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Purpose: The evaluation aims to assess emergency preparedness (EP) among Native American tribes in California to inform future development of priorities and strategies for improvement. The analysis explores funding barriers and gaps in resource availability. Methods: A cross-sectional survey was designed to explore four aspects of EP: 1) perceptions of preparedness; 2) funding mechanisms; 3) resource availability; and 4) plans for future preparedness efforts. The survey was conducted online, by telephone, fax, or mail. Analysis includes National Incident Management System (NIMS) and Standardized Emergency Management System (SEMS) compliance, and Federal Emergency Management Agency (FEMA) approval of disaster mitigation plans. Results and Discussion: Findings represent 40% of the federally-recognized California tribes. Participants included: tribal chairpersons and administrators, emergency services managers, fire chiefs, police chiefs, and environmental directors. Results indicated low awareness of funding regulations and instructional opportunities yet high interest; high dependency on external EP response resources; and needed improvements in community involvement. Conclusion: Partnerships with local emergency preparedness and academic organizations and improved communication are recommended to bridge gaps in resources and awareness. This evaluation provides one of the first systematic assessments of EP achievements and gaps among Native American tribes in California. Future studies are needed to explore these preliminary findings. [ABSTRACT FROM AUTHOR]

Intramural funding programs within both large and small research institutions are an essential mechanism to foster collaborative, novel, or preliminary research activity, and to further institutional research strategic goals. At most research institutions in the United States, these funding opportunities are managed by each funding agency or program, independently of each other. The lack of a shared administrative structure for these independent programs can lead to inefficiency and ineffectiveness of any one program. For example, a researcher must navigate several websites to determine which funding opportunities are available and then face multiple submission deadlines scattered across the entire academic year. The Resource Allocation Program (RAP), a shared administrative structure at the University of California, San Francisco (UCSF), has centralized the announcement, submission and review process for opportunities offered by multiple intramural funding sources. Results of the shared structure include increased efficiency due to consolidation of internal review committees, increased visibility of funding opportunities, increased transparency and consistency of the selection process, and enhanced availability of valuable review feedback. [ABSTRACT FROM AUTHOR]

In integrated health care systems, techniques that identify successes and opportunities for targeted improvement are needed. The authors propose a new method for estimating population health that provides a more accurate and dynamic assessment of performance and priority setting. Member data from a large integrated health system (n = 96,246, 73.8% female, mean age = 44 ± 0.01 years) were used to develop a mechanistic mathematical simulation, representing the top causes of US mortality in 2014 and their associated risk factors. An age- and sex-matched US cohort served as comparator group. The simulation was recalibrated and retested for validity employing the outcome measure of 5-year mortality. The authors sought to estimate potential population health that could be gained by improving health risk factors in the study population. Potential gains were assessed using both average life years (LY) gained and average quality-adjusted life years (QALYs) gained. The simulation validated well compared to integrated health system data, producing an AUC (area under the curve) of 0.88 for 5-year mortality. Current population health was estimated as a life expectancy of 84.7 years or 69.2 QALYs. Comparing potential health gain in the US cohort to the Kaiser Permanente cohort, eliminating physical inactivity, unhealthy diet, smoking, and uncontrolled diabetes resulted in an increase of 1.5 vs. 1.3 LY, 1.1 vs. 0.8 LY, 0.5 vs. 0.2 LY, and 0.5 vs. 0.5 LY on average per person, respectively. Using mathematical simulations may inform efforts by integrated health systems to target resources most effectively, and may facilitate goal setting. [ABSTRACT FROM AUTHOR]

Background: A variety of approaches have been used to contain escalating hospital costs. One approach is intensifying price competition. The increase in price based competition, which changes the incentives hospitals face, coupled with the fact that consumers can more easily evaluate the quality of hotel services compared with the quality of clinical care, may lead hospitals to allocate more resources into hotel rather than clinical services. Methods: To test this hypothesis we studied hospitals in California in 1982 and 1989, comparing resource allocations prior to and following selective contracting, a period during which the focus of competition changed from quality to price. We estimated the relationship between clinical outcomes, measured as risk-adjusted-mortality rates, and resources. Results: In 1989, higher competition was associated with lower clinical expenditures levels compared with 1982. The trend was stronger for non-profit hospitals. Lower clinical resource use was associated with worse risk adjusted mortality outcomes. Conclusions: This study raises concerns that cost reductions may be associated with increased mortality. [ABSTRACT FROM AUTHOR]

Examining resource allocation practices, including savings, of charter schools is critical to understanding their financial viability and sustainability. Using 9 years of finance data from California, we find charter schools spend less on instruction and pupil support services than traditional public schools. The lower spending on instruction and pupil support is offset, not by administrative costs, but by higher spending on operations, consultant services, and a greater rate of savings (carry-over). Further, analysis indicates that the differences in resource allocation patterns between charter schools and traditional public schools is not completely explained by the characteristics of students served. The resource allocation practices revealed in this study, combined with findings from prior research, shed some light on how charter schools may avoid financial deficiency and ensure their sustainability. [ABSTRACT FROM AUTHOR]

Federal school finance policy over the past 30 years has focused on resource allocation within school districts. Regulations require equal staffing across schools, particularly Title I schools, which are designated based on the percent of low-income students enrolled. The requirement to equalize staffing levels creates a loophole where, even with equal staffing levels, differences in staff experience and salary levels across schools lead to differences in actual spending across schools. In response, recent regulatory reforms have shifted from an emphasis on equal staffing to an emphasis on equal spending. Under the federal comprehensive support and improvement (CSI) system, states are required to periodically review within-district spending gaps for any district with a significant number of identified schools. We analyze spending gaps within districts in California and assess the extent to which the CSI system targets districts with inequitable spending patterns. We find that racial and income-based spending gaps across-schools are not substantially different for districts with CSI schools and districts with no CSI schools. Importantly, many districts with large spending gaps are not included in the policy and thus do not face federal regulations to measure and address resource disparities across schools. We discuss implications for school finance research and policy moving forward, particularly as schools respond to the global pandemic and reopening process. [ABSTRACT FROM AUTHOR]

Examines the reasons why the latest wave of education reform in California had limited impact. Failure to consolidate adequate resources; Absence of guarantees for schools identified to have below-average performance; Discussion of alternative approaches to resource allocation.

