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Although prior research has established a relationship between neighborhood structure and intimate partner violence (IPV), much of this literature focuses on serious IPV, despite the fact that less serious forms of IPV comprise the majority of IPV instances. Further, women are far more likely to experience all types of IPV victimization relative to men, especially simple assault, yet the relative importance of neighborhood structure across gradations of IPV and victim sex is relatively unexplored. We use data from Los Angeles, CA, and disaggregate IPV assaults across victim sex to examine whether neighborhood factors have differential effects on simple and aggravated IPV. We find differential effects of neighborhood structure by victim sex, especially for simple assault. Most notably, we find that neighborhood racial composition has significantly greater effects on females relative to male victims of simple IPV assault, while residential stability is protective of women more so than men. Only the percent of vacant or owner-occupied housing was specific to male simple IPV victimization. This suggests that neighborhood-based interventions should differ depending on the type of IPV being targeted. [ABSTRACT FROM AUTHOR]

Lira's focus on the Mexican-origin youth confined and sterilized at Pacific Colony provides valuable insights into racialized regimes of diagnosis, labor, and reproductive oppression. These studies lent scientific validity to the claim that racialized groups were innately inferior, and therefore justified the continued expansion of state efforts to confine, sterilize, surveil, or otherwise manage the reproduction and labor of Mexican-origin people in California. Natalie Lira's I Laboratory of Deficiency i is concise, clearly argued, and an important contribution to the history of reproduction, race, gender, and institutionalization in the United States. [Extracted from the article]

This study addresses the question of how and where arc magmas obtain their chemical and isotopic characteristics. The Wooley Creek batholith and Slinkard pluton are a tilted, mid- to upper-crustal part of a vertically extensive, late-Jurassic, arc-related magmatic system in the Klamath Mountains, northern California. The main stage of the system is divided into an older lower zone (c. 159 Ma) emplaced as multiple sheet-like bodies, a younger upper zone (c. 158–156 Ma), which is gradationally zoned upward from mafic tonalite to granite, and a complex central zone, which represents the transition between the lower and upper zones. Xenoliths are common and locally abundant in the lower and central zones and preserve a ghost stratigraphy of the three host terranes. Bulk-rock Nd isotope data along with ages and Hf and oxygen isotope data on zircons were used to assess the location and timing of differentiation and assimilation. Xenoliths display a wide range of εNd (whole-rock) and εHf (zircon), ranges that correlate with rocks in the host terranes. Among individual pluton samples, zircon Hf and oxygen isotope data display ranges too large to represent uniform magma compositions, and very few data are consistent with uncontaminated mantle-derived magma. In addition, zoning of Zr and Hf in augite and hornblende indicates that zircon crystallized at temperatures near or below 800 °C; these temperatures are lower than emplacement temperatures. Therefore, the diversity of zircon isotope compositions reflects in situ crystallization from heterogeneous magmas. On the basis of these and published data, the system is interpreted to reflect initial MASH-zone differentiation, which resulted in elevated δ18O and lowered εHf in the magmas prior to zircon crystallization. Further differentiation, and particularly assimilation–fractional crystallization, occurred at the level of emplacement on a piecemeal (local) basis as individual magma batches interacted with partial melts from host-rock xenoliths. This piecemeal assimilation was accompanied by zircon crystallization, resulting in the heterogeneous isotopic signatures. Magmatism ended with late-stage emplacement of isotopically evolved granitic magmas (c. 156 Ma) whose compositions primarily reflect reworking of the deep-crustal MASH environment. [ABSTRACT FROM AUTHOR]

"California and the Politics of Disability, 1850–1970" is a comprehensive study that explores the history of institutionalization in California. The author, Eileen V. Wallis, examines the rise and fall of the state's institutional infrastructure for individuals diagnosed as insane or mentally deficient, as well as other groups deemed problematic by state officials. The book provides insight into the complex web of actors and influences that shaped California's institutional system, including local, county, state, and federal officials, families with disabled relatives, and shifting social fears. While the book primarily focuses on bureaucracy, it also touches on the lived experiences of Californians deemed mentally disordered. The author traces California's unique place in national trends, from the establishment of asylums in the mid-nineteenth century to the state's leadership in deinstitutionalization efforts in the 1950s onwards. However, the book's narrative style and lack of explicit analytical themes may make it read more like a description of events rather than an analysis. Additionally, the use of modern terms to describe historical conditions may overlook the shifting definitions and ideas behind these terms over time. Despite these shortcomings, the book serves as a valuable reference for scholars interested in understanding the bureaucratic complexities and political debates surrounding disability in California. [Extracted from the article]

