Estimating the potential value of MSM-focused evidence-based implementation interventions in three Ending the HIV Epidemic jurisdictions in the United States: a model-based analysis.

INTRODUCTION: Improving the delivery of existing evidence-based interventions to prevent and diagnose HIV is key to Ending the HIV Epidemic in the United States. Structural barriers in the access and delivery of related health services require municipal or state-level policy changes; however, suboptimal implementation can be addressed directly through interventions designed to improve the reach, effectiveness, adoption or maintenance of available interventions. Our objective was to estimate the cost-effectiveness and potential epidemiological impact of six real-world implementation interventions designed to address these barriers and increase the scale of delivery of interventions for HIV testing and pre-exposure prophylaxis (PrEP) in three US metropolitan areas. METHODS: We used a dynamic HIV transmission model calibrated to replicate HIV microepidemics in Atlanta, Los Angeles (LA) and Miami. We identified six implementation interventions designed to improve HIV testing uptake ("Academic detailing for HIV testing," "CyBER/testing," "All About Me") and PrEP uptake/persistence ("Project SLIP," "PrEPmate," "PrEP patient navigation"). Our comparator scenario reflected a scale-up of interventions with no additional efforts to mitigate implementation and structural barriers. We accounted for potential heterogeneity in population-level effectiveness across jurisdictions. We sustained implementation interventions over a 10-year period and evaluated HIV acquisitions averted, costs, quality-adjusted life years and incremental cost-effectiveness ratios over a 20-year time horizon (2023-2042). RESULTS: Across jurisdictions, implementation interventions to improve the scale of HIV testing were most cost-effective in Atlanta and LA (CyBER/testing cost-saving and All About Me cost-effective), while interventions for PrEP were most cost-effective in Miami (two of three were cost-saving). We estimated that the most impactful HIV testing intervention, CyBER/testing, was projected to avert 111 (95% credible interval: 110-111), 230 (228-233) and 101 (101-103) acquisitions over 20 years in Atlanta, LA and Miami, respectively. The most impactful implementation intervention to improve PrEP engagement, PrEPmate, averted an estimated 936 (929-943), 860 (853-867) and 2152 (2127-2178) acquisitions over 20 years, in Atlanta, LA and Miami, respectively. CONCLUSIONS: Our results highlight the potential impact of interventions to enhance the implementation of existing evidence-based interventions for the prevention and diagnosis of HIV.

Current Practices and Attitudes of Community Health Centers Toward the Use of Algorithmic Logic to Identify Patients with Undiagnosed Hypertension.

Treating patients with uncontrolled hypertension is a powerful intervention for reducing the risk of heart attack and stroke. Leveraging health information technology to identify patients with undiagnosed hypertension using algorithmic logic can be an effective approach for reaching hypertensive patients who may otherwise be overlooked. Despite evidence that this strategy can support favorable cardiovascular health outcomes in the safety-net healthcare setting, little is known about its implementation outside of targeted practice and research environments. In 2021-2022, Community Clinic Association of Los Angeles County and the Los Angeles County Department of Public Health collaborated on a mixed methods, organizational assessment of community health centers to better understand their practices and attitudes toward the use of algorithmic logic to identify patients with undiagnosed hypertension. Results from the assessment suggest that awareness and use of this approach are limited; numerous challenges are associated with its adoption and implementation.

The differential impacts of COVID-19 mortality on mental health by residential geographic regions: The Los Angeles Pandemic Surveillance Cohort Study.

