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Background: Hummingbirds are frequently presented to California wildlife rehabilitation centers for medical care, accounting for approximately 5% of overall admissions. Age, sex, and reason for admission could impact hummingbird survivability, therefore identification of these factors could help maximize rehabilitation efforts. Methods: Mixed-effects logistic regression models were used to identify specific threats to the survival of 6908 hummingbirds (1645 nestlings and 5263 nonnestlings) consisting of five species (Calypte anna, Calypte costa, Selasphorus rufus, Selasphorus sasin, Archilochus alexandri), found in urban settings, and admitted to California wildlife rehabilitation centers over 26 years. Results: In total, 36% of birds survived and were transferred to flight cage facilities for further rehabilitation and/or release. Nestlings were more likely to be transferred and/or released compared to adult hummingbirds. After accounting for age, birds rescued in spring and summer were twice as likely to be released compared to birds rescued in the fall. A high number of nestlings were presented to the rehabilitation centers during spring, which coincides with the nesting season for hummingbirds in California, with the lowest number of nestlings presented in fall. Reasons for presentation to rehabilitation centers included several anthropogenic factors such as window collisions (9.6%) and interactions with domesticated animals (12.9%). Survival odds were lower if a hummingbird was rescued in a "torpor-like state" and were higher if rescued for "nest-related" reasons. Evaluation of treatment regimens administered at wildlife rehabilitation centers identified supportive care, including providing commercial nutrient-rich nectar plus solution, to significantly increase hummingbird survivability. Discussion: Our results provide evidence of threats to hummingbirds in urban habitats, based on reasons for rescue and presentation to rehabilitation centers. Reasons for hummingbird admissions to three California wildlife rehabilitation centers were anthropogenic in nature (i.e., being associated with domestic animals, window collisions, and found inside a man-made structure) and constituted 25% of total admissions. There was a clear indication that supportive care, such as feeding a commercial nectar solution, and medical treatment significantly increased the odds of survival for rescued hummingbirds. [ABSTRACT FROM AUTHOR]

Objective  There is limited research exploring the relationship between design and patient safety outcomes, especially in maternal and neonatal care. We employed design thinking methodology to understand how the design of labor and delivery units impacts safety and identified spaces and systems where improvements are needed. Study Design  Site visits were conducted at 10 labor and delivery units in California. A multidisciplinary team collected data through observations, measurements, and clinician interviews. In parallel, research was conducted regarding current standards and codes for building new hospitals. Results  Designs of labor and delivery units are heterogeneous, lacking in consistency regarding environmental factors that may impact safety and outcomes. Building codes do not take into consideration workflow, human factors, and patient and clinician experience. Attitude of hospital staff may contribute to improving safety through design. Three areas in need of improvement and actionable through design emerged: (1) blood availability for hemorrhage management, (2) appropriate space for neonatal resuscitation, and (3) restocking and organization methods of equipment and supplies. Conclusion  Design thinking could be implemented at various stages of health care facility building projects and during retrofits of existing units. Through this approach, we may be able to improve hospital systems and environmental factors. [ABSTRACT FROM AUTHOR]