Agencies incorporating new technology inevitably face challenges in the implementation process. In response to the passage of Proposition 83, which mandated lifelong supervision of people convicted of sex offenses in California, San Diego County initiated a pilot program assessing Global Positioning System (GPS) monitoring of such offenders considered high risk for reoffending. Using interviews of parole agents and administrators, parole agent records of supervision, and GPS monitoring data, we assess the challenges and lessons learned from the program which help inform the current policy context of electronic monitoring. Results show that rigorous GPS supervision involves substantial workload and resource increases for parole agencies, and may not be appropriate for all individuals convicted of sex offenses. The ethical and legal challenges of electronic monitoring, more generally, require further attention. The future of GPS monitoring will depend on how programs are implemented and resources are managed, as well as how ethical issues are addressed. [ABSTRACT FROM AUTHOR]

Salinity gradients across estuaries influence wetland carbon storage, methane (CH4) biogeochemistry, and plant productivity. Estuarine freshwater wetlands may experience increases in salinity during drought; however, the impact of salinization on greenhouse gas (GHG) emissions is uncertain. We measured ecosystem-scale GHG emissions from a wetland experiencing salinization during the 2011–2017 California drought and used information theory analyses to quantify couplings and causal interactions between CH4 fluxes and two dominant environmental drivers; gross ecosystem photosynthesis and temperature. Machine learning models were then used to estimate salinization-induced changes in CH4 fluxes and plant productivity. We observed dynamic CH4 flux-driver relationships across the salinization disturbance event, where temperature connections strengthened, and productivity connections dampened during salinization. Annual gross ecosystem productivity reduced by 64% during peak salinization, whereas annual CH4 emissions only reduced by 10%, suggesting that other CH4 substrate sources compensated for reductions in recent photosynthate. Our results demonstrate the value of applying information theory and machine learning approaches to ecological analyses and suggest that drought-induced salinization may increase GHG emissions from estuarine freshwater wetlands. [ABSTRACT FROM AUTHOR]

Objectives: Women face distinct barriers to meeting their reproductive health needs postpartum, especially women who deliver preterm. Pediatric encounters present unique opportunities to address women's family planning, particularly within 18 months of a prior pregnancy, when pregnancy has an elevated risk of an adverse outcome, such as preterm birth. To ensure maternal family planning initiatives are designed in a patient-centered manner, we explored perspectives on addressing reproductive health in a pediatric setting among women with and without a recent preterm delivery. Methods: We conducted semi-structured, qualitative interviews with 41 women (66% delivered preterm). Women who delivered at any gestational age were interviewed at a pediatric primary care clinic. We also interviewed women whose infants were either in a level II intensive care nursery or attending a high-risk infant follow-up clinic, all of whom had delivered preterm. Data were analyzed using team-based coding and theme analysis. Results: While women's preferred timing and setting for addressing peripartum contraception varied, they largely considered pediatric settings to be an acceptable place to discuss family planning. A few women felt family planning fell outside of the pediatric scope or distracted from the child focus. Women discussed various barriers to accessing family planning care postpartum, including circumstances unique to women who delivered preterm. Conclusions for Practice: Family planning interventions in pediatric settings were overall an acceptable approach to reducing barriers to care among our sample of women who predominantly delivered preterm. These exploratory findings justify further investigation to assess their generalizability and to develop maternal family planning interventions for pediatric settings. [ABSTRACT FROM AUTHOR]

