Thermotogota diversity and distribution patterns revealed in Auka and JaichMaa 'ja 'ag hydrothermal vent fields in the Pescadero Basin, Gulf of California.

Discovering new deep hydrothermal vent systems is one of the biggest challenges in ocean exploration. They are a unique window to elucidate the physical, geochemical, and biological processes that occur on the seafloor and are involved in the evolution of life on Earth. In this study, we present a molecular analysis of the microbial composition within the newly discovered hydrothermal vent field, JaichMaa 'ja 'ag, situated in the Southern Pescadero Basin within the Gulf of California. During the cruise expedition FK181031 in 2018, 33 sediment cores were collected from various sites within the Pescadero vent fields and processed for 16S rRNA amplicon sequence variants (ASVs) and geochemical analysis. Correlative analysis of the chemical composition of hydrothermal pore fluids and microbial abundances identified several sediment-associated phyla, including Thermotogota, that appear to be enriched in sediment horizons impacted by hydrothermal fluid flow. Comparative analysis of Thermotogota with the previously explored Auka hydrothermal vent field situated 2 km away displayed broad similarity between the two locations, although at finer scales (e.g., ASV level), there were notable differences that point to core-to-core and site-level factors revealing distinct patterns of distribution and abundance within these two sediment-hosted hydrothermal vent fields. These patterns are intricately linked to the specific physical and geochemical conditions defining each vent, illuminating the complexity of this unique deep ocean chemosynthetic ecosystem.

The health benefits of reducing micro-heat islands: A 22-year analysis of the impact of urban temperature reduction on heat-related illnesses in California's major cities.

This study investigates the relationship between temporal changes in temperatures characterizing local urban heat islands (UHIs) and heat-related illnesses (HRIs) in seven major cities of California. UHIs, which are a phenomenon that arises in the presence of impervious surfaces or the lack of green spaces exacerbate the effects of extreme heat events, can be measured longitudinally using satellite products. The two objectives of this study were: (1) to identify temperature trends in local temperatures to characterize UHIs across zip code tabulation areas (ZCTAs) in the seven observed cities over a 22-year period and (2) to use propensity score and inverse probability weighting to achieve exchangeability between different types of ZCTAs and assess the difference in hospital admissions recorded as HRIs attributable to temporal changes in UHIs. We use monthly land surface temperature data derived from MODIS Terra imagery from the summer months (June-September) from 2000 to 2022. We categorized ZCTAs (into three groups) based on their monthly land surface temperature trends. Of the 216 ZCTAs included in this study, the summertime land surface temperature trends of 43 decreased, while 161 remained unchanged, and 12 increased. Los Angeles had the greatest number of decreased ZCTAs, San Diego and San Jose had the highest number of increased ZCTAs. To analyze the number of monthly HRI attributable to changes in UHI, we used inverse probability of treatment weighting to analyze the difference in HRI between the years of 2006 and 2017 which were two major extreme heat events over the entire State. We observed an average reduction of 3.2 (95 % CI: 0.5; 5.9) HRIs per month and per ZCTAs in decreased neighborhoods as compared to unchanged. This study emphasizes the importance of urban climate adaptation strategies to mitigate the intensity and prevalence of UHIs to reduce health risks related to heat.

Naloxone and Patient Outcomes in Out-of-Hospital Cardiac Arrests in California.