Background: Acetazolamide is the most common medication used for prevention of acute mountain sickness (AMS), usually administered the day or night before ascent. The objective of this study was to evaluate the efficacy of day of ascent dosing of acetazolamide for AMS prevention. Methods: Double-blind, randomized, controlled noninferiority trial of acetazolamide 125 mg twice daily beginning either the night before or the morning of ascent. Healthy low altitude adults ascended from 1240 m (4100 ft) to 3810 m (12,570 ft) during summer 2018 on White Mountain, California. Primary outcome was incidence of AMS with the two different dosing patterns, assessed by the 1993 Lake Louise Questionnaire (LLQ) of ≥3 with headache and a minimum of 1 for other symptom. Results: One hundred four participants completed the study, with 54 (52%) randomized to night before acetazolamide and 50 (48%) to day of ascent dosing, without differences in baseline characteristics. There was 9% greater incidence of AMS in the day of ascent acetazolamide group (48.0% vs. 39%, 95% confidence interval [CI] −11.8 to 30, p = 0.46, number needed to treat [NNT] = 5.6 vs. 3.7), with the CI just surpassing the predetermined 26% noninferiority margin. There was a lower incidence of severe AMS (1993 LLQ >5) in the day of ascent group (n = 5, 10%, NNT = 2.3) compared with night before dosing (n = 12, 22%, NNT = 3.1) (95% CI −28 to 3.6), and lower average symptom severity in the day of ascent group (3 vs. 3.5, 95% CI −0.5 to 1.4). Conclusions: Day of ascent acetazolamide demonstrated higher rates of AMS compared with traditional dosing by a small margin. With similar rates of severe AMS and overall symptom severity, the potential for improved convenience and compliance may support day of ascent use. [ABSTRACT FROM AUTHOR]

Background: Acute mountain sickness (AMS) is a common disease that may have a pulmonary component, as suggested by interstitial pulmonary edema quantified by the B-line score (BLS) on ultrasound (US). This subclinical pulmonary edema has been shown to increase with ascent to high altitude and AMS severity, but has not been prospectively associated with AMS incidence in a large prospective study. Materials and Methods: This prospective observational study was part of a randomized controlled trial enrolling healthy adults over four weekends ascending White Mountain, California. Subjects were assessed by lung US and the Lake Louise Questionnaire at 4110 ft (1240 m), upon ascent to 12,500 ft (3810 m), and the next morning at 12,500 ft (3810 m). Results: Three hundred five USs in total were completed on 103 participants, with 73% total incidence of AMS. The mean (±standard deviation) BLS increased from baseline (1.15 ± 1.80) to high altitude (2.56 ± 2.86), a difference of 1.37 (±2.48) (p = 0.04). Overall BLS was found, on average, to be higher among those diagnosed with AMS than without (2.97 vs. 2.0, p = 0.04, 95% confidence interval [CI] −∞ to −0.04). The change in BLS (ΔBLS) from low altitude baseline was significantly associated with AMS (0.88 vs. 1.72, r2 = 0.023, 95% CI −∞ to −0.01, p = 0.048). Conclusions: Interstitial subclinical pulmonary edema by lung US was found to have a small but significant association with AMS. [ABSTRACT FROM AUTHOR]

Background: Acute mountain sickness is a common occurrence for travel to high altitudes. Although previous studies of ibuprofen have shown efficacy for the prevention of acute mountain sickness, recommendations have been limited, as ibuprofen has not been compared directly with acetazolamide until this study.Methods: Before their ascent to 3810 m on White Mountain in California, adult volunteers were randomized to ibuprofen (600 mg, 3 times daily, started 4 hours before the ascent), or to acetazolamide (125 mg, twice daily, started the night before the ascent). The main outcome measure was acute mountain sickness incidence, using the Lake Louise Questionnaire (LLQ), with a score of >3 with headache. Sleep quality and headache severity were measured with the Groningen Sleep Quality Survey (GSQS). This trial was registered at ClinicalTrials.gov: NCT03154645 RESULTS: Ninety-two participants completed the study: 45 (49%) on ibuprofen and 47 (51%) on acetazolamide. The total incidence of acute mountain sickness was 56.5%, with the incidence for the ibuprofen group being 11% greater than that for acetazolamide, surpassing the predetermined 26% noninferiority margin (62.2% vs 51.1%; 95% confidence interval [CI], -11.1 to 33.5). No difference was found in the total LLQ scores or subgroup symptoms between drugs (P = .8). The GSQS correlated with LLQ sleep (r = 0.77; 95% CI, 0.67-0.84)=%. The acetazolamide group had higher peripheral capillary oxygen saturation than the ibuprofen group (88.5% vs 85.6%; P = .001).Conclusion: Ibuprofen was slightly inferior to acetazolamide for acute mountain sickness prevention and should not be recommended over acetazolamide for rapid ascent. Average symptoms and severity were similar between drugs, suggesting prevention of disease. [ABSTRACT FROM AUTHOR]