OBJECTIVE: This study examines the association between changes in mental health before and during the COVID-19 pandemic and COVID-19 mortality across geographic areas and by race/ethnicity. METHODS: A cross-sectional survey was conducted in Los Angeles County between April and May 2021. The study used the Patient Health Questionnaire-2 to assess major depression risk. Participants' home ZIP codes were classified into low, middle, and high COVID-19 mortality impacted areas (CMIA). RESULTS: While there were existing mental health disparities due to differences in demographics and social determinants of health across CMIA in 2018, the pandemic exacerbated the disparities, especially for residents living in high CMIA. Non-White residents in high CMIA reported the largest deterioration in mental health. Differences in mental health by CMIA persisted after controlling for resident characteristics. CONCLUSIONS: Living in an area with higher COVID-19 mortality rates may have been associated with worse mental health, with Non-White residents reporting worse mental health outcomes in the high mortality area. POLICY IMPLICATIONS: It is crucial to advocate for greater mental health resources in high COVID-19 mortality areas especially for racial/ethnic minorities.

Barriers and facilitators of habit building for long-term adherence to antihypertensive therapy among people with hypertensive disorders in Los Angeles, California: a qualitative study.

OBJECTIVES: The aim of this study was to a) explore barriers and facilitators associated with medication-taking habit formation, and b) elicit feedback on the components of an intervention designed to help form strong habits for long-term medication adherence. DESIGN: The study design was qualitative; we conducted semistructured interviews between September 2021 and February 2022. SETTING: The interviews were conducted online, with 27 participants recruited at the Cedars-Sinai Medical Center in Los Angeles, California. PARTICIPANTS: A purposive sample of 20 patients who were over 18 years of age, had been diagnosed with hypertensive disorder (or reported high blood pressure; >140/90 mm Hg) and who were prescribed antihypertensive therapy at the time of recruitment, along with seven providers were interviewed. RESULTS: Contextual factors included frequent changes to prescription for regimen adjustment, and polypharmacy. Forgetfulness, perceived need for medication, and routine disruptions were identified as possible barriers to habit formation. Facilitators of habit formation included identification of stable routines for anchoring, planning, use of external reminders (including visual reminders) and pillboxes for prescription management, and extrinsic motivation for forming habits. Interestingly, experiencing medication side effects was identified as a possible barrier and a possible facilitator of habit formation. Feedback on study components included increasing text size, and visual appeal of the habit leaflet; and imparting variation in text message content and adjusting their frequency to once a day. Patients generally favoured the use of conditional financial incentives to support habit formation. CONCLUSION: The study sheds light on some key considerations concerning the contextual factors for habit formation among people with hypertension. As such, future studies may evaluate the generalisability of our findings, consider the role of visual reminders in habit formation and sustenance, and explore possible disruptions to habits. TRIAL REGISTRATION NUMBER: NCT04029883.

Community Leadership Institute for Equity: Planning Processes and Procedures to Develop Partnered Conferences.

BACKGROUND: Community-partnered participatory research (CPPR) is a research approach that supports equitable collaboration of community and academic co-leaders in research and policy. Despite CPPR's 25-year history, infrastructure supporting community members in bidirectional learning has not been formalized. OBJECTIVE: This paper describes processes and procedures using CPPR to plan conferences to develop community leadership training infrastructure. METHODS: We utilized rapid ethnographic analysis to examine conference planning processes for community leadership in CPPR. Community and academic leaders in Los Angeles, New Orleans, and Chicago met weekly over two months to plan, given COVID-19, three Zoom conferences on a leadership training institute for CPPR, with planning for (1) community co-leadership in research and policy; (2) local and national CPPR programs; and (3) models for bidirectional training. RESULTS: The planning process emphasized bidirectional learning for community and academic members for research and services/policy to benefit communities, within a Community Leadership Institute for Equity (C-LIFE) to promote equity and power sharing for community leaders. The planning process identified major themes of framing of C-LIFE conference planning goals, developing the conference structure, promoting equity and diversity, envisioning the future of CPPR, challenges, collaborations, future curriculum ideas for C-LIFE, evaluation and next-steps for Zoom conferences in November 2020. CONCLUSIONS: It was feasible to use CPPR to plan Zoom conferences to promote community leadership training across multiple sites. Key planning themes included promoting equity, addressing structural racism, bidirectional learning and integrating community, academic, and policy priorities with community co-leaders as change agents.

Los Angeles County dentists' opinions on discussing human papilloma virus-related oral health issues and recommending vaccine to patients.