Importance: The incidence of opioid-associated out-of-hospital cardiac arrest (OA-OHCA) has grown from less than 1% of OHCA in 2000 to between 7% and 14% of OHCA in recent years; American Heart Association (AHA) protocols suggest that emergency medical service (EMS) clinicians consider naloxone in OA-OHCA. However, it is unknown whether naloxone improves survival in these patients or in patients with undifferentiated OHCA. Objective: To evaluate the association of naloxone with clinical outcomes in patients with undifferentiated OHCA. Design, Setting, and Participants: Retrospective cohort study of EMS-treated patients aged 18 or older who received EMS treatment for nontraumatic OHCA in 3 Northern California counties between 2015 and 2023. Data were analyzed using propensity score-based models from February to April 2024. Exposure: EMS administration of naloxone. Main Outcomes and Measures: The primary outcome was survival to hospital discharge; the secondary outcome was sustained return of spontaneous circulation (ROSC). Covariates included patient and cardiac arrest characteristics (eg, age, sex, nonshockable rhythm, any comorbidity, unwitnessed arrest, and EMS agency) and EMS clinician determination of OHCA cause as presumed drug-related. Results: Among 8195 patients (median [IQR] age, 65 [51-78] years; 5540 male [67.6%]; 1304 Asian, Native Hawaiian, or Pacific Islander [15.9%]; 1119 Black [13.7%]; 2538 White [31.0%]) with OHCA treated by 5 EMS agencies from 2015 to 2023, 715 (8.7%) were believed by treating clinicians to have drug-related OHCA. Naloxone was administered to 1165 patients (14.2%) and was associated with increased ROSC using both nearest neighbor propensity matching (absolute risk difference [ARD], 15.2%; 95% CI, 9.9%-20.6%) and inverse propensity-weighted regression adjustment (ARD, 11.8%; 95% CI, 7.3%-16.4%). Naloxone was also associated with increased survival to hospital discharge using both nearest neighbor propensity matching (ARD, 6.2%; 95% CI, 2.3%-10.0%) and inverse propensity-weighted regression adjustment (ARD, 3.9%; 95% CI, 1.1%-6.7%). The number needed to treat with naloxone was 9 for ROSC and 26 for survival to hospital discharge. In a regression model that assessed effect modification between naloxone and presumed drug-related OHCA, naloxone was associated with improved survival to hospital discharge in both the presumed drug-related OHCA (odds ratio [OR], 2.48; 95% CI, 1.34-4.58) and non-drug-related OHCA groups (OR, 1.35; 95% CI, 1.04-1.77). Conclusions and Relevance: In this retrospective cohort study, naloxone administration as part of EMS management of OHCA was associated with increased rates of ROSC and increased survival to hospital discharge when evaluated using propensity score-based models. Given the lack of clinical practice data on the efficacy of naloxone in OA-OHCA and OHCA in general, these findings support further evaluation of naloxone as part of cardiac arrest care.

Seismic hazard analysis and financial impact assessment of railway infrastructure in the US West Coast: A machine learning approach.

This research examines the seismic hazard impact on railway infrastructure along the U.S. West Coast (Washington, Oregon and California), using machine learning to explore how measures of seismic hazard such as fault density, earthquake frequency, and ground shaking relate to railway infrastructure accidents. By comparing linear and non-linear models, it finds non-linear approaches superior, particularly noting that higher fault densities and stronger peak ground shaking correlate with increased infrastructure accident rates. Shallow earthquakes with magnitudes of 3.5 or greater and hypocentral depths <20 km also exhibit a pronounced correlation with the incidence of railway infrastructure accidents The study extends to financial impact analysis through Net Present Value and Monte Carlo Simulation, and evaluates damage costs from 2000-2023 to guide financial planning and risk management strategies. It highlights the crucial role of advanced financial tools in optimizing maintenance and long-term planning that could result in better preparedness in high seismic hazard regions and emphasizes the need for robust risk management strategies in enhancing railway operational safety that considers the local and regional tectonic and seismic activity and local ground shaking intensity.

Acute Kidney Injury in Hospitalized Patients With Exertional Rhabdomyolysis.