Background: People with sickle cell disease (SCD) have a life expectancy of <50 years, so understanding their end-of-life care is critical. Objective: We aimed to determine where individuals with SCD were dying and their patterns of care in the year preceding death to highlight end-of-life research priorities and possible opportunities for intervention. Design: Using the California SCD Data Collection Program database (containing administrative data, vital records, and Medicaid claims), we examined people with SCD who died between 2006 and 2015 (cases) at age <80 years and examined their hospital and emergency department (ED) utilization in their last year of life. Comparators included living controls with SCD matched 1:1 based on age, analysis year, insurance, and income. Results: We identified 486 people with SCD (cases) who died at a median age of 45 years (SD: 16 years). Most died in the hospital (63%) and ED (15%). In their last year of life, people with SCD were hospitalized for an average of 42 days (SD: 49 days) over five admissions. Inpatient admissions and ED visits were stable throughout the year until the month before death when acute care utilization sharply increased. In their last year of life, cases had more hospitalizations than controls, but similar ED utilization. Conclusions: People with SCD are dying acutely at a young age and most die in the hospital and the ED. Since clinicians caring for people with SCD currently cannot predict which acute events may be life-threatening, a comprehensive palliative approach to people with SCD must extend beyond chronic pain management and psychosocial support to include advance care planning. [ABSTRACT FROM AUTHOR]

Background: Studies of adolescent and young adult (AYA) oncology end-of-life care utilization are critical because cancer is the leading cause of nonaccidental AYA death and end-of-life care contributes significantly to health care expenditures. This study was designed to determine the quantity of and disparities in inpatient utilization in the last year of life of AYAs with cancer.Methods: The California Office of Statewide Health Planning and Development administrative discharge database, linked to death certificates, was used to perform a population-based analysis of cancer patients aged 15 to 39 years who died in 2000-2011. The number of hospital days and the inpatient costs were determined for each patient in the last year of his or her life, as were clinical and sociodemographic factors associated with high inpatient utilization. Admission patterns as death approached were also evaluated.Results: The 12,883 patients were admitted for 40 days on average in the last year of life, and this cost $151,072 per patient in inpatient costs. As death approached, the admission rates and the percentage of all admissions occurring at nonspecialty centers increased. Five percent of patients used 20% of bed days in the last year (high utilizers). Factors associated with high utilization included younger age (15-30 years), Hispanic ethnicity, non-health maintenance organization insurance, and hematologic malignancies.Conclusions: AYA oncology decedents were admitted for 40 days in their last year of life. Subgroups with high utilization had distinct sociodemographic and clinical characteristics, and nonspecialty center admissions increased as death approached. This demonstrates the need for palliative care at nonspecialty centers. Future studies need to determine whether these patterns are goal-concurrent, include high utilizers, and monitor the effects of health care reform. Cancer 2018;124:1819-27. © 2018 American Cancer Society. [ABSTRACT FROM AUTHOR]

We used a community-based participatory research approach to develop, implement, and evaluate one of the first health curricula for female intimate partner violence (IPV) survivors residing at a transitional housing program. The curriculum comprised 12 workshops that were developed based on the survivors’ experiences, needs, and interests. Evaluation participants included 20 of the 37 women who attended at least one workshop, 12 workshop facilitators, and two housing center staff. Participants found the curriculum to be engaging, interactive, and helpful in building a supportive community. Suggestions for curricular improvement as well as opportunities for further research and curricular development are discussed. [ABSTRACT FROM AUTHOR]

Background: Private health insurance is associated with improved outcomes in patients with cancer. However, to the authors' knowledge, little is known regarding the impact of the Patient Protection and Affordable Care Act Dependent Coverage Expansion (ACA-DCE), which extended private insurance to young adults (to age 26 years) beginning in 2010, on the insurance status of young adults with cancer.Methods: The current study was a retrospective, population-based analysis of hospitalized young adult oncology patients (aged 22-30 years) in California during 2006 through 2014 (11,062 patients). Multivariable regression analyses examined factors associated with having private insurance. Results were presented as adjusted odds ratios and 95% confidence intervals. A difference-in-difference analysis examined the influence of the ACA-DCE on insurance coverage by race/ethnicity and federal poverty level.Results: Multivariable regression demonstrated that patients of black and Hispanic race/ethnicity were less likely to have private insurance before and after the ACA-DCE, compared with white patients. Younger age (22-25 years) was associated with having private insurance after implementation of the ACA-DCE (odds ratio, 1.20; 95% confidence interval, 1.06-1.35). In the difference-in-difference analysis, private insurance increased among white patients aged 22 to 25 years who were living in medium-income (2006-2009: 64.6% vs 2011-2014: 69.1%; P = .003) and high-income (80.4% vs 82%; P = .043) zip codes and among Asians aged 22 to 25 years living in high-income zip codes (73.2 vs 85.7%; P = .022). Private insurance decreased for all Hispanic patients aged 22 to 25 years between the 2 time periods.Conclusions: The ACA-DCE provision increased insurance coverage, but not among all patients. Private insurance increased for white and Asian patients in higher income neighborhoods, potentially widening social disparities in private insurance coverage among young adults with cancer. Cancer 2018;124:110-7. © 2017 American Cancer Society. [ABSTRACT FROM AUTHOR]