Public health agencies face difficult decisions when allocating scarce resources to control the spread of HIV/AIDS. Decisions are often made with few local empirical data. We demonstrated the use of the robust decision making approach in Los Angeles County, an approach that is data driven and allows decision makers to compare the performance of various intervention strategies across thousands of simulated future scenarios. We found that the prevailing strategy of emphasizing behavioral risk reduction interventions was unlikely to achieve the policy goals of the national HIV/AIDS strategy. Of the alternative strategies we examined, those that invested most heavily in interventions to initiate antiretroviral treatment and support treatment adherence were the most likely to achieve policy objectives. By employing similar methods, other public health agencies can identify robust strategies and invest in interventions more likely to achieve HIV/AIDS policy goals. [ABSTRACT FROM AUTHOR]

Presents a study which assessed whether insurance coverage is associated with the differences in hospital resource allocation among sick newborns in California in 1987. Measures of hospital resource allocation to sick newborns and difference by insurance status; Differences in total charges according to insurance status among sick newborns; Severity of medical problems among sick newborns in the state.

Abstract: This paper presents a case study of two California school districts, San Francisco and Oakland, each of which have implemented their own versions of what is popularly known as a weighted student formula (WSF). One primary goal of the WSF policy is to increase the equity with which resources are distributed to schools. With respect to equity, the findings suggest that for particular schooling levels per-pupil spending became more responsive to student poverty and that the increase in responsiveness appears to have coincided with implementation of the WSF in the two districts. Moreover, each district relies on a different mechanism for driving resources to the schools: San Francisco relying to a greater degree on the unrestricted funds, while Oakland relies more heavily on restricted sources which, as directed by law, drive dollars to special need populations. Interestingly, neither district exhibited any significant change in the distribution of teacher experience after implementation of their SBF models; schools serving the highest proportion of students from low-income families continued to employ teachers with the least experience after implementation of the SBF models. While an additional goal of WSF was to drive more resources down to the school level to be spent, our analysis found little substantial change in the proportion of resources expended at the school versus the district level. [Copyright &y& Elsevier]

Studies the changes in survival, allocation of resources and growth rate of three dune plant species from Mono Lake, California in response to experimental burial. Burial and survival of plants at four different levels in both field and pot experiments; Relative growth rate of all species was highly correlated with net assimilation.

Objective: To assess whether newborns' insurance coverage was associated with differences in the allocation of hospital services.Design: Retrospective analysis of computerized hospital discharge data, comparing resource allocation among newborns according to insurance status, controlling for race/ethnicity, diagnoses, hospital characteristics (ownership, teaching status, nursery level), and disposition.Setting: All California civilian acute-care hospitals.Patients: Population-based sample, excluding out-of-hospital and military hospital births. Resource allocation was studied among all newborns discharged in 1987 with evidence of serious problems (N = 29,751).Main Outcome Measures: Length of stay, total charges, and charges per day.Results: Sick newborns without insurance received fewer inpatient services than comparable privately insured newborns with either indemnity or prepaid coverage. This pattern was observed across all hospital ownership types. Mean stay was 15.7 days for all privately insured newborns (15.6 days for those with indemnity and 15.7 days for those with prepaid coverage), 14.8 days for Medicaid-covered newborns, and 13.2 days for uninsured newborns (P less than .001). Length of stay, total charges, and charges per day were 16%, 28%, and 10% less, respectively, for the uninsured than for all privately insured newborns (P less than .001). Resources for newborns covered by Medicaid were generally greater than for the uninsured and less than for the privately insured. Both uninsured and Medicaid-covered newborns were found to have more severe medical problems than the privately insured.Conclusions: The findings cannot be explained by differences in medical need or by differences in non-medically indicated services; they constitute prima facie evidence of inequities that need to be addressed by policy changes. [ABSTRACT FROM AUTHOR]

Local governments prioritize spending on various types and levels of public services. Although scholars have shown that citizen preferences and institutional factors, such as economic, political, and legal arrangements, play a role in resource allocation, scholars have not systematically examined the impact of local elected officials’ own ideological preferences on service prioritization. A better understanding of the impact of personal ideology on local government resource allocation is needed as this provision of funds has implications for democratic governance and responsiveness. We develop and use a novel measure of local elected official ideology using a 2011 survey of California local elected officials to test the hypothesis that local decision-maker ideology affects attitudes on funding-specific service categories. We find evidence that local elected officials’ attitudes toward service reductions are associated with both their own individual ideology, measured on the conservative–liberal spectrum, and the ideology of their constituents. [ABSTRACT FROM AUTHOR]

Abstract: We examine the impact of teacher professional development on a key aspect of teacher quality—teacher knowledge. Specifically we use English Language Arts teacher content and pedagogy assessments to determine whether the California Professional Development Institutes significantly improve teacher content knowledge and whether teachers retain that knowledge six months after the institutes are completed. The results indicate that teachers vary significantly in pre-institute knowledge on the four assessed domains, that they demonstrate significant knowledge growth between the pre- and post-assessments, but that practical classroom experience hinders knowledge retention as measured six months later. Further, pre-exiting knowledge gaps are not systematically reduced thereby not alleviating the uneven distribution of teacher quality among California elementary schools. [Copyright &y& Elsevier]

Youth occupy a unique place in our democratic society. They must primarily rely on others to speak on their behalf as decisions are made about the allocation of resources within and across various youth-serving institutions. Advocacy organizations comprise crucial representational assets for all youth, but America's poorest children and youth especially need an effective voice to speak for and about them. Yet advocates for youth in urban areas face tough challenges since urban voters typically have few positive connections to youth. This article draws on three years of research focused on three organizations in the San Francisco Bay Area that have successfully advocated for better policies for youth. The authors explore the strategies that these organizations have employed to overcome the challenges they face, with particular attention to the advantages that follow from advocating at the local rather than at the state or federal level. [ABSTRACT FROM AUTHOR]

