Hospices in California have undergone significant and complicated ownership changes in recent years. Little is known about the impact of these ownership changes on hospices. The purpose of our longitudinal, retrospective descriptive study was to describe the ownership changes impacting hospices 2018 to 2021 in California. Using descriptive statistics, we measured characteristics of hospices with and without ownership changes employing public data from the California Home Health Agencies and Hospice Annual Utilization Report. Ownership change characteristics were measured via publicly available hospice provider and facility data. Spatial characteristics were additionally measured via latitude and longitude publicly available data. Our findings showed that ownership changes were significant and complicated. An influx of for-profit organizations into the California market was primarily responsible for these changes. Additionally, lack of corporate financial public disclosure and voluntary hospice accreditation, certification, and reporting result in a lack of free, publicly available, definitive comprehensive data on for-profit hospice ownership. This hinders information gathering on and provider/familial choice-making regarding hospices. Our study provides critical insight into the impact of ownership changes and lack of definitive, free, publicly available information on adult hospices in California caring for children and has important clinical, research, and policy implications.

Commercial fisheries along the US West Coast are important components of local and regional economies. They use various fishing gear, target a high diversity of species, and are highly spatially heterogeneous, making it challenging to generate a synoptic picture of fisheries activity in the region. Still, understanding the spatial and temporal dynamics of US West Coast fisheries is critical to meet the US legal mandate to manage fisheries sustainably and to better coordinate activities among a growing number of users of ocean space, including offshore renewable energy, aquaculture, shipping, and interactions with habitats and key non-fishery species such as seabirds and marine mammals. We analyzed vessel tracking data from Vessel Monitoring System (VMS) from 2010 to 2017 to generate high-resolution spatio-temporal estimates of contemporary fishing effort across a wide range of commercial fisheries along the entire US West Coast. We identified over 247,000 fishing trips across the entire VMS data, covering over 25 different fisheries. We validated the spatial accuracy of our analyses using independent estimates of spatial groundfish fisheries effort generated through the NOAA\'s National Marine Fisheries Service Observer Program. Additionally, for commercial groundfish fisheries operating in federal waters in California, we combined the VMS data with landings and ex-vessel value data from California commercial fisheries landings receipts to generate highly resolved estimates of landings and ex-vessel value, matching over 38,000 fish tickets with VMS data that included 87% of the landings and 76% of the ex-vessel value for groundfish. We highlight fisheries-specific and spatially-resolved patterns of effort, landings, and ex-vessel value, a bimodal distribution of fishing effort with respect to depth, and variable and generally declining effort over eight years. The information generated by our study can help inform future sustainable spatial fisheries management and other activities in the marine environment including offshore renewable energy planning.

OBJECTIVE: To describe the implementation of a test-negative design case-control study in California during the Coronavirus Disease 2019 (COVID-19) pandemic.
METHODS: Test-negative case-control study.
METHODS: Between February 24, 2021 - February 24, 2022, a team of 34 interviewers called 38,470 Californians, enrolling 1,885 that tested positive for SARS-CoV-2 (cases) and 1,871 testing negative for SARS-CoV-2 (controls) for 20-minute telephone survey. We estimated adjusted odds ratios for answering the phone and consenting to participate using mixed effects logistic regression. We used a web-based anonymous survey to compile interviewer experiences.
RESULTS: Cases had 1.29-fold (95% CI: 1.24-1.35) higher adjusted odds of answering the phone and 1.69-fold (1.56-1.83) higher adjusted odds of consenting to participate compared to controls. Calls placed from 4pm to 6pm had the highest adjusted odds of being answered. Some interviewers experienced mental wellness challenges interacting with participants with physical (e.g., food, shelter, etc.) and emotional (e.g., grief counseling) needs, and enduring verbal harassment from individuals called.
CONCLUSIONS: Calls placed during afternoon hours may optimize response rate when enrolling controls to a case-control study during a public health emergency response. Proactive check-ins and continual collection of interviewer experience(s) and may help maintain mental wellbeing of investigation workforce. Remaining adaptive to the dynamic needs of the investigation team is critical to a successful study, especially in emergent public health crises, like that represented by the COVID-19 pandemic.