Background: Patients with a terminal illness should have access to their chosen location of death. Cancer is the leading cause of non-accidental death among adolescents and young adults (AYAs; those aged 15-39 years). Although surveys have suggested that a majority of these patients prefer a home death, to the authors' knowledge, little is known regarding their barriers to accessing their preferred location of death. As a first step, the authors sought to determine, across a large population, 20-year trends in the location of death among AYA patients with cancer.Methods: Using the Vital Statistics Death Certificate Database of the California Office of Statewide Health Planning and Development, the authors performed a retrospective, population-based analysis of California patients with cancer aged 15 to 39 years who died between 1989 and 2011. Sociodemographic and clinical factors associated with hospital death were examined using multivariable logistic regression.Results: Of 30,573 AYA oncology decedents, 57% died in a hospital, 33% died at home, and 10% died in other locations (eg, hospice facility or nursing facility). Between 1989 and 1994, hospital death rates decreased from 68.3% to 53.6% and at-home death rates increased from 16.8% to 35.5%. Between 1995 and 2011, these rates were stable. Those individuals who were more likely to die in a hospital were those aged <30 years, of minority race, of Hispanic ethnicity, who lived ≤10 miles from a specialty center, and who had a diagnosis of leukemia or lymphoma.Conclusions: Overall, the majority of AYA cancer deaths occurred in a hospital, with a 5-year shift to more in-home deaths that abated after 1995. In-hospital deaths were more common among younger patients, patients of minority race/ethnicities, and those with a leukemia or lymphoma diagnosis. Further study is needed to determine whether these rates and disparities are consistent with patient preferences. Cancer 2017;123:4178-4184. © 2017 American Cancer Society. [ABSTRACT FROM AUTHOR]

Few studies have explored the perspectives of survivors of intimate partner violence (IPV) regarding their health and their children’s health, their experiences accessing and utilizing health care, and health initiatives that would best serve their families’ needs. We facilitated focus groups with female IPV survivors and adolescents who witnessed IPV. Women described their health and their children’s health as poor and reported challenges with health care utilization, whereas teenagers generally perceived their health as typical for their age. Participants requested health education workshops, community resources, and social support. This study lays the foundation for further research and the development of health initiatives. [ABSTRACT FROM AUTHOR]

Objective: To examine a library-based approach to addressing food insecurity through a child and adult summer meal programme. The study examines: (i) risk of household food insecurity among participants; (ii) perspectives on the library meal programme; and (iii) barriers to utilizing other community food resources.Design: Quantitative surveys with adult participants and qualitative semi-structured interviews with a sub-sample of adult participants.Setting: Ten libraries using public and private funding to serve meals to children and adults for six to eight weeks in low-income Silicon Valley communities (California, USA) during summer 2015.Subjects: Adult survey participants (≥18 years) were recruited to obtain maximum capture, while a sub-sample of interview participants was recruited through maximum variation purposeful sampling.Results: Survey participants (n 161) were largely Latino (71 %) and Asian (23 %). Forty-one per cent of participants screened positive for risk of food insecurity in the past 12 months. A sub-sample of programme participants engaged in qualitative interviews (n 67). Interviewees reported appreciating the library's child enrichment programmes, resources, and open and welcoming atmosphere. Provision of adult meals was described as building community among library patrons, neighbours and staff. Participants emphasized lack of awareness, misinformation about programmes, structural barriers (i.e. transportation), immigration fears and stigma as barriers to utilizing community food resources.Conclusions: Food insecurity remains high in our study population. Public libraries are ideal locations for community-based meal programmes due to their welcoming and stigma-free environment. Libraries are well positioned to link individuals to other social services given their reputation as trusted community organizations. [ABSTRACT FROM AUTHOR]