Background: Estimated life expectancy for older patients with diabetes informs decisions about treatment goals, cancer screening, long-term and advanced care, and inclusion in clinical trials. Easily implementable, evidence-based, diabetes-specific approaches for identifying patients with limited life expectancy are needed. Objective: Develop and validate an electronic health record (EHR)–based tool to identify older adults with diabetes who have limited life expectancy. Design: Predictive modeling based on survival analysis using Cox-Gompertz models in a retrospective cohort. Participants: Adults with diabetes aged ≥ 65 years from Kaiser Permanente Northern California: a 2015 cohort (N = 121,396) with follow-up through 12/31/2019, randomly split into training (N = 97,085) and test (N = 24,311) sets. Validation was conducted in the test set and two temporally distinct cohorts: a 2010 cohort (n = 89,563; 10-year follow-up through 2019) and a 2019 cohort (n = 152,357; 2-year follow-up through 2020). Main Measures: Demographics, diagnoses, utilization and procedures, medications, behaviors and vital signs; mortality. Key Results: In the training set (mean age 75 years; 49% women; 48% racial and ethnic minorities), 23% died during 5 years follow-up. A mortality prediction model was developed using 94 candidate variables, distilled into a life expectancy model with 11 input variables, and transformed into a risk-scoring tool, the Life Expectancy Estimator for Older Adults with Diabetes (LEAD). LEAD discriminated well in the test set (C-statistic = 0.78), 2010 cohort (C-statistic = 0.74), and 2019 cohort (C-statistic = 0.81); comparisons of observed and predicted survival curves indicated good calibration. Conclusions: LEAD estimates life expectancy in older adults with diabetes based on only 11 patient characteristics widely available in most EHRs and claims data. LEAD is simple and has potential application for shared decision-making, clinical trial inclusion, and resource allocation. [ABSTRACT FROM AUTHOR]

Due to the mixed distribution of buildings and vegetation, wildland-urban interface (WUI) areas are characterized by complex fuel distributions and geographical environments. The behavior of wildfires occurring in the WUI often leads to severe hazards and significant damage to man-made structures. Therefore, WUI areas warrant more attention during the wildfire season. Due to the ever-changing dynamic nature of California's population and housing, the update frequency and resolution of WUI maps that are currently used can no longer meet the needs and challenges of wildfire management and resource allocation for suppression and mitigation efforts. Recent developments in remote sensing technology and data analysis algorithms pose new opportunities for improving WUI mapping methods. WUI areas in California were directly mapped using building footprints extracted from remote sensing data by Microsoft along with the fuel vegetation cover from the LANDFIRE dataset in this study. To accommodate the new type of datasets, we developed a threshold criteria for mapping WUI based on statistical analysis, as opposed to using more ad-hoc criteria as used in previous mapping approaches. This method removes the reliance on census data in WUI mapping, and does not require the calculation of housing density. Moreover, this approach designates the adjacent areas of each building with large and dense parcels of vegetation as WUI, which can not only refine the scope and resolution of the WUI areas to individual buildings, but also avoids zoning issues and uncertainties in housing density calculation. Besides, the new method has the capability of updating the WUI map in real-time according to the operational needs. Therefore, this method is suitable for local governments to map local WUI areas, as well as formulating detailed wildfire emergency plans, evacuation routes, and management measures. [ABSTRACT FROM AUTHOR]

A severe outbreak of wildfire across the US Pacific Coast during August 2020 led to persistent fire activity through the end of summer. In late September, Fire Weather Outlooks predicted higher than usual fire activity into the winter in parts of California, with concomitant elevated fire danger in the Southeastern US. To help inform the regional and national allocation of firefighting personnel and equipment, we developed visualizations of resource use during recent late season, high-demand analogs. Our visualizations provided an overview of the crew, engine, dozer, aerial resource, and incident management team usage by geographic area. While these visualizations afforded information that managers needed to support their decisions regarding resource allocation, they also revealed a potentially significant gap between resource demand and late-season availability that is only likely to increase over time due to lengthening fire seasons. This gap highlights the need for the increased assessment of suppression resource acquisition and allocation systems that, to date, have been poorly studied. [ABSTRACT FROM AUTHOR]

Channel allocation has a direct and profound impact on the performance of vehicle-to-everything (V2X) networks. Considering the dynamic nature of vehicular environments, it is appealing to devise a blended strategy to perform effective resource sharing. In this paper, we exploit deep learning techniques predict vehicles’ mobility patterns. Then we propose an architecture consisting of centralized decision making and distributed channel allocation to maximize the spectrum efficiency of all vehicles involved. To achieve this, we leverage two deep reinforcement learning techniques, namely deep Q-network (DQN) and advantage actor-critic (A2C) techniques. In addition, given the time varying nature of the user mobility, we further incorporate the long short-term memory (LSTM) into DQN and A2C techniques. The combined system tracks user mobility, varying demands and channel conditions and adapt resource allocation dynamically. We verify the performance of the proposed methods through extensive simulations and prove the effectiveness of the proposed LSTM-DQN and LSTM-A2C algorithms using real data obtained from California state transportation department. [ABSTRACT FROM AUTHOR]

Objectives. To assess wildfire risks to California inpatient health care facilities in 2022. Methods. Locations of inpatient facilities and associated inpatient bed capacities were mapped in relation to California Department of Forestry and Fire Protection fire threat zones (FTZs), which combine expected fire frequency with potential fire behavior. We computed the distances of each facility to the nearest high, very high, and extreme FTZs. Results. Half (107 290 beds) of California's total inpatient capacity is within 0.87 miles of a high FTZ and 95% (203 665 beds) is within 3.7 miles of a high FTZ. Half of the total inpatient capacity is within 3.3 miles of a very high FTZ and 15.5 miles of an extreme FTZ. Conclusions. Wildfires threaten a large number of inpatient health care facilities in California. In many counties, all health care facilities may be at risk. Public Health Implications. Wildfires in California are rapid-onset disasters with short preimpact phases. Policies should address facility-level preparedness including smoke mitigation, sheltering measures, evacuation procedures, and resource allocation. Regional evacuation needs, including access to emergency medical services and patient transportation, must also be considered. (Am J Public Health. 2023;113(5):555–558. https://doi.org/10.2105/AJPH.2023.307236) [ABSTRACT FROM AUTHOR]

