Orthopaedic registries have shown value in tracking and surveillance of patients, implants, and outcomes associatedwith procedures. No current anterior cruciate ligament reconstruction registry (ACLRR) exists in the United States.Purpose: To describe the current cohort captured by an institutional ACLRR and describe the outcomes observed in the registeredpatients and how findings from the ACLRR are disseminated.Study Design: Cohort study; Level of evidence, 2.Methods: The anterior cruciate ligament reconstructions (ACLRs) registered between February 2005 and September 2011 by 244surgeons in 48 medical centers were evaluated. The ACLRR collected data intra- and postoperatively using paper forms and electronicmedical records. The ACLRR cohort was longitudinally followed and outcomes were prospectively ascertained. Outcomes(ie, revisions, subsequent operations, venous thromboembolism, and surgical site infections) were adjudicated via chart review.Descriptive statistics are used to describe the cohort and Kaplan-Meier curves to evaluate survival.Results: During the study period, 16,192 ACLRs (15,101 primary and 1091 revisions) with a median follow-up of 1.6 years (interquartilerange, 0.7-2.8 years) were registered. Male patients received 64% of both primary and revision ACLRs. The mean age atsurgery was 29.5 years (SD, 11.4 years) for primary and revision reconstructions. Cartilage injuries were noted in 25.2% of primaryand 37.5% of revision ACLRs, and meniscal injuries were identified in 60.8% and 53.2%, respectively. Autografts were used in57.6% of primary ACLRs and 20.9% of revisions. Allografts were used in 42.4% of primaries and 78.8% of revisions. In primaryACLR, the most common femoral and tibial fixation types were interference screws (42.2% and 79.7%, respectively). Fixationtype distribution was nearly identical in primaries and revisions. Of the primary ACLRs, 3.7% had subsequent operations onthe same knee and 1.7% on the contralateral knee. Deep surgical site infection developed in 0.3% of primaries and 0.8% ofrevisions. Symptomatic deep vein thromboses were seen in 0.2% of both primaries and revisions. The overall revision ratewas 1.7%. Lower rates of graft survival were identified in younger patients and those with allografts.Conclusion: Large, community-based ACLRRs are useful in informing participating surgeons of current treatment practices,prevalence of concurrent injuries, and outcomes associated with the procedures. Information from the ACLRR can be used todevelop interactive patient and surgeon tools that can be used to optimize patient care. [ABSTRACT FROM AUTHOR]

This research compares several national-origin groups in terms of how parents' entry, legalization and naturalization ( i.e., membership) statuses relate to their children's educational attainment. In the case of Asian groups, the members of which predominantly come to the United States as permanent legal migrants, we hypothesize (1) that father's and mother's statuses will be relatively homogenous and few in number and (2) that these will exert minimal net effects on second-generation attainment. For Mexicans, many of whom initially come as temporary unauthorized migrants, we hypothesize (1) that parental status combinations will be heterogeneous and greater in number and (2) that marginal membership statuses will exert negative net effects on education in the second generation. To assess these ideas, we analyze unique intergenerational data from Los Angeles on the young adult members of second-generation national-origin groups and their parents. The findings show that Asian immigrant groups almost universally exhibit similar father-mother migration statuses and high educational attainment among children. By contrast, Mexicans manifest more numerous discrepant father-mother combinations, with those in which the mother remains unauthorized carrying negative implications for children's schooling. The paper discusses the theoretical and policy implications of the delays in incorporation that result from Mexican Americans needing extra time and resources compared to the members of other groups to overcome their handicap of marginal membership status ( i.e., being more likely to enter and remain unauthorized). [ABSTRACT FROM AUTHOR]

This paper examines relationships between legal and illegal farmworker migration from Mexico and state-level labor market, agricultural, demographic, and public policy variables. The study uses a nationally representative farmworker survey providing direct legal status data. Consistent with previous literature, results indicate that personal and community networks are primary determinants of locational choices. Conversely, border enforcement is negatively related to migration to certain areas. Results are strongest for California migrants and for those with previous migration experience. Potential welfare and education program values are uncorrelated with locations of recent Mexican agricultural workers. [ABSTRACT FROM AUTHOR]

his paper presents an object-centred account of the politics of memory at a National Historic Landmark: Angel Island Immigration Station, San Francisco. Once a port of entry and detention for Chinese immigrants arriving in the United States, the Immigration Station exists today as a historic site managed by California State Parks who are in the midst of implementing a new interpretive programme with a mission to: ‘turn a history of exclusion into a future of inclusion’. The discussion fixes on three objects located within the park which play an important role in the representation of the site's past despite being labelled as ‘noncontributing’ in the site's National Historic Landmark's nomination. The biographies of a bronze bell, a granite monument, and a group of wax mannequins as sketched out here suggest novel ways to be sensitive to the many and often unexpected contributions brought by the materiality of an object in practices of remembrance. [ABSTRACT FROM AUTHOR]