We used carbon and nitrogen isotopes to investigate changes in the diet of California condors from the Pleistocene to the recent. During the Pleistocene, condors from California fed on both terrestrial megafauna and marine mammals. Early accounts reported condors feeding on the carcasses of marine mammals, but by the late 1700s, condor diets had shifted predominantly to terrestrial animals, following the commercial harvesting of marine mammals and the development of cattle ranching on land. At present, dairy calves provided by humans significantly augment condor diet, constituting an artificial support of the current population. Reestablishing a marine mammal component in the condor diet may be an effective strategy for fostering viable condor populations independent of direct human subsidies. [ABSTRACT FROM AUTHOR]

The prevalence of smoking among homeless adults is approximately 70 %. Cessation programs designed for family shelters should be a high priority given the dangers cigarette smoke poses to children. However, the unique nature of smoking in the family shelter setting remains unstudied. We aimed to assess attitudes toward smoking cessation, and unique barriers and motivators among homeless parents living in family shelters in Northern California. Six focus groups and one interview were conducted (N = 33, ages 23-54). The focus groups and interviews were audiorecorded, transcribed verbatim, and a representative team performed qualitative theme analysis. Eight males and 25 females participated. The following major themes emerged: (1) Most participants intended to quit eventually, citing concern for their children as their primary motivation. (2) Significant barriers to quitting included the ubiquity of cigarette smoking, its central role in social interactions in the family shelter setting, and its importance as a coping mechanism. (3) Participants expressed interest in quitting 'cold turkey' and in e-cigarettes, but were skeptical of the patch and pharmacotherapy. (4) Feelings were mixed regarding whether individual, group or family counseling would be most effective. Homeless parents may be uniquely motivated to quit because of their children, but still face significant shelter-based social and environmental barriers to quitting. Successful cessation programs in family shelters must be designed with the unique motivations and barriers of this population in mind. [ABSTRACT FROM AUTHOR]

Background American Academy of Pediatrics guidelines emphasize regionalized systems of care for pediatric chronic illness. There remains a paucity of information on the status of regionalized systems of care for pediatric congenital heart disease (CHD). Objectives This study evaluated variations in use of pediatric cardiology specialty care centers (PCSCC) for pediatric patients with CHD in California between 1983 and 2011. Methods We performed a retrospective, total population analysis of pediatric CHD patients using the California Office of Statewide Health Planning and Development unmasked database. PCSCCs were identified by California's Title V program. Results There were 164,310 discharges meeting inclusion criterion. Discharges from PCSCCs grew from 58% to 88% between 1983 and 2011. Regionalized care was highest for surgical (96%) versus nonsurgical (71%) admissions. Admissions with a public payer increased from 42% (1983) to 61% (2011). Total bed days nearly doubled, and median length of stay increased from 2 to 3 days (nonspecialty care) and from 4 to 5 days (specialty care). There was a decrease in the pediatric CHD in-hospital death rate from 5.1 to 2.3 per 100,000 between 1983 and 2011, and a shift toward a larger percent of deaths occurring in the newborn period. Conclusions California’s inpatient regionalized specialty care of pediatric CHD has increased substantially since 1983, especially for surgical CHD discharges. The death rate has decreased, the number of bed days has increased, and a large proportion of these discharges now have public payers. Health care reform efforts must consider these shifts while protecting advances in regionalization of pediatric CHD care. [ABSTRACT FROM AUTHOR]