Importance: An association between serum creatine kinase (CK) levels and the risk of kidney failure in patients with exertional rhabdomyolysis (ERM) has been suggested. However, the actual incidence of AKI in hospitalized patients with ERM along with the contributing cofactors that may increase the risk of AKI have rarely been investigated. Objectives: To examine the incidence of kidney injury in hospitalized patients with ERM and to identify additional cofactors that might contribute to the development of kidney injury in patients with ERM. Design, Setting, and Participants: This retrospective cohort study was conducted in a diverse community population of patients 18 years or older with ERM who were hospitalized across Kaiser Permanente Northern California between January 1, 2009, and December 31, 2019. Patients were initially identified through electronic screening for all-cause rhabdomyolysis admissions, followed by manual medical record reviews to verify their eligibility for the study. The diagnosis of AKI and chronic kidney disease (CKD) was determined using KDIGO (Kidney Disease Improving Global Outcomes) criteria and confirmed by medical record review. Data analysis was performed from October 1, 2023, to January 31, 2024. Exposures: History of strenuous physical exercise before hospitalization for ERM. Main Outcome and Measures: Development of AKI, CKD, and compartment syndrome and number of deaths. Results: Among 3790 patients hospitalized for rhabdomyolysis between 2009 and 2019 in Kaiser Permanente Northern California, 200 (mean [SD] age, 30.5 [8.5] years; 145 [72.5%] male) were confirmed to have ERM via medical record review. Seventeen patients (8.5%) developed AKI, none developed CKD, 1 (0.5%) developed compartment syndrome, and there were no fatalities. There was no association between serum CK levels and the risk of AKI. However, the risk of AKI was significantly higher in patients with ERM who used nonsteroidal anti-inflammatory drugs (NSAIDs) before admission (11 of 17 with AKI [64.7%] vs 40 of 183 without AKI [21.9%], P < .001) or experienced dehydration (9 of 183 without AKI [52.9%] vs 9 of 17 with AKI [4.9%], P < .001). This analysis suggests that eliminating preadmission NSAID use and dehydration could reduce the risk of potential AKI in patients with ERM by 92.6% (95% CI, 85.7%-96.1%) in this population. Conclusions and Relevance: The findings of this cohort study of hospitalized patients with ERM suggest that serum CK elevation alone is insufficient as an indicator of AKI in patients with ERM. Concurrent risk factors, such as NSAID use or dehydration, may be associated with AKI development in patients with ERM.

Continued Homelessness and Depressive Symptoms in Older Adults.

Importance: Depression is common in adults experiencing homelessness. It is unclear whether continued homelessness is associated with more depressive symptoms. Objective: To examine the association between residential status and depressive symptoms in adults aged 50 years or older experiencing homelessness at study entry. Design, Setting, and Participants: This cohort study analyzed results from the Health Outcomes of People Experiencing Homelessness in Older Middle Age (HOPE HOME) project, which in 2013 began enrolling adults aged 50 years or older experiencing homelessness in Oakland, California, and conducted structured interviews every 6 months for a mean duration of 5.5 years through 2023 (for this cohort study). Eligible participants included those aged 50 years or older, able to speak English, and experiencing homelessness at enrollment. We analyzed data collected from 2013 to 2023. Exposures: The exposure of interest was residential status. At follow-up visits, residential status was categorized as (1) homelessness (meeting the HEARTH [Homeless Emergency Assistance and Rapid Transition to Housing] Act definition) or (2) housed (living in a noninstitutional environment and not meeting the HEARTH Act definition). Main Outcomes and Measures: The primary outcome was moderate to severe depressive symptoms (with Center for Epidemiologic Studies-Depression [CES-D] scale score ≥22). The augmented inverse probability of treatment weighting (AIPTW) approach was used to examine the association between continued homelessness and depressive symptoms. The AIPTW adjusted for the following variables: number of chronic health conditions, age, sex, visiting a health care practitioner, receiving outpatient mental health treatment, receiving mental health medication, exposure to abuse, substance use disorder, and binge drinking. Results: The cohort was composed of 450 participants, of whom 343 (76.2%) were males, and the mean (SD) age was 58.5 (5.2) years. Participants completed a median (IQR) of 8.9 (8-11) follow-up visits. With 1640 person-years of observation time, participants continued homelessness for 880 person-years (57.1%) and experienced being housed for 715 person-years (44.3%). Many participants (304 [78.0%]) were housed during at least 1 follow-up visit. The odds of a CES-D scale score of 22 or higher was significantly higher among participants who continued experiencing homelessness than among housed participants (marginal causal odds ratio, 1.08; 95% CI, 1.04-1.11; P < .001). Conclusions and Relevance: This cohort study found that continued homelessness was associated independently with increased odds of depressive symptoms. Obtaining housing may have a favorable role in depression and overall well-being of older adults experiencing homelessness and may be considered as a mental health intervention.