Dentists are well-positioned to discuss oral health issues related to Human Papillomavirus (HPV) and recommend the HPV vaccine to their patients, mainly because the HPV virus causes oropharyngeal cancers.. We assessed Los Angeles (LA) County dentists' opinions on discussing HPV-related oral health issues and recommending the HPV vaccine to their patients. We tested if opinions differed between dentists whose primary patient population was only adults versus children and adults. We mailed a 19-item survey to 2000 randomly sampled LA County dentists for this cross-sectional study. The primary outcome variable was a summary opinion score of 7 opinion statements. We ran descriptive, bivariate comparisons and adjusted linear regression models. Overall, 261 dentists completed the survey. A majority (58.5%) worried they would lose patients if they recommended the vaccine; 49% thought dentists were not appropriate to educate, counsel, or advise on HPV-related issues; 42% were concerned about the safety of the vaccine; and 40% did not feel comfortable recommending the vaccine. The mean summary opinion score was 21.4 ± 5.4 for the total sample. Regression analysis showed no differences in opinions between dentists whose primary patient population was only adults versus children and adults (Coefficient = 0.146, p = 0.83). Overall, the responding dentists were not very favorable about discussing oral health-related HPV issues and recommending the HPV vaccine to their patients. Additionally, the overall opinions were similar between dentists whose primary patient population was only adults versus children and adults.

Correlates of HIV Testing Among Asian Immigrant Female Sex Workers in New York City and Los Angeles County.

This analysis examined correlates of HIV testing among Asian immigrant female sex workers in massage parlors. We interviewed 69 Chinese and Korean immigrant women who provided sexual services in massage parlors in New York City or Los Angeles County (2014-2016). Multivariable logistic regression results showed that participants who were younger, have lived in the U.S. for a longer period of time, had greater English proficiency, perceived higher HIV risk, or were living with an intimate partner were more likely to have had an HIV test. Disclosing sex work to a close friend was also positively associated with HIV testing at p < .1. These correlates may reflect differential access to information, systems, and social networks that would facilitate HIV testing, highlighting the importance of reducing social isolation and increasing HIV education, especially for older women who have come to the U.S. more recently. As the literature has indicated that Asian immigrant female sex workers experience high rates of intersectional stigma, efforts to mitigate these intersecting stigmas could further these objectives.

Successful Distribution of Tecovirimat During the Peak of the Mpox Outbreak - Los Angeles County, June 2022-January 2023.

Tecovirimat is the first-line antiviral treatment recommended for severe mpox or for persons with mpox who are at risk for severe disease; tecovirimat is available in the United States under an expanded access investigational new drug (IND) protocol. During the 2022-2023 mpox outbreak, local U.S. health jurisdictions facilitated access to tecovirimat. In June 2022, Los Angeles County (LAC) rapidly developed strategies for tecovirimat distribution using existing medical countermeasure distribution networks established by the Public Health Emergency Preparedness Program and the Hospital Preparedness Program, creating a hub and spoke distribution network consisting of 44 hub facilities serving 456 satellite sites across LAC. IND patient intake forms were analyzed to describe mpox patients treated with tecovirimat. Tecovirimat treatment data were matched with case surveillance data to calculate time from specimen collection to patients receiving tecovirimat. Among 2,281 patients with mpox in LAC, 735 (32%) received tecovirimat during June 2022-January 2023. Among treated patients, approximately two thirds (508; 69%) received treatment through community clinics and pharmacies. The median interval from specimen collection to treatment was 2 days (IQR = 0-5 days). Local data collection and analysis helped to minimize gaps in treatment access and facilitated network performance monitoring. During public health emergencies, medical countermeasures can be rapidly deployed across a large jurisdiction using existing distribution networks, including clinics and pharmacies.

Using a Cohort-Based Quality Improvement Coaching Model to Optimize Chronic Disease Management for Federally Qualified Health Center Patients.