The American College of Cardiology andAmerican Heart Association guidelines recommend that management of adult congenital heart disease (ACHD) be coordinated by specialty ACHD centers and that ACHD surgery for patients with moderate or complex congenital heart disease (CHD) be performed by surgeons with expertise and training in CHD. Given this, the aim of this study was to determine the proportion of ACHD surgery performed at specialty ACHD centers and to identify factors associated with ACHD surgery being performed outside of specialty centers. This retrospective population analysis used California's Office of Statewide Health Planning and Development's discharge database to analyze ACHD cardiac surgery (in patients 21 to 65 years of age) in California from 2000 to 2011. Designation as a "specialty ACHD center" was defined on the basis of a national ACHD directory. A total of 4,611ACHD procedures were identified. The proportion of procedures in patients with moderate and complex CHD delivered at specialty centers increased from 46% to 71% from 2000 to 2011. In multivariate analysis among those discharges forACHDsurgery in patients with moderate or complexCHD, performance of surgery outside a specialty center was more likely to be associated with patients who were older, Hispanic, insured by health maintenance organizations, and living farther from a specialty center. In conclusion, although the proportion of ACHD surgery for moderate or complex CHDbeing performed at specialty ACHD centers has been increasing, 1 in 4 patients undergo surgery at nonspecialty centers. Increased awareness of ACHD care guidelines and of the patient characteristics associated with differential access to ACHD centers may help improve the delivery of appropriate care for all adults with CHD. [ABSTRACT FROM AUTHOR]

The supervision and monitoring of sex offenders has been one of the most hotly contested areas in corrections policy in recent years. The public has called for greater levels of offender scrutiny as the result of heinous acts perpetrated by sex offenders, while critics point to recent legislation with onerous housing restrictions coupled with public censure that prevent many offenders from reentering successfully into society. The current study provides a test of the effectiveness of GPS monitoring for high risk sex offender parolees over and above surveillance and monitoring provided by specialized sex offender caseloads. Using data from a GPS pilot program, 94 high risk sex offenders monitored by GPS and 91 high risk sex offenders on specialized caseloads were followed for 12 months. GPS sex offenders were less likely to be found guilty of failing to register as non-GPS sex offenders and marginally less likely to abscond– reflecting relative success in meeting two goals of sex offender legislation- knowing where sex offenders are and making sure they are registered. Additionally, GPS offenders were less likely to be found guilty of committing a new criminal violation; however we observed no significant differences in the type of new crime violation. [ABSTRACT FROM PUBLISHER]

Background Much is to be learned about what implementation strategies are the most beneficial to communities attempting to adopt evidence-based practices. This paper presents outcomes from a randomized implementation trial of Multidimensional Treatment Foster Care (MTFC) in child public service systems in California and Ohio, including child welfare, juvenile justice, and mental health. Methods Fifty-one counties were assigned randomly to one of two different implementation strategies (Community Development Teams (CDT) or independent county implementation strategy (IND)) across four cohorts after being matched on county characteristics. We compared these two strategies on implementation process, quality, and milestone achievements using the Stages of Implementation Completion (SIC) (Implement Sci 6(1):1-8, 2011). Results A composite score for each county, combining the final implementation stage attained, the number of families served, and quality of implementation, was used as the primary outcome. No significant difference between CDT and IND was found for the composite measure. Additional analyses showed that there was no evidence that CDT increased the proportion of counties that started-up programs (i.e., placed at least one family in MTFC). For counties that did implement MTFC, those in the CDT condition served over twice as many youth during the study period as did IND. Of the counties that successfully achieved program start-up, those in the CDT condition completed the implementation process more thoroughly, as measured by the SIC. We found no significant differences by implementation condition on the time it took for first placement, achieving competency, or number of stages completed. Conclusions This trial did not lead to higher rates of implementation or faster implementation but did provide evidence for more robust implementation in the CDT condition compared to IND implementation once the first family received MTFC services. This trial was successful from a design perspective in that no counties dropped out, even though this study took place during an economic recession. We believe that this methodologic approach of measurement utilizing the SIC, which is comprised of the three dimensions of quality, quantity, and timing, is appropriate for a wide range of implementation and translational studies. Trial registration Trial ID: NCT00880126 (ClinicalTrials.gov). [ABSTRACT FROM AUTHOR]