The Impact of Changing Abortion Legislation on Emergency Medicine Residents in a State With Protected Abortion Rights.

Background The US Supreme Court's 2022 ruling in Dobbs v Jackson Women's Health Organization overturned Roe v Wade, allowing individual states to determine abortion restrictions, significantly impacting graduate medical education (GME). While focus has been on states enacting restrictions, the impacts in states where abortion rights are safeguarded are equally important. Emergency medicine (EM) serves as a safety net within the health care system, making it ideal for understanding the broader implications of these legal changes on GME. Objective To explore the experiences and perspectives of EM residents regarding changing abortion legislation in California, an abortion-protective state. Methods We conducted a qualitative study using transcendental phenomenology. Thirteen postgraduate year 4 EM residents from a single large university-based program in California participated in semistructured interviews in 2023. Data were analyzed using thematic analysis. Results Four themes were identified: (1) impact of changing abortion legislation on practice; (2) personal and professional decisions influenced by legislation; (3) navigating legal uncertainties in practice; and (4) advocacy and engagement beyond clinical practice. Residents reported varying levels of awareness and concern about the implications of abortion laws on EM practice, the influence of these laws on their career decisions, the need for legal guidance, and a commitment to advocacy. These themes highlight a complex interplay between legal changes, personal values, and professional responsibilities. Conclusions This study highlights the significant impact of the Dobbs decision on EM residents in California, revealing that residents face unique ethical, legal, and advocacy challenges that may affect their professional identity formation.

Longitudinal assessment of the impact of COVID-19 infection on mask-wearing behaviors.

BACKGROUND: Wearing a mask was a crucial component in slowing the COVID-19 pandemic. However, little is known about the intersectionality between mask usage, risk perception, and infection. The purpose of this study was to investigate whether risk perceptions and masking behaviors are associated with contracting SARS-CoV-2 and how contracting SARS-CoV-2 subsequently changes masking behaviors in specific situations. METHODS: This cohort study utilized survey data from the UC San Diego ZAP COVID-19 study (n = 1,230) to evaluate the risk of contracting SARS-CoV-2 in relation to baseline risk perceptions and masking behaviors in various situations and how contracting SARS-CoV-2 affects subsequent masking behavior. RESULTS: We found that more consistent self-reported mask use in indoor public spaces (p = 0.03) and in other people's houses (p = 0.002) was associated with remaining free of SARS-CoV-2 infection. We also found that contracting SARS-CoV-2 was associated with a subsequent increase in mask use in other people's houses (p = 0.01). CONCLUSIONS: Our findings suggest that consistent mask use is correlated with decreased infection and that contracting SARS-CoV-2 may modify mask use behaviors in high-risk situations. These findings may help inform future public health messaging for infectious disease prevention. TRIAL REGISTRATION: This study has not been previously registered as it is an observational study. There was no pre-registration of the analytic plan for the present study.

Formulary Reconciliation: Implementation of a Comprehensive Approach to Formulary Maintenance and Standardization.

At our institution UC San Diego Health, formulary qualifiers such as indication expansions and restrictions based on provider specialty, patient location, or patient characteristics are input as free text into an online formulary platform. Inconsistency in formulary categories and their descriptions since the implementation of the electronic system have led to confusion and inconsistent formulary application amongst staff. We reviewed 880 unique medications with formulary qualifiers to standardize both categories and language. There were 537 items with inpatient restrictions (eg, restricted to service), 147 items with a restriction to outpatient use only, 94 items with a formulation restriction, 91 items with associated guidelines, and 11 items with formulary expansions. Formulary status descriptions were updated to be consistent and clear. A standardized and well-maintained formulary, via formulary reconciliation, can provide concise and informative insight to the formulary status for frontline healthcare staff.