Vehicle use is associated with negative externalities such as traffic congestion, air pollution, and greenhouse gas emissions. Particularly in the U.S. as a car-oriented country, vehicle use — in terms of vehicle-miles of travel (VMT) — has been on the rise and is projected to increase in the future. To curb the VMT growth and mitigate the associated externalities, policy makers can design informed strategies based on VMT predicted by vehicle use models. However, traditional vehicle use models capture merely the observed heterogeneity across vehicle decision making units (e.g., individuals) and ignore the latent or taste heterogeneity sourced in individuals' attitudes and lifestyle preferences, which may cause biased and inconsistent results that mislead implications for policy makers. To address this research gap, the present study introduces a latent class regression model, where a probabilistic multinomial logit component endogenously classifies a sample of vehicle use observations so as to be homogeneous within and heterogeneous across the classes with respect to VMT. At the same time, a finite set of linear regression equations in the number of the latent classes yields class-specific VMT. The model is estimated on a sample dataset from the State of California identifying three latent classes, verifying the hypothesis of positing vehicle use on both observed and unobserved heterogeneity. The estimation results are analyzed to infer implications of potential policies aiming at reducing VMT through increasing fuel cost and switching to telework, and to evaluate the efficiency of resource allocation to policies by targeting different classes with distinctive characteristics. • Presents a latent class regression model of vehicle use in terms of VMT. • Empirically analyzes the model on a sample data from the State of California. • Identifies 3 classes with heterogeneous characteristics and preferences profiles. • Suggests policies to reduce VMT through higher fuel cost and switching to telework. • Evaluates efficiency of policies targeting classes with distinctive characteristics. [ABSTRACT FROM AUTHOR]

Hospital bypass behaviours (i.e. people go to faraway hospitals instead of close ones) of Emergency General Surgery (EGS) patients may cause treatment delays and worsened health outcomes. This study aimed to find the associations between EGS bypass behaviours and spatial access to EGS services as well as other factors at the individual level and ZIP Code Tabulation Area (ZCTA) level in California. We used a gravity model to calculate spatial access to EGS services at the ZCTA level. A Bayesian hierarchical spatial model was used to access associated variables of EGS bypass while accounting for spatial autocorrelation. Results show that better spatial access to EGS hospitals was associated with lower likelihood of EGS bypass. Other factors such as rural–urban status, health insurance type and race/ethnicity were also related to EGS bypass behaviours. Besides, people with similar EGS bypass behaviours seemed to cluster together due to spatial effect. Our results have important implications for EGS resource allocation, utilization and EGS disparity alleviation. [ABSTRACT FROM AUTHOR]

Abstract: Using data for 108 colleges in the California Community College System, this paper poses two questions. First, do California community colleges differ in their missions? Second, if they do, can inter-college differences in missions be explained? We address the first question by developing college-specific measures of curriculum mix, which we use to characterize colleges as to their curriculum emphases and specializations. We find that colleges differ in the extent to which they offer a transfer specialization or a nontransferable voc-ed specialization. Turning to the second question, we attempt to explain inter-college differences in curriculum emphasis and specialization with institutional variables including student demographics, labor market characteristics, and community characteristics. While not strong, we view our results as suggesting that curriculum emphases and specializations are related to student demographics and community needs. [Copyright &y& Elsevier]

Each year, wildfires ravage the western U.S. and change the lives of millions of inhabitants. Situated in southern California, coastal Santa Barbara has witnessed devastating wildfires in the past decade, with nearly all ignitions started by humans. Therefore, estimating the risk imposed by unplanned ignitions in this fire-prone region will further increase resilience toward wildfires. Currently, a fire-risk map does not exist in this region. The main objective of this study is to provide a spatial analysis of regions at high risk of fast wildfire spread, particularly in the first two hours, considering varying scenarios of ignition locations and atmospheric conditions. To achieve this goal, multiple wildfire simulations were conducted using the FARSITE fire spread model with three ignition modeling methods and three wind scenarios. The first ignition method considers ignitions randomly distributed in 500 m buffers around previously observed ignition sites. Since these ignitions are mainly clustered around roads and trails, the second method considers a 50 m buffer around this built infrastructure, with ignition points randomly sampled from within this buffer. The third method assumes a Euclidean distance decay of ignition probability around roads and trails up to 1000 m, where the probability of selection linearly decreases further from the transportation paths. The ignition modeling methods were then employed in wildfire simulations with varying wind scenarios representing the climatological wind pattern and strong, downslope wind events. A large number of modeled ignitions were located near the major-exit highway running north–south (HWY 154), resulting in more simulated wildfires burning in that region. This could impact evacuation route planning and resource allocation under climatological wind conditions. The simulated fire areas were smaller, and the wildfires did not spread far from the ignition locations. In contrast, wildfires ignited during strong, northerly winds quickly spread into the wildland–urban interface (WUI) toward suburban and urban areas. [ABSTRACT FROM AUTHOR]