Pesticides are critical for protecting agricultural crops, but the off-site transport of these materials via spray drift and runoff poses risks to surface waters and aquatic life. California\'s Central Coast region is a major agricultural hub in the United States characterized by year-round production and intensive use of pesticides and other chemical inputs. As a result, the quality of many waterbodies in the region has been degraded. A recent regulatory program enacted by the Central Coast Regional Water Quality Control Board set new pesticide limits for waterways and imposed enhanced enforcement mechanisms to help ensure that water quality targets are met by specific dates. This regulatory program, however, does not mandate specific changes to pest management programs. In this study, we evaluate the economic, environmental, and pest management impacts of adopting two alternative pest management programs with reduced risks to surface water: 1) replacing currently used insecticide active ingredients (AIs) that pose the greatest risk to surface water with lower-risk alternatives and 2) converting conventional arthropod pest management programs to organic ones. We utilize pesticide use and toxicity data from California\'s Department of Pesticide Regulation to develop our baseline and two alternative scenarios. We focus on three crop groups (cole crops, lettuce and strawberry) due to their economic importance to the Central Coast and use of high-risk AIs. For Scenario 1, we estimate that implementing the alternative program in the years 2017-2019 would have reduced annual net returns on average by $90.26 - $190.54/ha, depending on the crop. Increased material costs accounted for the greatest share of this effect (71.9%-95.6%). In contrast, Scenario 2 would have reduced annual net returns on average by $5,628.12 - $18,708.28/ha during the study period, with yield loss accounting for the greatest share (92.8-97.9%). Both alternative programs would have reduced the associated toxic units by at least 98.1% compared to the baseline scenario. Our analysis provides important guidance for policymakers and agricultural producers looking to achieve environmental protection goals while minimizing economic impacts.

This study quantifies the financial and environmental impacts of a microalgal bioenergy system that attempts to maximize circular flows by recovering and reusing the carbon, nutrients, and water within the system. The system produces microalgal biomass using liquid digestate of an anaerobic digester that processes 45 metric tons of food waste and generates 28.6 m3 of permeate daily in California, and three energy production scenarios from the biomass are considered: producing biodiesel, electricity, and both. In all scenarios, the resulting energy products delivered only modest reductions in environmental impacts as measured by carbon dioxide equivalent emissions. The carbon intensities (CIs) of biodiesel from this study were 91.0 gCO2e/MJ and 93.3 gCO2e/MJ, which were lower than 94.71 gCO2e/MJ of conventional petroleum diesel, and the CI of electricity from this study was 70.6 gCO2e/MJ, lower than the average electricity grid CI in California (82.92 gCO2e/MJ). The economic analysis results show that generating electricity alone can be profitable, while biodiesel produced via this system is not cost competitive with conventional diesel due to high capital expenses. Thus, generating electricity in lieu of biodiesel appears to be a better option to maximize the use of waste flows and supply lower-carbon energy.

Magnetic resonance imaging has been recommended as a primary imaging modality among high-risk individuals undergoing screening for pancreatic cancer. We aimed to delineate potential precursor lesions for pancreatic cancer on MR imaging.
We conducted a case-control study at Kaiser Permanente Southern California (2008-2018) among patients that developed pancreatic cancer who had pre-diagnostic MRI examinations obtained 2-36 months prior to cancer diagnosis (cases) matched 1:2 by age, gender, race/ethnicity, contrast status and year of scan (controls). Patients with history of acute/chronic pancreatitis or prior pancreatic surgery were excluded. Images underwent blind review with assessment of a priori defined series of parenchymal and ductal features. We performed logistic regression to assess the associations between individual factors and pancreatic cancer. We further assessed the interaction among features as well as performed a sensitivity analysis stratifying based on specific time-windows (2-3 months, 4-12 months, 13-36 months prior to cancer diagnosis).
We identified 141 cases (37.9% stage I-II, 2.1% III, 31.4% IV, 28.6% unknown) and 292 matched controls. A solid mass was noted in 24 (17%) of the pre-diagnostic MRI scans. Compared to controls, pre-diagnostic images from cancer cases more frequently exhibited the following ductal findings: main duct dilatation (51.4% vs 14.3%, OR [95% CI]: 7.75 [4.19-15.44], focal pancreatic duct stricture with distal (upstream) dilatation (43.6% vs 5.6%, OR 12.71 [6.02-30.89], irregularity (42.1% vs 6.0%, OR 9.73 [4.91-21.43]), focal pancreatic side branch dilation (13.6% vs1.6%, OR 11.57 [3.38-61.32]) as well as parenchymal features: atrophy (57.9% vs 27.4%, OR 46.4 [2.71-8.28], focal area of signal abnormality (39.3% vs 4.8%, OR 15.69 [6.72-44,78]), all p < 0.001).
In addition to potential missed lesions, we have identified a series of ductal and parenchymal features on MRI that are associated with increased odds of developing pancreatic cancer.

Wildfires are a significant threat to human health, in part through degraded air quality. Prescribed burning can reduce wildfire severity but can also lead to an increase in air pollution. The complexities of fires and atmospheric processes lead to uncertainties when predicting the air quality impacts of fire and make it difficult to fully assess the costs and benefits of an expansion of prescribed fire. By modeling differences in emissions, surface conditions, and meteorology between wildfire and prescribed burns, we present a novel comparison of the air quality impacts of these fire types under specific scenarios. One wildfire and two prescribed burn scenarios were considered, with one prescribed burn scenario optimized for potential smoke exposure. We found that PM2.5 emissions were reduced by 52%, from 0.27 to 0.14 Tg, when fires burned under prescribed burn conditions, considerably reducing PM2.5 concentrations. Excess short-term mortality from PM2.5 exposure was 40 deaths for fires under wildfire conditions and 39 and 15 deaths for fires under the default and optimized prescribed burn scenarios, respectively. Our findings suggest prescribed burns, particularly when planned during conditions that minimize smoke exposure, could be a net benefit for the impacts of wildfires on air quality and health.