Objectives:To describe the experience of a low-income population during the transition from the neonatal intensive care unit (NICU) to home and to compare these experiences with pediatrician perspectives.Study Design:A prospective cohort study in a Level III, 40-bed NICU at a county hospital in Northern California affiliated with seven outpatient pediatric clinics. We surveyed parents in English or Spanish at discharge (n=79) and two weeks after discharge (n=49), along with outpatient pediatricians (n=17). Parents assessed experiences with discharge and the frequency with which barriers were encountered after discharge. We compared parent experiences with pediatrician estimates on four of these barriers.Result:Spanish survey participants had more difficulty finding a NICU doctor (P=0.05) or nurse (P=0.001) to answer their questions. After discharge, 16% of families experienced significant challenges with two or more barriers. In contrast, the majority of pediatricians estimated that 50% or more families had significant challenges with all four barriers.Conclusion:Communication difficulties were the most commonly reported barriers during the NICU stay and physicians overestimated the frequency that families experienced challenges after discharge. Parent input is important to create effective interventions aimed at improving care and limiting disparities. [ABSTRACT FROM AUTHOR]

Abstract: Objective: Illustrate the value of a strategy used for measuring the costs and resources used in the implementation process over and above the costs of the intervention itself in the context of a two-arm randomized controlled trial. Methods: Counties in California and Ohio (sites) were invited to implement Multidimensional Treatment Foster Care (MTFC), an alternative to congregate care for youth. Participating sites (n =53) were randomized to one of two implementation strategies, (1) Community Development Teams (CDT) where sites share information and move through the implementation process as a cohort facilitated by an MTFC purveyor or (2) Individual Implementation (IND: “as usual”) where sites work individually with the MTFC purveyor. The implementations were monitored using the Stages of Implementation Completion (SIC) measure of a number of observable activities, developed as part of the trial to segment the implementation process into 8 stages of implementation. Resource data gathered from the implementation purveyors and site participants were used to map costs onto each of the 8 stages to generate total cost measures stratified by type of resource and stage of implementation for each of the study arms. Results: The SIC provided a feasible costing template to map costs onto observable activities and to enable the examination of important differences in implementation strategies for an evidence-based practice. The average total implementation cost prior to program start-up of CDT was $133,106; IND costs $118,699. While CDT costs more in a number of stages, it resulted in fewer county staff hours being used and shorter mean times to implementation than IND. In cases where rapidity of implementation of reducing staff time required for implementation is valued, then CDT would be the preferable implementation approach. Conclusions: The SIC is a useful tool for determining implementation resources needed for new evidence-based practice programs for youth and particularly for comparing different implementation strategies that might be tried in pilot programs. [Copyright &y& Elsevier]

OBJECTIVE: Despite the documented utility of regionalized systems of pediatric specialty care, little is known about the actual use of such systems in total populations of chronically ill children. The objective of this study was to evaluate variations and trends in regional patterns of specialty care hospitalization for children with chronic illness in California. METHODS: Using California's Office of Statewide Health Planning and Development unmasked discharge data set between 1999 and 2007, we performed a retrospective, total-population analysis of variations in specialty care hospitalization for children with chronic illness in California. The main outcome measure was the use of pediatric specialty care centers for hospitalization of children with a chronic condition in California. RESULTS: Analysis of 2 170 102 pediatric discharges revealed that 41% had a chronic condition, and 44% of these were discharged from specialty care centers. Specialty care hospitalization varied by county and type of condition. Multivariate analyses associated increased specialty care center use with public insurance and high pediatric specialty care bed supply. Decreased use of regionalized care was seen for adolescent patients, black, non-Hispanic children, and children who resided in zip codes of low income or were located farther from a regional center of care. CONCLUSIONS: Significant variation exists in specialty care hospitalization among chronically ill children in California. These findings suggest a need for greater scrutiny of clinical practices and child health policies that shape patterns of hospitalization of children with serious chronic disease. [ABSTRACT FROM AUTHOR]

The article describes the initial phase of a randomized trial that tests two methods of implementing multidimensional treatment foster care, which is an evidence-based intervention that crosses child public service systems, in 40 non-early adopting California counties. The results presented support the feasibility of using a randomized design to test contrasting implementation models and engaging system leaders to participate in the clinical trial.