The evaluation of communities' vulnerability to prolonged power outages offers valuable insights for prioritizing improvements in infrastructure resilience, thereby alleviating societal consequences. This study proposes a data-driven approach aiming at developing a Social Vulnerability Index (SoVI) to prolonged power outages leveraging three county-level datasets in California including (1) demographic features, (2) power outage factors, and (3) backup power factors. Furthermore, the study conducts a sensitivity analysis on three distinct datasets under two scenarios (Scenario 1: the current SoVI in 2022, Scenario 2: the prediction of SoVI in the year 2030). The results of Scenario 1 indicate that the counties with more affected customers, the number of power outages, and less education attainment tend to be more vulnerable to power outages in 2022. Scenario 1 reveals that the number of affected customers and power outages are the primary features influencing around 29% and 18% of counties, while educational attainment, public Electric Vehicles (EVs) chargers, and homes with rooftop photovoltaic (PV) substantially impact approximately 32%, 11%, and 8% of counties, respectively. However, in Scenario 2, crucial factors affecting the anticipated SoVI in 2030 include public EV chargers, houses with rooftop PV, power outages, and adults living alone. In contrast to Scenario 1, the prevalence of adults living alone has emerged as a notable factor impacting SoVI in 2030, while both scenarios underscore the pivotal role of EV chargers in influencing SoVI concerning power outages. The proposed SoVI facilitates informed policy decisions and infrastructure improvements in energy resilience, resource allocation, and disaster preparedness, contributing valuable insights for targeted interventions in these domains. • A data-driven approach was proposed to quantify the social vulnerability index (SoVI) to power outages. • This paper applies Principal Component Analysis (PCA) to identify the most correlated features from county-level datasets. • The paper conducts a sensitivity analysis to predict SoVI in2030 and evaluate how counties' dynamics change over time. • This paper provides insights into how policymakers can reduce the social vulnerability to power outages in California. [ABSTRACT FROM AUTHOR]

During the Covid‐19 pandemic, the University of California convened the University of California Critical Care Bioethics Working Group, a team of twenty individuals tasked with developing a set of triage procedures. This article highlights several crucial components of the UC procedures and describes the reasoning behind them. The recommendations and the reasoning in the UC protocol are distinctive because of the emphasis the working group placed on grounding its decisions on the public's preferences for triage protocols. To highlight the distinctiveness of the recommendations and reasoning, this article contrasts the UC procedures with the triage procedures known as the "Pittsburgh framework." Among the specific topics discussed are age discrimination, disability discrimination, the prioritization of critical workers for scarce resources, and triage priority for pregnant patients. [ABSTRACT FROM AUTHOR]

apidly changing wildfire regimes across the Western United States have driven more frequent and severe wildfires, resulting in wide-ranging societal threats from wildfires and wildfire-generated smoke. However, common measures of fire severity focus on what is burned, disregarding the societal impacts of smoke generated from each fire. We combine satellite-derived fire scars, air parcel trajectories from individual fires, and predicted smoke PM2.5 to link source fires to resulting smoke PM2.5 and health impacts experienced by populations in the contiguous United States from April 2006 to 2020. We quantify fire-specific accumulated smoke exposure based on the cumulative population exposed to smoke PM2.5 over the duration of a fire and estimate excess asthma-related emergency department (ED) visits as a result of this exposure. We find that excess asthma visits attributable to each fire are only moderately correlated with common measures of wildfire severity, including burned area, structures destroyed, and suppression cost. Additionally, while recent California fires contributed nearly half of the country’s smoke-related excess asthma ED visits during our study period, the most severe individual fire was the 2007 Bugaboo fire in the Southeast. We estimate that a majority of smoke PM2.5 comes from sources outside the local jurisdictions where the smoke is experienced, with 87% coming from fires in other counties and 60% from fires in other states. Our approach could enable broad-scale assessment of whether specific fire characteristics affect smoke toxicity or impact, inform cost-effectiveness assessments for allocation of suppression resources, and help clarify the growing transboundary nature of local air quality. [ABSTRACT FROM AUTHOR]

There is interest in stock enhancement to support fisheries for California halibut Paralichthys californicus , a regionally important yet depleted species in the Southern California Bight (SCB), U.S. A quantitative model was developed to assess the cost of increasing harvestable California halibut in the SCB via releases of cultured juveniles. Reduced post-release survival of cultured juveniles was incorporated into the model, as was sex-specific lifetime survival, growth, and maturity. Simulations examined how adult California halibut population metrics were influenced by key release-strategy variables (i.e., size, number, survival, and sex ratio of released juveniles). A target increase in abundance of harvestable (≥ 559 mm total length; TL) California halibut by 5% in the entire SCB could likely be achieved by releasing large numbers (0.1–1.6 million per year) of larger-sized juveniles (40–200 mm TL). However, this was strongly mediated by their survival and sex ratio; fewer and smaller juveniles were required when releases comprised better surviving and / or more female individuals. Depending on the survival and sex ratio of released juveniles, increasing harvestable abundance in the SCB to achieve this 5% target was estimated to cost US$ 0.2–2.9 million annually, or US$ 14–219 per additional harvestable California halibut in the wild. This exploratory modeling study demonstrates that releasing juvenile California halibut could be a feasible management tool in the SCB, and provides a theoretical basis for field experiments. More broadly, it suggests that the allocation of resources to the production of larger and / or better surviving juveniles, in addition to optimizing release sex ratios, should be explored in stock enhancement programs. • Stock enhancement of California halibut was simulated by quantitative modeling. • Pre-defined target was achieved by releasing 0.1–1.6 million larger-sized (40–200 mm) juveniles. • Outcomes were strongly mediated by survival and sex ratio of released fish. • Annual costs to achieve the target were US$ 0.2–2.9 million. • Provides guidance for the allocation of resources in stock enhancement programs. [ABSTRACT FROM AUTHOR]

Background: An economic evaluation of Sun Safe Schools intervention designed to aid California elementary schools with implementing sun safety practices consistent with local board–approved policy. Design: Program cost analysis: intervention delivery and practice implementation. Setting: California elementary schools (58 interventions and 60 controls). Principals at 52 intervention and 53 control schools provided complete implementation data. Participants: Principals completing pre-/postintervention surveys assessing practice implementation. Intervention: Phone-based 45-minute session with a project coach on practice implementation, follow-up e-mails/phone contacts, $500 mini-grant. Schools chose from a list of 10 practices for implementation: ultraviolet monitoring, clothing, hats, and/or sunscreen recommendations, outdoor shade, class education, staff training and/or modeling, parent outreach, and resource allocation. The duration of intervention was 20 months. Rolling recruitment/intervention: February 2014 to December 2017. Measures: Intervention delivery and practice implementation costs. Correlations of school demographics and administrator beliefs with costs. Analysis: Intervention delivery activities micro-costed. Implemented practices assessed using costing template. Results: Intervention schools: 234 implemented practices, control schools: 157. Twenty-month delivery costs: $29 310; $16 653 (per school: $320) for project staff, mostly mini-grants and coaching time. Administrator costs: $12 657 (per school: $243). Per-student delivery costs: $1.01. Costs of implemented practices: $641 843 for intervention schools (per-school mean: $12 343, median: $6 969); $496 365 for controls (per-school mean: $9365, median: $3123). Delivery costs correlated with implemented practices (0.37, P <.01) and total practice costs (0.37, P <.05). Implemented practices correlated with principal beliefs about the importance of skin cancer prevention to student health (0.46, P <.001) and parents (0.45, P <.001). Conclusion: Coaching of elementary school personnel can stimulate sun safety practice implementation at a reasonable cost. Findings can assist schools in implementing appropriate sun safety practices. [ABSTRACT FROM AUTHOR]