Objective:We documented time to key milestones and determined reasons for transport-related delays during simulated emergency cesarean.Study Design:Prospective, observational investigation of delivery of care processes by multidisciplinary teams of obstetric providers on the labor and delivery unit at Lucile Packard Children's Hospital, Stanford, CA, USA, during 14 simulated uterine rupture scenarios. The primary outcome measure was the total time from recognition of the emergency (time zero) to that of surgical incision.Result:The median (interquartile range) from time zero until incision was 9 min 27 s (8:55 to 10:27 min:s).Conclusion:In this series of emergency cesarean drills, our teams required approximately nine and a half minutes to move from the labor room to the nearby operating room (OR) and make the surgical incision. Multiple barriers to efficient transport were identified. This study demonstrates the utility of simulation to identify and correct institution-specific barriers that delay transport to the OR and initiation of emergency cesarean delivery. [ABSTRACT FROM AUTHOR]

In October 2007, wildfires burned nearly 300,000 acres in San Diego County, California. Emergency risk communication messages were broadcast to reduce community exposure to air pollution caused by the fires. The objective of this investigation was to determine residents’ exposure to, understanding of, and compliance with these messages. From March to June 2008, the authors surveyed San Diego County residents using a 40-question instrument and random digit dialing. The 1,802 respondents sampled were predominantly 35–64 years old (65.9%), White (65.5%), and educated past high school (79.0%). Most (82.5%) lived more than 1 mile away from the fires, although many were exposed to smoky air for 5–7 days (60.7%) inside and outside their homes. Most persons surveyed reported hearing fire-related health messages (87.9%) and nearly all (97.9%) understood the messages they heard. Respondents complied with most to all of the nontechnical health messages, including staying inside the home (58.7%), avoiding outdoor exercise (88.4%), keeping windows and doors closed (75.8%), and wetting ash before cleanup (75.6%). In contrast, few (<5%) recalled hearing technical messages to place air conditioners on recirculate, use High-Efficiency Particulate Air filters, or use N-95 respirators during ash cleanup, and less than 10% of all respondents followed these specific recommendations. The authors found that nontechnical message recall, understanding, and compliance were high during the wildfires, and reported recall and compliance with technical messages were much lower. Future disaster health communication should further explore barriers to recall and compliance with technical recommendations. [ABSTRACT FROM PUBLISHER]

This article addresses the problem of estimating the potential economic and environmental gains for utility grids of shifting the electric-vehicle (EV) charging time and location. The current literature on shifting EV charging loads has been limited by real-world data availability and has typically therefore relied on simulated studies. Collaborating with a large automobile company and a major utility grid operator in California, this research used actual EV operational data and grid-operation data including locational marginal prices, marginal-grid-emission-rate data, and renewable-energy-generation ratio information. With assumptions about the future potential availability of EV charging stations, this research estimated the maximum potential gains in the economic and environmental performance of the electrical-grid operation by optimizing the time and location of EV charging. For the problem of rescheduling the charging sessions, the optimization models and objective functions were specifically designed based on the information available to the energy system operators that influence their economic and environmental performance like grid congestion, emissions, and renewable energy. The results present the maximum potential in reducing the operational costs and the marginal emissions and increasing the renewable energy use in the utility grid by rescheduling the EV charging load with respect to its time and location. The analysis showed that the objective functions of minimizing the marginal cost or the marginal emission rate performed the best overall. [ABSTRACT FROM AUTHOR]