A central focus of pollination biology is to document the relative effectiveness of different flower visitors as pollinators. Ongoing research seeks to determine the role that introduced honey bees (Apis mellifera L.) play in the pollination of both invasive and native plants. Here we report on the importance of A. mellifera as pollinators of a California native plant, Triteleia laxa Bentham. In observation plots and transect censuses, A. mellifera overwhelmingly dominated the T. laxa flower visitor assemblage. We believe the proximity to agriculture, where A. nwllifera density is higher relative to areas far from agriculture, contributes to the discrepancy between A. mellifera abundance at the two sites. Although A. nwllifera were inferior flower visitors qualitatively (visited less flowers per minute), they were the most frequent interactors with flowers. Furthermore, the proportion of visits to flowers on the same plant among flower visitor species did not differ, suggesting a general mechanism by which insects forage at T. laxa flowers and that A. nwllifera do not cause more deleterious geitonogamy than do native pollinators. Flower visitation rates as a function of floral display size did not differ between A. mellifera and other flower visitors. The difference in the magnitude of flower visitation (largely by A. mellifera) between sites is consistent with a difference in seed set between sites. These results suggest that non-native A. mellifera bees can play an important role in the pollination of native plant species. [ABSTRACT FROM AUTHOR]

Orographic precipitation of Pacific-sourced moisture creates a rain shadow across the central part of the Sierra Nevada (California) that contrasts with the southern part of the range, where seasonal monsoonal precipitation sourced to the south obscures this rain shadow effect. Orographic rainout systematically lowers the hydrogen isotope composition of precipitation (δDppt) and therefore δDppt reflects a measure of the magnitude of the rain shadow. Hydrogen isotope compositions of volcanic glass (δDglass) hydrated at the earth's surface provide a unique opportunity to track the elevation and precipitation history of the Sierra Nevada and adjacent Basin and Range Province. Analysis of 67 well dated volcanic glass samples from widespread volcanic ash-fall deposits located from the Pacific coast to the Basin and Range Province demonstrates that between 0.6 and 12.1 Ma the hydrogen isotope compositions of meteoric water displayed a large (>40‰) decrease from the windward to the leeward side of the central Sierra Nevada, consistent with the existence of a rain shadow of modern magnitude over that time. Evidence for a Miocene-to-recent rain shadow of constant magnitude and systematic changes in the longitudinal climate and precipitation patterns strongly suggest that the modern first-order topographic elements of the Sierra Nevada characterized the landscape over at least the last 12 million years. [ABSTRACT FROM AUTHOR]

The article looks at outpatient drug costs for children in California with serious chronic illnesses who are covered in the fee-for-service component of the California Children's Services (CCS) public health insurance program for the period 2010 to 2012. It notes that over 40 percent of total pharmacy costs for the children studied were for antihemophilic agents.

This study sought to determine if pharmacies in Los Angeles County had implemented 2017 legislation requiring insurance companies based in California to fully reimburse for 13 cycles of oral contraceptives dispensed at once. We conducted a secret shopper telephone survey of Los Angeles County pharmacies nearly 5 years after the legislation went into effect. We chose the categorical state family program (Family PACT) to represent all programs covered by the legislation. Representative numbers of pharmacies were randomly selected in each of Los Angeles County's eight service planning areas in proportion to the number of women living in each area. We asked pharmacies if they would fill a prescription for a year's supply of contraception all at once for a patient enrolled in Family PACT. We contacted a total of 582 pharmacies and excluded the 150 unresponsive pharmacies. Of the 432 pharmacies contacted, only 3.2% said they would dispense a 1-year supply of pills at once to a patient enrolled in this representative program. Nearly 50% explicitly said they would not dispense 13 cycles at one time regardless of the prescription. Only 3.2% of surveyed pharmacies in Los Angeles County said they would comply with current legislation, which requires dispensing 1-year supply of pills at once. Collaboration among physicians, pharmacies, and patients along with enhanced insurance company oversight will be needed to improve dispensing practices to achieve the lower unintended pregnancy rates associated with providing adequate contraceptive supplies. [ABSTRACT FROM AUTHOR]

The author reflects on the proposal to reorganize the California Teachers' Association. The committee on reorganization is proposing to submit to the members in various sections a statement of what could be accomplished were the fee $3 or $5. According to the author, before California can take the next great step in advance her reorganization plans must provide for a membership fee sufficient to handle satisfactorily the many activities that are attaching themselves to the association.