Factors Associated with Patient Engagement in a Health and Social Needs Case Management Program.

INTRODUCTION: Many patients offered case management services to address their health and social needs choose not to engage. Factors that drive engagement remain unclear. We sought to understand patient characteristics associated with engagement in a social needs case management program and variability by case manager. METHODS: Between August 2017 and February 2021, 43,347 Medicaid beneficiaries with an elevated risk of hospital or emergency department use were offered case management in Contra Costa County, California. Results were analyzed in 2022 using descriptive statistics and multilevel logistic regression models to examine 1) associations between patient engagement and patient characteristics and 2) variation in engagement attributable to case managers. Engagement was defined as responding to case manager outreach and documentation of at least 1 topic to mutually address. A sensitivity analysis was performed by stratifying the pre-COVID-19 and COVID-19 cohorts. RESULTS: A total of 16,811 (39%) of eligible patients engaged. Adjusted analyses indicate associations between higher patient engagement and female gender, age 40 and over, Black/African American race, Hispanic/Latino ethnicity, history of homelessness, and a medical history of certain chronic conditions and depressive disorder. The intraclass correlation coefficient indicates that 6% of the variation in engagement was explained at the case manager level. CONCLUSIONS: Medicaid patients with a history of housing instability and specific medical conditions were more likely to enroll in case management services, consistent with prior evidence that patients with greater need are more receptive to assistance. Case managers accounted for a small percentage of variation in patient engagement.

Stakeholder-informed pragmatic trial protocol of the TabCAT-BHA for the detection of cognitive impairment in primary care.

BACKGROUND: Cognitive impairment and dementia are frequently under-recognized. Health system strategies anchored in primary care are essential to address gaps in timely, comprehensive diagnosis. The goal of this paper is to describe the adaptation of a tablet-based brain health assessment (TabCAT-BHA) intervention and the study protocol to test its effectiveness in improving the detection of cognitive impairment, including dementia. METHODS: This mixed-methods, pragmatic, cluster randomized, hybrid effectiveness-implementation trial is being conducted in two 18-month waves with 26 Kaiser Permanente Southern California primary care clinics, with 13 serving as intervention clinics and 13 as usual care clinics. Patients 65 years and older with memory concerns (n ~ 180,000) receiving care at the 26 clinics will be included in the analyses. Primary care clinics are provided the following practice supports as part of the TabCAT-BHA intervention: brief education and training on neurocognitive disorders and study workflows; digital tools to assess cognitive function and support clinician decision making and documentation; and registered nurse support during the work-up and post-diagnosis periods for primary care providers, patients, and families. The intervention was adapted based on engagement with multiple levels of clinical and operational leaders in the healthcare system. Effectiveness outcomes include rates of cognitive impairment diagnosis in primary care and rates of completed standardized cognitive assessments and specialist referrals with incident diagnoses. Implementation outcomes include acceptability-appropriateness-feasibility, adoption, and fidelity. RESULTS: We identified seven themes organized by system-, provider-, and patient-level domains that were used to adapt the TabCAT-BHA intervention. Accordingly, changes were made to the provider education, diagnostic work-up, and post-diagnostic support. Results will be reported in fall of 2027. CONCLUSIONS: Our engagement with multiple primary and specialty care clinical and operational leaders to adapt the TabCAT-BHA intervention to these primary care clinics has informed the protocol to evaluate the intervention's effectiveness for improving the detection of cognitive impairment, including dementia, in an integrated healthcare system. TRIAL REGISTATION: Clinicaltrials.gov: NCT06090578 (registered 10/24/23).

Barriers and proposed solutions to at-home colorectal cancer screening tests in medically underserved health centers across three US regions to inform a randomized trial.