This study focuses on determining the impacts and potential value of unmanaged and managed uni-directional and bi-directional charging of plug-in electric vehicles (PEVs) to integrate intermittent renewable resources in California in the year 2030. The research methodology incorporates the utilization of multiple simulation tools including V2G-SIM, SWITCH, and GridSim. SWITCH is used to predict a cost-effective generation portfolio to meet the renewable electricity goals of 60% in California by 2030. PEV charging demand is predicted by incorporating mobility behavior studies and assumptions charging infrastructure and vehicle technology improvements. Finally, the production cost model GridSim is used to quantify the impacts of managed and unmanaged vehicle-charging demand to electricity grid operations. The temporal optimization of charging sessions shows that PEVs can mitigate renewable oversupply and ramping needs substantially. The results show that 3.3 million PEVs can mitigate over-generation by ~4 terawatt hours in California—potentially saving the state up to about USD 20 billion of capital investment costs in stationary storage technologies. [ABSTRACT FROM AUTHOR]

Abstract: Understanding the key factors influencing policy perception can be critical for informing the design of public policies. Feebates is a unique public policy that is meant to influence vehicle purchases. It presents buyers with a rebate for purchasing low-emission vehicles and a fee for purchasing high-emission vehicles. Because feebates directly impacts the consumer, understanding the dynamics of public perception, support, and opposition is important. This study explores the public perception of a potential feebate policy within California, and evaluates the robustness of an ordinal regression model to predict policy sentiment. The authors conducted a series of 12 focus groups throughout the State, which were followed by a computer-assisted telephone interview (CATI) survey of 3072 California residents in Fall 2009. The survey results were used to gain insights into consumer response to the policy, while focus groups gauged participant understanding of the feebate concept and overall response in preparation for the statewide survey. The survey data was weighted to match key demographics of the population and probed respondents on sentiments towards climate change, foreign oil dependence, policy fairness as well as overall perceptions of the policy. The results suggested that roughly three quarters (~76%) of the population would have supported a feebate policy, while one-in-five (~22%) would have opposed it. To evaluate how key factors simultaneously influence policy support/opposition, the authors estimated an ordinal regression model on policy support, which could correctly re-predict 89.4% of the sample׳s policy support or opposition. To assess the model׳s robustness, it was validated through re-estimation with 10,000 randomly drawn subsamples. Models estimated using these subsamples were then applied to predict policy perception for the remaining hold-out sample. The model performed very well, as hold-out sample opinions were predicted at an average accuracy of 89.1%, with little variance in performance. The authors conclude with a discussion of the implications of these results on public support for feebates and comment on the use of ordinal regression to predict policy opinion. [Copyright &y& Elsevier]

Abstract: Over the last several decades, hydrogen fuel cell vehicles (FCVs) have emerged as a zero tailpipe-emission alternative to the battery electric vehicle (EV). To address questions about consumer reaction to FCVs, this report presents the results of a “ride-and-drive” clinic series (N =182) held in 2007 with a Mercedes-Benz A-Class “F-Cell” hydrogen FCV. The clinic evaluated participant reactions to driving and riding in an FCV, as well as vehicle refueling. Pre-and post-clinic surveys assessed consumer response. More than 80% left with a positive overall impression of hydrogen. The majority expressed a willingness to travel 5–10min to find a hydrogen station. More than 90% of participants would consider an FCV driving range of 300miles (480km) to be acceptable. Stated willingness-to-pay preferences were explored. The results show that short-term exposure can improve consumer perceptions of hydrogen performance and safety among people who are the more likely early adopters. [Copyright &y& Elsevier]