In this paper we examine the role of claims of global conspiracy in undermining a local environmental planning process known as Natural Heritage 2020 (NH 2020) in Nevada County, California. County officials intended NH 2020 to mitigate the environmental impacts of rapid growth in this gentrifying rural community. This program illustrates the increasing use by land-use planners of landscape-scale approaches derived from conservation biology to protect biodiversity on private land. In Nevada County, this new planning vision met intense resistance. The ensuing struggle demonstrates the conflicts that can arise between social groups with competing visions for the future of the local environment in response to efforts to realize particular visions through land-use planning and policymaking. Opponents perceived a significant threat to their property rights from the use of a landscape-scale vision from conservation biology in county planning, which some depicted as part of a global environmental conspiracy. We explore the links between broader conservation science, ideology, and activism in the case of NH 2020, and suggest that quite real conceptual connections to global conservation politics potentially make local conservation planning efforts susceptible to claims of ‘outside’ interference. Although NH 2020 had no direct link (despite claims by some opponents) to global conservation efforts, the successful use of claims of global conspiracy in efforts to halt the program underscores social realities that planners and scholars need to consider when promoting what they often view as simply ‘good planning.’ [ABSTRACT FROM AUTHOR]

Studies of migration and financial globalization focus on either the movement of money, with people staying put, or on the movement of people, with little attention to the impact of the money that moves with them. This paper uses in-depth interviews with executives at ethnic-Chinese foreign-bank offices in Los Angeles to consider the comovement of people and money. We find that understanding the causes and consequences of this comovement requires adding both ethnic and macrostructural layers to discussions of financial globalization. The forces that have led to the rise of a ChineseAmerican banking sector and to the opening of twenty-one Chinese foreign-bank offices in Los Angeles are intertwined: immigration from the Chinese diaspora to the USA, the growth trajectory and financial transformation of East Asia, and the financial and economic evolution of Los Angeles. Ethnic-Chinese foreign-bank offices in Los Angeles have dual roles: they function both as global outposts managing their headquarters' cross-border financial flows, and as localized institutions that are gradually becoming incorporated into Southern California's internal banking and financial markets. Foreign and domestic ethnic-Chinese banks play complementary roles in facilitating ethnic-Chinese economic development in Southern California. Framing these cross-border money-population flows and this cross-border institution building, respectively, are macrostructural constraints rooted in aggregate net financial flows and the changing strategies of global megabanks. [ABSTRACT FROM AUTHOR]

The ability of firms, industries, and regions continually to translate information and knowledge into viable new products, services, and production processes in the face of constantly changing technology and market conditions is increasingly at the core of competitive success in the contemporary economy. Such economic learning is ultimately dependent on the ability of individuals to learn, and yet most of the literature in this area has focused on firms and organizational learning processes, and is only beginning to engage seriously with people's learning processes. This paper explores the links between social learning processes and dynamics of innovation in Silicon Valley, arguing that cross-firm, occupationally based, 'communities of practice' provide a critical context for individuals to learn and maintain the competencies they need to be successful in the region's dynamic but volatile economy. These cross-firm occupational learning communities in many cases are being built through the activities of formal professional associations, which are playing an increasingly important role in providing the organizational infrastructure to sustain these learning communities. Using a case study of an association of women in Internet design and development occupations, the author illustrates the value of such communities in supporting individual and collective learning processes. These findings suggest that economic development strategies could productively be focused on identifying, strengthening, and expanding access to such cross-firm occupational learning communities. [ABSTRACT FROM AUTHOR]

The term “living wage” has been used in two separate ways: (1) a wage rate that will enable workers and their families to live above a reasonable poverty threshold; and (2) a somewhat more ambitious standard, a wage rate that will meet a family’s basic budgetary needs. Both of these concepts are difficult to quantify, but quantification is necessary for setting meaningful benchmarks in formulating and debating living wage policies. This paper offers an approach to setting benchmarks as they apply to workers in Santa Monica, California. [Copyright &y& Elsevier]

California's power crisis has implications for power markets worm wide, because of the severity and unpredictability of its impacts. This paper discusses the causes of the crisis and derives lessons for energy policy makers. The crisis was triggered by a fundamental imbalance between the growing demand for power and stagnant power supply. California's market design greatly magnified the problem, by disconnecting the retail and wholesale markets for electricity, and by requiring the investor-owned utilities to buy their power on a spot market. Low hydro conditions, hot weather, and rising natural gas prices put the market over the edge. A major lesson that has been learned is to introduce demand elasticity in restructured market designs, and permit buyers of power to hedge against price volatility by engaging in forward contracts. [ABSTRACT FROM AUTHOR]