Objectives: Tracheostomy utilization has dramatically increased recently. Large gaps exist between expected and actual outcomes resulting in significant decisional conflict and regret. We determined 1-year patient outcomes and healthcare utilization following tracheostomy to aid in decision-making and resource allocation.Design: Retrospective cohort study.Setting: All California hospital discharges from 2012 to 2013 with follow-up through 2014.Patients: Nonsurgical patients who received a tracheostomy for acute respiratory failure.Interventions: None.Measurements and Main Results: Our primary outcome was 30-day, 90-day, and 1-year mortality. We also determined hospitals readmissions rates and healthcare utilization in the first year following tracheostomy. We identified 8,343 tracheostomies during the study period. One-year mortality following tracheostomy was high, 46.5%. Older adults (≥ 65 yr) had significantly higher mortality compared with younger patients (< 65 yr) (54.7% vs 36.5%; p < 0.0001). Median survival for older adults was 175 days (95% CI, 150-202 d) compared with greater than 1 year for younger adults (adjusted hazard ratio, 1.25; 95% CI, 1.14-1.36). Within 1 year of tracheostomy, 60.3% of patients required hospital readmission. Older adults were more likely to be readmitted in the first year after tracheostomy compared with younger adults (66.1% vs 55.2%; adjusted hazard ratio, 1.19; 95% CI, 1.09-1.29). Total short-term acute care hospital costs (index and readmissions) in the first year after tracheostomy were high (mean, $215,369; SD, $160,874).Conclusions: Long-term outcomes following tracheostomy are extremely poor with high mortality, morbidity, and healthcare resource utilization especially among older patients. Some subsets of younger patients may have better outcomes compared with the general tracheostomy population. Short-term acute care costs were extremely high in the first year following tracheostomy. If extended to the entire U.S. population, total short-term acute care hospital costs approach $11 billion dollars per year for tracheostomy-related to acute respiratory failure. These findings may aid families and surrogates in the decision-making process. [ABSTRACT FROM AUTHOR]

Abstract: This paper examines the problem of critical infrastructure protection in urban environments and provides a mechanism for evaluating the performance allocated resources on defense of the region. In the devised formulation, a bi-level mixed integer program and hypercube queuing model compose the mathematical model used to represent the concept of critical infrastructure protection between an attacker and a defender operating within the urban environment and an experimental design is used as the basis for observing salient properties and trends. Applying the model within Los Angeles County, California, results demonstrate the trade-offs observed in various protection schemes and illustrate how continuously increasing defense resources does not guarantee a safer region. The implication of detection strategy on response capability is also assessed through the case study, illustrating the importance of balance when deriving solutions. We also show how the mathematical model may be used to support research and development in defense technologies by identifying resource characteristics that strongly influence infrastructure protection. [Copyright &y& Elsevier]

Trade-offs in sex resource allocation are commonly inferred from a negative correlation between male and female reproduction. We found that for three California oak species, aboveground annual net productivity (ANP) differences among individuals were primarily correlated with water availability and soil fertility. Reproductive biomass increased with ANP, but the relative allocation to reproduction was constant, indicating that reproduction tracked productivity, which in turn tracked site quality. Although there was a negative correlation between male and female reproduction, this was not the result of a resource investment trade-off, but rather a byproduct of the positive correlation between female reproductive biomass and ANP combined with the greater overall resource allocation to female, compared to male, function. Thus, we reject the hypothesis of a trade-off between these key life-history components within individuals of these species. For long-lived individuals, a plastic resource tracking response to environmental fluctuations may be more adaptive than directly linking life-history traits through trade-offs. [ABSTRACT FROM AUTHOR]

We studied home range and habitat selection of radio-marked adult California spotted owls (Strix occidentalis occidentalis) randomly selected from among the breeding population of owls in the central Sierra Nevada, California from June to October 2006. The most parsimonious home-range estimate for our data was 555 ha (SE = 100 ha). Home-range size was positively correlated with the number of vegetation patches in the home range (habitat heterogeneity). We used resource selection ratios to examine selection of vegetation types by owls within our study area. Owl home ranges contained a high proportion of mature conifer forest, relative to its availability, although the confidence interval for this estimate overlapped one. We also used resource selection functions (RSF) to examine owl foraging habitat selection. Relative probability of selection of foraging habitat was correlated with vegetation classes, patch size, and their interaction. Owls showed highest selection rates for large patches (>10 ha) of pole-sized coniferous forest. Our results suggested that spotted owls in the central Sierra Nevada used habitat that contained a high proportion of mature conifer forest at the home-range scale, but at a finer scale (foraging site selection) owls used other vegetation classes interspersed among mature forest patches, consistent with our hypothesis that spotted owls may use other forest types besides old growth and mature forests when foraging. Our study provides an unbiased estimate of habitat use by spotted owls in the central Sierra Nevada. Our results suggest that forest managers continue to protect remaining mature and old-growth forests in the central Sierra Nevada because owl home ranges contain high proportions of these habitats. However, our results also showed that owls used younger stands as foraging habitat so that landscape heterogeneity, with respect to cover types, may be an important consideration for management but we did not attempt to relate our findings to fitness of owls. Thus management for some level of landscape heterogeneity for the benefit of owls should proceed with caution or under an adaptive management framework. [ABSTRACT FROM AUTHOR]