Background: Older populations are increasing and comprise a substantial portion of high-altitude travelers. Aging physiology may influence susceptibility to acute mountain sickness, though prior research remains inconclusive. The goal of this study was to investigate the relationship between increasing age and acute mountain sickness.Methods: This study was a pooled analysis of 5 prospective randomized controlled trials conducted at White Mountain, California from 2010, 2016-2019 with identical 4-hour rapid ascent from 1242 m to overnight sojourn at 3810 m. Acute mountain sickness was defined by the 2018 Lake Louise Questionnaire criteria.Results: There were 491 participants analyzed, 234 (48%) diagnosed with acute mountain sickness and 71 (14%) with moderate acute mountain sickness. Mean age was 37 years (±13). There was no significant correlation between Lake Louise Questionnaire severity and age (r = -0.02; 95% confidence interval [CI], -0.11-0.07, P = .7), 40-year-old dichotomy (t = -0.6; 95% CI, -0.53-0.28, P = .6), or decade of life (P = .4). Logistic regression found no increased odds of acute mountain sickness for increasing age by decade of life (odds ratio [OR] 1.0; 95% CI, 0.97-1.0) or 40-year-old dichotomy (OR 1.4; 95% CI, 0.97-2.1). A history of acute mountain sickness increased odds of acute mountain sickness (OR 3.2; 95% CI, 1.5-7.7).Conclusions: Older age was not associated with incidence nor severity of acute mountain sickness. A history of altitude illness increased odds of acute mountain sickness and should be used for pre-ascent risk stratification. [ABSTRACT FROM AUTHOR]

• Study of six electric vehicle-grid integration use cases in a real-world smart charging project. • Included over 400 Northern California households in the largest pilot project of its type. • Analyzes efficacy of electric vehicle charge shifting strategies across time and space. • Demonstrates ability to shift electric vehicle charging patterns with a driver incentive. • Finds that 15–30% of charge was shifted in/out of any given hour depending on case. Management of electric vehicle (EV) charging is likely to be critical in avoiding large increases in peak electricity demand and subsequent build outs of generation and distribution infrastructure. Additionally, management of EV charging can help to more effectively utilize renewable energy resources. This study analyzed charging data from a real-world pilot program, the largest household-based study to date to analyze the effectiveness of different smart charging use cases at reducing charging costs and increasing utilization of renewable energy. The study included six different use cases that featured varying optimization signals and driver incentives. Study results suggest that the optimizations are effective at shifting load from times of high grid costs and congestion, most notably during early evening hours, to times of lower grid costs in the early morning and midday. The study finds that 15–20% of charge was shifted out of any given hour and 20–30% of charge was shifted into a given hour in the most effective use cases. In addition to shifting charging across time periods, charging events were also effectively shifted to different locations during some use cases, such as from overnight at households to during the day at workplaces. [ABSTRACT FROM AUTHOR]

In response to biodiversity loss and biotic community homogenization in urbanized landscapes, there are increasing efforts to conserve and increase biodiversity within urban areas. Accordingly, around the world, previously extirpated species are (re)colonizing and otherwise infiltrating urban landscapes, while other species are disappearing from these landscapes. Tracking the occurrence of traditionally urban intolerant species and loss of traditionally urban tolerant species should be a management goal of urban areas, but we generally lack tools to study this phenomenon. To address this gap, we first used species' occurrences from iNaturalist, a large collaborative dataset of species observations, to calculate an urban association index (UAI) for 967 native animal species that occur in the city of Los Angeles. On average, the occurrence of native species was negatively associated with our composite measure of urban intensity, with the exception of snails and slugs, which instead occur more frequently in areas of increased urban intensity. Next, we assessed 8,348 0.25 x 0.25 mile grids across the City of Los Angeles to determine the average grid-level UAI scores (i.e., a summary of the UAIs present in a grid cell, which we term Community Urban Tolerance Index or CUTI). We found that areas of higher urban intensity host more urban tolerant species, but also that taxonomic groups differ in their aggregate tolerance of urban areas, and that spatial patterns of tolerance vary between groups. The framework established here has been designed to be iteratively reevaluated by city managers of Los Angeles in order to track the progress of initiatives to preserve and encourage urban biodiversity, but can be rescaled to sample different regions within the city or different cities altogether to provide a valuable tool for city managers globally., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Curti et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)