INTRODUCTION: At-home colorectal cancer (CRC) screening is an effective way to reduce CRC mortality, but screening rates in medically underserved groups are low. To plan the implementation of a pragmatic randomized trial comparing two population-based outreach approaches, we conducted qualitative research on current processes and barriers to at-home CRC screening in 10 community health centers (CHCs) that serve medically underserved groups, four each in Massachusetts and California, and two tribal facilities in South Dakota. METHODS: We conducted 53 semi-structured interviews with clinical and administrative staff at the participating CHCs. Participants were asked about CRC screening processes, categorized into eight domains: patient identification, outreach, risk assessment, fecal immunochemical test (FIT) workflows, FIT-DNA (i.e., Cologuard) workflows, referral for a follow-up colonoscopy, patient navigation, and educational materials. Transcripts were analyzed using a Rapid Qualitative Analysis approach. A matrix was used to organize and summarize the data into four sub-themes: current process, barriers, facilitators, and solutions to adapt materials for the intervention. RESULTS: Each site's process for stool-based CRC screening varied slightly. Interviewees identified the importance of offering educational materials in English and Spanish, using text messages to remind patients to return kits, adapting materials to address health literacy needs so patients can access instructions in writing, pictures, or video, creating mailed workflows integrated with a tracking system, and offering patient navigation to colonoscopy for patients with an abnormal result. CONCLUSION: Proposed solutions across the three regions will inform a multilevel intervention in a pragmatic trial to increase CRC screening uptake in CHCs.

Cancer stage and consideration of cannabis use among adult cancer survivors in Southern California.

BACKGROUND: The benefits of cannabis in symptom management among cancer survivors are widely acknowledged; however, patterns of cannabis use by cancer stage at diagnosis are unknown. METHODS: Here, we examined the association between cancer stage at diagnosis and consideration of cannabis use since diagnosis. We analyzed cross-sectional survey data from 954 cancer survivors, weighted to be representative of a National Cancer Institute-Designated Comprehensive Cancer Center's patient population. We used survey-weighted multivariable logistic regression to examine the association between cancer stage at diagnosis (advanced [III/IV] versus non-advanced [I/II]) and consideration of cannabis use (yes versus no) since diagnosis. RESULTS: Sixty percent of the population was diagnosed with non-advanced stages of cancer, and 42% had considered using cannabis since diagnosis. The odds of consideration of cannabis use were 63% higher (odds ratio = 1.63, 95% confidence interval = 1.06 to 2.49) among cancer survivors diagnosed at stages III/IV than among those diagnosed at stages I/II. CONCLUSION: Cancer stage may be a predictor of consideration of cannabis use after diagnosis.

Examining air pollution exposure dynamics in disadvantaged communities through high-resolution mapping.

This study bridges gaps in air pollution research by examining exposure dynamics in disadvantaged communities. Using cutting-edge machine learning and massive data processing, we produced high-resolution (100 meters) daily air pollution maps for nitrogen dioxide (NO2), fine particulate matter (PM2.5), and ozone (O3) across California for 2012-2019. Our findings revealed opposite spatial patterns of NO2 and PM2.5 to that of O3. We also identified consistent, higher pollutant exposure for disadvantaged communities from 2012 to 2019, although the most disadvantaged communities saw the largest NO2 and PM2.5 reductions and the advantaged neighborhoods experienced greatest rising O3 concentrations. Further, day-to-day exposure variations decreased for NO2 and O3. The disparity in NO2 exposure decreased, while it persisted for O3. In addition, PM2.5 showed increased day-to-day variations across all communities due to the increase in wildfire frequency and intensity, particularly affecting advantaged suburban and rural communities.

A new genus of Herpyllobiidae (Copepoda: Cyclopoida) from a deep-living annelid (Polychaeta: Sigalionidae).