The need to move mental health systems toward more recovery-oriented treatment modes is well established. Progress has been made to define needed changes but evidence is lacking about the resources required to implement them. The Mental Health Services Act (MHSA) in California was designed to implement more recovery-oriented treatment modes. We use data from county funding requests and annual updates to examine how counties budgeted for recovery-oriented programs targeted to different age groups under MHSA. Findings indicate that initial per-client budgeting for Full Services Partnerships under MHSA was maintained in future cycles and counties budgeted less per client for children. With this analysis, we begin to benchmark resource allocation for programs that are intended to be recovery-oriented, which should be evaluated against appropriate outcome measures in the future to determine the degree of recovery-orientation. [ABSTRACT FROM AUTHOR]

The article presents a study on the selection of guidelines regarding the workers' compensation system. It describes the guideline selection process used in California. It aims to inform the policy makers in their attempt to develop a rational and publicly acceptable approach in selecting mandatory treatment guidelines for use in workers' compensation. It summarizes the major steps in the California guidelines selection process which include defining the purpose of the guidelines, assigning decision-making authority, and deciding whether to use existing guidelines or develop new ones. It concludes that selecting mandatory workers' compensation guidelines should involve careful planning and a transparent and well-defined process.

The inspection of food facilities is a crucial public service designed to prevent foodborne illnesses among retail food consumers. To enhance the existing food inspection process in San Bernardino County, California, a risk-based food inspection program and assessment instrument has been developed and proposed. A literature review and interviews with health professionals were conducted to establish a baseline understanding of various inspection procedures currently being employed throughout the nation. San Bernardino subsequently developed an assessment instrument and attendant inspection schedules that reflect best practices. The proposed inspection model categorizes food facilities as high, moderate, or low risk according to food properties, service population characteristics, facility history, and predefined operational risks. The San Bernardino model supports health department decision making with respect to inspection resource allocation and also makes possible sliding permit fees that reflect the relative risk associated with each facility. [ABSTRACT FROM AUTHOR]

Background: The cost of treating and managing cases of active tuberculosis (TB) disease--from diagnosis to treatment completion--is needed by agencies working on public health budgets, resource allocation and cost-effectiveness analysis. Although components of TB costs have been published in the United States (US), no recent study has assessed overall costs for TB care and potential gaps. To systematically review the US literature for costs of treating and managing cases of active TB disease, adjust these costs to current (2015) values, and assess gaps. We quantified total direct costs--from the perspective of the health care payer--of the treatment and case management of active TB disease. Estimates were based on published figures in the US, and operational data of the California Department of Public Health. Result: The average direct cost of treating and managing a TB case was $34,600 in 2015. The average cost of a multidrug-resistant TB case was $110,900. Health care spending for treating and case managing TB patients in California amounted to approximately $75.6 million for the 2133 new cases reported in 2015. Most published cost estimates were based on data from the 1990s. Conclusion: TB is resource-intensive to treat and manage. Our synthesis provides inputs for budgets and economic analyses. New studies to provide original cost data are needed to better reflect current clinical and public health practices. [ABSTRACT FROM AUTHOR]

Matching oncology nurses' assignments with patient acuity has critical implications for providing safe, effective, and efficient care. Despite this, there is a lack of well-established methods for accurate assessment of oncology patient acuity. Valid and reliable patient acuity scales are needed to accurately assess acuity of oncology patients. The purpose of this pilot study was to evaluate the psychometric properties (reliability and validity) of the Karmanos Cancer Institute Patient Acuity Scale (KPAS). The Karmanos Cancer Institute (KCI) nurse practice committee charged a small group of nurses to develop a patient acuity scale. Representatives from each inpatient unit were invited to join the acuity scale task force with the goal of developing and proposing a standardized patient acuity scale that could be used across all KCI non-ICU inpatient-nursing units to facilitate making equitable nurse-patient assignment and staffing decisions. The KPAS was developed and organized to rate patients across three levels of acuity (1=stable, 2=complex, 3=high risk) and two domains (severity of illness and nurse workload). Two inpatient units were selected to trial the KPAS (1 bone marrow transplant unit and 1 post-operative surgical unit) for 60 days and would be required to complete the scale five times per day to coincide with daily staff scheduling. At the conclusion of the 60-day pilot, the acuity scale scores were assessed. The following information was also included on the data collection sheets: number of code blue events, number of rapid response events, and number of patient falls. Staff nurses on the two inpatient trial units completed an acuity scale survey. Survey results suggested minimal scale modification and led researchers to conclude that the scale was reliable and valid in capturing KCI acute care population. A standardized acuity scale provides a method to accurately assess all types of oncology patients. The KPAS provided a means for hospital leadership to adequately staff units based on patient acuity. The KPAS created a level playing field where different patient populations could be fairly compared for resource allocation. [ABSTRACT FROM AUTHOR]

Recent federal initiatives have used estimates of population reach as a proxymetric for intervention impact, in part to inform resource allocation and programmatic decisions about competing priorities in the community. However, in spite of its utility, population reach as a singular metric of intervention impact may be insufficient for guiding multifaceted program decisions. A more comprehensive, validated approach to measure or forecast dose may complement reach estimates to inform decision makers about optimal ways to use limited resources. [ABSTRACT FROM AUTHOR]

Historically, California supplemented federal funding of HIV prevention and testing so that Californians with HIV could become aware of their infection and obtain lifesaving treatment. However, budget deficits in 2009 led the state to eliminate its supplemental funding for HIV prevention. We analyzed the impact of California's HIV resource allocation change between state fiscal years 2009 and 2011. We found that the number of HIV tests declined 19 percent, from 66,629 to 53,760, in local health jurisdictions with high HIV burden. In low-burden jurisdictions, the number of HIV tests declined 90 percent, from 20,302 to 2,116. New diagnoses fell from 2,434 in 2009 to 2,235 in 2011 (calendar years) in high-burden jurisdictions and from 346 to 327 in low-burden ones. California's budget crunch prompted state and local programs to redirect remaining HIV funds from risk reduction education to testing activities. Thus, the impact of the budget cuts on HIV tests and new HIV diagnoses was smaller than might have been expected given the size of the cuts. As California's fiscal outlook improves, we recommend that the state restore supplemental funding for HIV prevention and testing. [ABSTRACT FROM AUTHOR]