The licensed cannabis industry represents one of the top five most economically valued agricultural commodities in California, yet farming largely remains on remote, environmentally sensitive, \"marginal\" lands. Using mixed methods, this paper examines the determinants of this marginalization, their embedded elaboration, and their relation to historical policy regimes. We used Generalized Additive Models (GAMs) to determine the most important predictors of licensed cannabis industry development since the inception of a statewide licensing program in 2018 and to compare the distribution of licensed cannabis to other forms of rural agriculture, including vineyards and pasture, to understand landscape factors and environmental sensitivity of land uses. We found that a county\'s median income and the extent of traditional (non-cannabis) agriculture, as measured by the proportion of on-farm (non-cannabis) employment, were both negatively associated with its amount of licensed cannabis agriculture. Ethnographic data suggests that cannabis is often excluded from traditional agricultural areas, through formal local-level bans, restrictive zoning, high \"prime\" farmland values, and cultural exclusions from other powerful resource users. The resulting relegation to \"marginal\" lands foments conflicts with amenity land users and environmentalists, even as it partly supports \"legacy\" cultivators whose farms were established under prior policy regimes. Results suggest that cannabis is more likely to be grown under conditions that introduce regulatory hurdles, including farming on steeper slopes, with natural streams onsite, and without access to large groundwater aquifers for irrigation. Our findings suggest that failure to allow licensed cannabis farming in traditional agriculture regions has led to a self-fulfilling prophecy wherein cannabis cultivation is largely relegated to environmentally sensitive areas where cultivation activity has an elevated tendency for environmental impacts.

OBJECTIVE: Data on vaccine-associated corneal transplant rejections are limited. We examined the association between graft rejection and vaccination.
METHODS: Matched case-control METHODS: We used electronic health records to identify corneal transplant recipients between January 2008 and August 2022 at Kaiser Permanente Southern California. Cases were transplant recipients who experienced a graft rejection (outcome) during the study period. Randomly selected controls who did not experience a corneal graft rejection at their matched cases\' index date (rejection date) were matched in a 3:1 ratio to cases. For controls, index date was determined by adding the number of days between transplant and graft rejection of their matched case to the control\'s transplant date.
RESULTS: The study included 601 cases and 1803 matched controls (mean age 66 years [s.d. 17.0], 52% female, 47% non-Hispanic white). Twenty-three% of cases and 22% of controls received ≥1 vaccinations within 12 weeks prior to the index date. The adjusted odds ratio (aOR) for vaccination in the 12 weeks prior to index date, comparing cases to controls was 1.17 (95% CI: 0.91, 1.50]). The aOR was 1.09 (0.84, 1.43) for 1 vaccination, 1.53 (0.90, 2.61) for 2 vaccinations, and 1.79 (0.55, 5.57) for ≥3 vaccinations. The aOR was 1.60 (0.81, 3.14) for mRNA vaccines, and 1.19 (0.80, 1.78) for adjuvanted/high dose vaccines.
CONCLUSIONS: We found no evidence to suggest an association between vaccination and graft rejection. Our findings provide support for the completion of recommended vaccinations for corneal transplant recipients, without significantly increasing the risk of graft rejection.

BACKGROUND: Inpatient total hip and total knee arthroplasty were substantially impacted by the SARS-CoV-2 (COVID-19) pandemic. We sought to characterize the transition of total joint arthroplasty (TJA) to the outpatient setting in 2 large state health systems during this pandemic.
METHODS: Adult patients who underwent primary elective TJA between January 1, 2016 and December 31, 2020 were retrospectively reviewed using the New York Statewide Planning and Research Cooperative System and California Department of Health Care Access and Information datasets. Yearly inpatient and outpatient case volumes and patient demographics, including age, sex, race, and payer coverage, were recorded. Continuous and categorical variables were compared using descriptive statistics. Significance was set at P < .05.
RESULTS: In New York during 2020, TJA volume decreased 16% because 22,742 fewer inpatient TJAs were performed. Much of this lost volume (46.6%) was offset by a 166% increase in outpatient TJA. In California during 2020, TJA volume decreased 20% because 34,114 fewer inpatient TJAs were performed. Much of this lost volume (37%) was offset by a 47% increase in outpatient TJA.
CONCLUSIONS: This present study demonstrates a marked increase in the proportion of TJA being performed on an outpatient basis in both California and New York. In both states, despite a decrease in overall TJA volume in 2020, outpatient TJA volume increased markedly.
METHODS: Therapeutic Level IV, Retrospective Cohort Study.