Stressing the network's facilitation of immigrants searches for jobs and housing, migration network theory has conceptually overlooked the manner in which immigrants' social networks also expand the supply of jobs and housing in target destinations by means of the ethnic economy. An expanded migration network theory takes into account the ethnic economy's role in creating new resources in the destination economy. However, the power of this objection wanes in the context of working-class immigrations that generate few entrepreneurs. Introduced here, the concept of immigrant economy responds to this contingency. Unlike ethnic economies, in which co-ethnics hire co-ethnics, immigrant economies arise when immigrants hire non-co-ethnic fellow immigrants. This situation usually arises when very entrepreneurial immigrant groups coexist in a labor market with working-class immigrant groups that generate few entrepreneurs of their own. Using evidence from the garment industry of Los Angeles, this paper estimates that only a third of immigrant employees found their jobs in a conventional ethnic economy. Half owed their employment to the immigrant economy in which, for the most part, Asian entrepreneurs employed Latino workers. [ABSTRACT FROM AUTHOR]

This paper reports on a survey of employers to assess the impact of immigration and employer practices on black employment chances in Los Angeles. We observe a process of cumulative causation in which a set of mutually reinforcing changes raise barriers to the hiring of blacks. Network hiring seems to have a dual function, bringing immigrant communities into the workplace, while at the same time detaching vacancies from the open market, thus diminishing opportunities for blacks. Employers also perceive immigrants as far more desirable employees than blacks, in part, because they expect that immigrants will be the more productive workers, in part, because they also see immigrants as more tractable labor. Any managerial propensity to favor immigrants is likely to be reinforced by the attitudes of the predominantly Latino workforce, as inserting a black worker in a predominantly Latino crew is not a technique for increasing productivity, given the hostility between the two groups. And African-Americans seem to play their own role in this process, apparently opting out of the low-level labor market in response to rising expectations, on the one hand, and the anticipation of employment difficulties on the other. [ABSTRACT FROM AUTHOR]

California's enactment of determinate sentencing came as a major event in the widespread abandonment of correctional rehabilitation. The law was initially a compromise between the interests of law enforcement and those of civil liberties and prisoner's rights groups. Penalties were soon increased, however, by amendments favorable to law enforcement. Total imprisonment has increased substantially under the new law, mainly because of an increasing commitment rate. Data for the first year show that most offenders committed to prison received the middle base term, with more of the remaining cases receiving the upper than the lower term. The upper base term was used more often for multiple- than for single-count cases, and especially for those offenders given consecutive rather than concurrent sentences. The standard enhancements were applied more often in robbery cases than in all other cases combined. Nevertheless, possible enhancements were frequently not applied, and enhancement for one type of circumstance--excessive property loss--very seldom occurred. Some possible implications of this for plea bargaining are discussed in the paper, especially in relation to the large increase in commitments under determinate sentencing. The length of prison terms is not directly comparable to terms under the indeterminate system because of the good-time provision in the new system. However, if it is assumed that most of the potential good time will be credited to inmates, prison terms for men given during the first year under the law will be shorter. Women's terms will be longer than under the former system. Standard deviations are smaller for most offenses, suggesting some reduction in sentencing disparity. Because piecemeal amendments can have substantial consequences, the law may be unusually vulnerable to further efforts to increase penalties. It is unclear whether the new system provides any logical limit to increasing sentences, commitment... [ABSTRACT FROM AUTHOR]

Reports on the Fourth Occasional California Workshop on Environmental and Resource Economics held at the University of California, Santa Barbara (UCSB) on October 16 and 17, 1999. Samples of papers presented evaluating policy and trends set by them; Funding from the United States Environmental Protection Agency; Schedule of next workshop.

Purpose: This study examines policies set in the collective bargaining agreements (CBAs) negotiated between teachers’ unions and school boards and explores what kinds of districts have contract provisions that restrict district administrators, enhance administrative flexibility, and/or improve teachers’ professional work lives and that have contracts that are more restrictive overall. Method: The author analyzes a sample of 465 California CBAs and uses linear probability models to highlight the relationships between a set of 95 representative provisions and characteristics of districts that may make them “hard to staff.” A measure of overall contract restrictiveness is generated and used to assess the relationships between these district characteristics and contract strength. Findings: Some CBA provisions restrict district administrators, whereas others may provide administrators with greater flexibilities. In addition, many provisions serve to enhance teachers’ working conditions. Many of the most restrictive clauses are more frequently found in the contracts of urban districts and districts with higher proportions of minority and poor students. However, many of these same districts have contracts that include important flexibilities and provisions that may enhance teachers’ working conditions. Large and urban districts have more restrictive contracts overall, although districts with high proportions of poor and minority students do not. Implications: As policymakers consider renegotiating provisions within CBAs and diminishing the strength of CBAs themselves, it will be important to consider the specific regulations within CBAs and whether they truly constrain administrators or serve some other purpose and whether specific high-need districts are more or less harmed by the contents of CBAs. [ABSTRACT FROM PUBLISHER]

Reports on the 13th Annual Communicating Nursing Research Conference held at the Ambassador Hotel in Los Angeles, California from April 30 to May 2, 1980. Approximate number of attendees; Presentation of special certificate of appreciation; Organization of conference papers.