Background: School accountability policies and high-stakes testing have created new demands on state policy makers to provide assistance to low-performing schools. California's response was the Immediate Intervention/Underperforming Schools Program (II/USP) and the High Priority School Grants Program (HPSGP). Objective/Research Question/Focus of Study: This study explores the effects of the HPSGP on improving academic performance of the lowest performing schools in California. The study focuses on the organizational factors that influenced resource allocation decisions. The discussion addresses what might be done to ameliorate some of the key problems implicated in nonperforming schools. Participants: Data for this study came from site visits to 15 schools that received HPSGP funding. Of the 15 schools we studied, 10 were high schools, and the remainder elementary schools. Eleven of the schools were urban, and four were rural. Program Description: Schools in the bottom 10th percentile are eligible to apply for HPSGP funds. The State of California provided 655 schools with $400 per pupil each year for three years, with an optional fourth year. Participating schools also could apply for an optional planning grant of $50,000 in the initial year. Research Design: Using qualitative case studies of 15 schools in California, the study compares HPSGP recipient schools that made significant academic improvement with HPSGP schools that remained stagnant. The site visits, which took place between February and May 2006, comprised structured interviews with principals, teachers, HPSGP and special program coordinators, and school site council members, as well as classroom observations and focus groups. During a two-day visit, at least five people at each school were interviewed. Conclusion: This study found that organizational characteristics, such as leadership of principals, member participation in decision-making, and existence of coherent goals and plans, have a significant influence on the ability of schools to make effective use of grant funding and to achieve higher student performance. The study's main finding was that improving schools were deliberative and purposive in their use of program, funds. Nonimproving schools, on the other hand, were opportunistic, lacking a plan or vision for using funding to build effective regimes of teaching and learning. [ABSTRACT FROM AUTHOR]

The article discusses issues related to the use of data to plan and fund HIV/AIDS care services for underserved populations under the Ryan White Comprehensive AIDS Resources Emergency (CARE) Act. To consolidate all programs funded under the CARE Act, the HIV/AIDS Bureau of the Health Resources and Services Administration (HRSA) was formed in August 1997. The CARE Act became law on August 15, 1990, to improve the quality and availability of care for people with HIV/AIDS and their families. It was amended and reauthorized in May 1996 and again in November 2000. HRSA has improved the availability of service data to CARE Act programs by developing the CARE Act Data Report, which is used by all service programs of the CARE Act. But, the CARE Act planning is complicated by the kinds and quality of the data it must consider. Qualitative data are a rich source for describing what the epidemiologic data cannot. Priority setting and resource allocation is mandated in the CARE Act as a planning step in which information compiled from other planning work, particularly needs assessments, is used to determine how to prioritize needs.

Despite more than a decade of education and research-oriented intervention programs, inner city children with asthma continue to engage in episodic "rescue" patterns of healthcare and experience a disproportionate level of morbidity. The aim of this study was to establish and evaluate a sustainable community-wide pediatric asthma disease management program designed to shift inner city children in Los Angeles from acute episodic care to regular preventive care in accordance with national standards. In 1995 the Southern California Chapter of the Asthma and Allergy Foundation of America (AAFA), the Los Angeles County Department of Health Services (LAC DHS), and the Los Angeles Unified School District (LAUSD) established an agreement to initiate and sustain the Breathmobile™ Program. This program includes automated case identification, mobile school-based clinics, and highly structured clinical encounters supported by an advanced information technology solution. Interdisciplinary teams of asthma care specialists provide regular and ongoing care to children at school and county clinic sites over a wide geographic area of urban Los Angeles. Each team operates in a specially equipped mobile clinic (Breathmobile™), efficiently moving a structured healthcare process to school and county clinic sites with large numbers of children. Demographic, clinical, and participation data is tracked carefully in an electronic medical record system. Program operations, clinical oversight, and patient tracking are centralized at a care coordination center. Clinical operations and methods have been replicated in fixed specialty clinic sites at the Los Angeles County + University of Southern California Medical Center. Clinical and process measures are regularly evaluated to assure quality, plan iterative improvement, and support evidence-based care. Four Breathmobiles™ deliver ongoing care at more than 90 school sites. The program has engaged over five thousand patients and their families in a continuity care model that has demonstrated efficacy over usual episodic care. More than 90% of patients in all asthma severity categories achieved clinical control of asthma with significant reductions in inpatient (IP) and emergency department (ED) use. On February 14, 2002, the program became the first program in the United States to receive the award of disease-specific care certification by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO). Proper design and resource allocation can sustain a school-based community-wide pediatric asthma disease management program and shift a population of inner city children from acute episodic care to routine preventive care in accordance with national standards. An evidence-based approach to evaluating and maintaining quality, coupled with stratified care delivery, can assure the efficient use of safety net healthcare resources. (Disease Management 2005;8:205–222) [ABSTRACT FROM AUTHOR]

The ecology of a recently evolved species, Mimulus cupriphilus, was compared with its presumed progenitor, M. guttatus. Both species live sympatrically as annuals on two small copper mines in Calaveras county, California, USA. There are almost no other species present in the areas where Mimulus dominates. The production of seed by the two species was compared. The relationship between capsule number and plant height differs, with M. cupriphilus having the steeper slope, so that at any particular height it produces more capsules. Mean seed number per capsule, and the relationship between seed number and size of plant, also varies between the two species. M. cupriphilus is normally self-fertilizing, and thus has a higher probability that a capsule will be fertilized than M. guttatus, which relies more on fertilization by insects. The various parameters can be combined to produce a predicted relationship between size of plant and seed production. When plants are small, M. cupriphilus will produce more seeds, but at heights greater than about 9 cm M. guttatus will be fitter. The overall resource allocation pattern also reveals that M. cupriphilus devotes a greater proportion of its dry weight to seed and capsule production. These results show that in the habitat where the two species co-exist, arid deserted copper mines, the derived species is better adapted. [ABSTRACT FROM AUTHOR]