A taxonomic study of deep-sea polychaetes collected at a depth of 2,805 m off the northern coast of California revealed a scaleworm of the family Sigalionidae with an attached parasitic copepod. The copepod represents an undescribed genus of the family Herpyllobiidae, comprising mesoparasitic copepods chiefly recorded from polychaetes of the family Polynoidae. Blakerius gen. nov. diverges from the other herpyllobiid genera by its possession of 1) a chalice-shaped ectosoma with several protuberances along the posterior margin and a long cylindrical shaft with a hyaline coating and integumental sculpturing, a short stalk with a small, anteriorly placed sclerotized ring, 2) a relatively large, discoid-shaped endosoma with digitiform process, and 3) attached male copepodids with 3-segmented antennules, containing limbless sac-like males. The new genus is compared with other herpyllobiids. This discovery increases the number of known herpyllobiid genera to six and is the first record of a herpyllobiid parasitizing a sigalionid polychaete.urn: lsid: zoobank.org:pub:5E31FEED-D3EB-460E-AEA4-02A9D3A778D6.

Food Environment After Implementation of a Healthy Checkout Policy.

Importance: In March 2021, Berkeley, California, became the world's first jurisdiction to implement a healthy checkout policy, which sets nutrition standards for foods and beverages in store checkouts. This healthy checkout ordinance (HCO) has the potential to improve customers' dietary intake if stores comply by increasing the healthfulness of foods and beverages at checkouts. Objectives: To compare the percentage of checkout products that were HCO compliant and that fell into healthy and unhealthy food and beverage categories before and 1 year after HCO implementation in Berkeley relative to comparison cities. Design, Setting, and Participants: In this cohort study in which Berkeley implemented an HCO and other cities did not, a difference-in-differences analysis was conducted of 76 258 product facings at checkouts of 23 stores in Berkeley and 75 stores in 3 comparison cities in California. Data were collected in February 2021 (approximately 1 month before implementation of the HCO) and 1 year later in February 2022 and analyzed from October 2023 to May 2024. Exposure: The HCO, which permits only the following products at checkouts in large food stores: nonfood and nonbeverage products, unsweetened beverages, and foods with 5 g or less of added sugars per serving and 200 mg or less of sodium per serving in the following categories: sugar-free gum and mints, fruit, vegetables, nuts, seeds, legumes, yogurt or cheese, and whole grains. Main Outcomes and Measures: A product facing's (1) HCO compliance and (2) category, including healthy compliant categories and unhealthy noncompliant categories, determined using a validated photograph-based tool to assess product characteristics. Results: Of the 76 258 product facings at store checkouts, the percentage that were HCO compliant increased from 53% (4438 of 8425) to 83% (5966 of 7220) in Berkeley, a 63% increase relative to comparison cities (probability ratio [PR], 1.63; 95% CI, 1.41-1.87). The percentage of food and beverage checkout facings that were HCO compliant increased in Berkeley from 29% (1652 of 5639) to 62% (2007 of 3261), a 125% increase relative to comparison cities (PR, 2.25; 95% CI, 1.80-2.82). The percentage of Berkeley food and beverage facings consisting of candy, sugar-sweetened beverages, and other sweets significantly decreased (candy: from 30% [1687 of 5639] to 6% [197 of 3261]; PR, 0.21; 95% CI, 0.10-0.42; sugar-sweetened beverages: from 11% [596 of 5639] to 5% [157 of 3261]; PR, 0.41; 95% CI, 0.23-0.75; other sweets: from 7% [413 of 5639] to 3% [101 of 3261]; PR, 0.37; 95% CI, 0.15-0.88), while the percentage consisting of unsweetened beverages (from 4% [226 of 5639] to 19% [604 of 3261]; PR, 4.76; 95% CI, 2.54-8.91) and healthy foods (from 6% [350 of 5639] to 20% [663 of 3261]; PR, 2.90; 95% CI, 1.79-4.72) significantly increased. Conclusions and Relevance: This cohort study of the first healthy checkout policy found substantial improvements in the healthfulness of food environments at checkouts 1 year after implementation of the policy. These results suggest that healthy checkout policies have the potential to improve the healthfulness of store checkouts.

Accelerated competency-based education in primary care (ACE-PC): a 3-year UC Davis and Kaiser permanente partnership to meet California's primary care physician workforce needs.

PROBLEM: Our nation faces an urgent need for more primary care (PC) physicians, yet interest in PC careers is dwindling. Students from underrepresented in medicine (UIM) backgrounds are more likely to choose PC and practice in underserved areas yet their representation has declined. Accelerated PC programs have the potential to address workforce needs, lower educational debt, and diversify the physician workforce to advance health equity. APPROACH: With support from Kaiser Permanente Northern California (KPNC) and the American Medical Association's Accelerating Change in Medical Education initiative, University of California School of Medicine (UC Davis) implemented the Accelerated Competency-based Education in Primary Care (ACE-PC) program - a six-year pathway from medical school to residency for students committed to health equity and careers in family medicine or PC-internal medicine. ACE-PC accepts 6-10 students per year using the same holistic admissions process as the 4-year MD program with an additional panel interview that includes affiliated residency program faculty from UC Davis and KPNC. The undergraduate curriculum features: PC continuity clinic with a single preceptor throughout medical school; a 9-month longitudinal integrated clerkship; supportive PC faculty and culture; markedly reduced student debt with full-tuition scholarships; weekly PC didactics; and clinical rotations in affiliated residency programs with the opportunity to match into specific ACE-PC residency tracks. OUTCOMES: Since 2014, 70 students have matriculated to ACE-PC, 71% from UIM groups, 64% are first-generation college students. Of the graduates, 48% have entered residency in family medicine and 52% in PC-internal medicine. In 2020, the first graduates entered the PC workforce; all are practicing in California, including 66% at federally qualified health centers, key providers of underserved care.

Impact of Droughts on Served Drinking Water Disparities in California, 2007-2020.

Objectives. To quantify the impact of droughts on drinking water arsenic and nitrate levels provided by community water systems (CWSs) in California and to assess whether this effect varies across sociodemographic subgroups. Methods. I integrated CWS characteristics, drought records, sociodemographic data, and regulatory drinking water samples (n = 83 317) from 2378 water systems serving 34.8 million residents from 2007 to 2020. I analyzed differential drought effects using fixed-effect regression analyses that cumulatively accounted for CWS-level trends, income, and agricultural measures. Results. CWSs serving majority Latino/a communities show persistently higher and more variable drinking water nitrate levels. Drought increased nitrate concentrations in majority Latino/a communities, with the effect doubling for CWSs with more than 75% Latino/a populations served. Arsenic concentrations in surface sources also increased during drought for all groups. Differential effects are driven by very small (< 500) and privately owned systems. Conclusions. Impending droughts driven by climate change may further increase drinking water disparities and arsenic threats. This underscores the critical need to address existing inequities in climate resilience planning and grant making. (Am J Public Health. 2024;114(9):935-945. https://doi.org/10.2105/AJPH.2024.307758).

Life cycle and development of the marine leech Branchellion lobata (Hirudinea: Piscicolidae), from round stingrays, Urobatis halleri, from southern California.

During captivity, round stingrays, Urobatis halleri, became infected with the marine leech Branchellion lobata. When adult leeches were deprived of blood meal, they experienced a rapid decrease in body mass and did not survive beyond 25 days. If kept in aquaria with host rays, B. lobata fed frequently and soon produced cocoons, which were discovered adhered to sand grains. A single leech emerged from each cocoon (at ~ 21 days), and was either preserved for histology or molecular analysis, or monitored for development by introduction to new hosts in aquaria. Over a 74-day observation period, leeches grew from ~ 2 to 8 mm without becoming mature. Newly hatched leeches differed from adults in lacking branchiae and apparent pulsatile vesicles. The microbiome of the hatchlings was dominated by a specific, but undescribed, member of the gammaproteobacteria, also recovered previously from the adult leech microbiome. Raising B. lobata in captivity provided an opportunity to examine their reproductive strategy and early developmental process, adding to our limited knowledge of this common group of parasites.