CONTEXT: In fall 2020, Community Clinic Association of Los Angeles County, in collaboration with the Los Angeles County Department of Public Health, launched a 3-year, cohort-based quality improvement (QI) coaching program to assist Federally Qualified Health Centers (FQHCs) in improving their clinical management of hypertension, high blood cholesterol, diabetes, and chronic kidney disease. PROGRAM: The QI program utilized a cohort-based coaching model in which 5 FQHCs were each assigned a practice transformation coach who provided them with guidance and support to monitor clinical quality measures. These measures were then used to facilitate changes and improvements in clinical workflows and approaches to patient care. To encourage peer learning and promote inter-organizational collaboration, the coaching team hosted quarterly cohort check-ins and an online group messaging board where the participating FQHCs could share lessons learned. Throughout the program, the FQHCs were provided trainings and resources to advance their clinical quality measures of choice. IMPLEMENTATION: To implement the program, each FQHC selected 2 clinical quality measures to focus on, completing a minimum of 1 Plan-Do-Study-Act cycle per year for each measure. Throughout, the coaches met regularly with FQHC staff to discuss progress, strategize on how best to address challenges encountered, and identify training or resource needs for their clinic sites. EVALUATION: To drive implementation of QI interventions and monitor overall progress, the FQHCs reported quarterly on the clinical quality measures being addressed. By program's end, all 5 FQHCs reached their 10% improvement goals. DISCUSSION: This QI coaching program allowed participating FQHCs to build new competencies and achieve measurable improvements in how they managed their patients' chronic diseases. This model of practice serves as a promising approach for achieving sustainable clinical improvements in these FQHCs.

Testing an Innovative Approach to Improve Hypertension Management at a Federally Qualified Health Center.

Despite the availability of effective treatments, hypertension control rates remain inadequate in the United States and locally in Los Angeles County. To address this health condition, QueensCare Health Centers developed and launched a team-based hypertension management program that was led by clinical pharmacists and designed to mitigate treatment barriers encountered at the system, provider, and patient levels. System- and provider-focused strategies included incorporating self-monitored blood pressure values into the electronic health record and retraining clinicians to regularly review these values; adding a community health worker to the disease management team; and utilizing clinical pharmacists to assess and titrate medications. Patient-focused strategies included tailoring education materials to reduce literacy and linguistic barriers; providing tailored one-on-one education and support; and providing blood pressure cuffs and pedometers. This multilevel intervention serves as a practical example of how team-based care can be optimized at a Federally Qualified Health Center.

Body mapping: A decolonial method towards intergenerational healing.

In this paper, I examine the embodied transformative memory of GuateMaya feminist group, GuateMaya Mujeres Resistiendo-Los Angeles (GMR-LA). Through a decolonial feminist perspective and feminist ethnographic approach, I built an intimate relationship with the grassroot group in Los Angeles. GMR-LA comprises Guatemala's 36-year (1960-1996) war survivors and women in the diaspora who continue to amplify the cultural memory of the disappeared. The article will delve into the concept of healing cartographies and the ethnographic work I employed in Los Angeles from 2019 to 2023. A particular method I used was body mapping to examine the embodied transformative memory of the groups and women who seek justice. Body mapping has been used with HIV-positive patients and migrant children. Latin American feminist decolonial geographers (Cabnal, 2010; Zaragocin and Caretta 2020; GeoBrujas, 2021b) are using the method of body mapping as a decolonial, counter-cartographic perspective that highlights Indigenous peoples' lived experiences. I use the method to explore the relationships between the body, memory, and healing from intergenerational trauma. Informed by decolonial feminists, I aim to center the oral and embodied testimonios of the GuateMaya feminist group and be guided by a body-mind-spirit perspective to amplify the concerns, visions, and futures of GuateMaya feminist groups across the hemisphere.

Cannabis Use Reported by Patients Receiving Primary Care in a Large Health System.

Importance: Despite the changing legal status of cannabis and the potential impact on health, few health systems routinely screen for cannabis use, and data on the epidemiology of cannabis use, and especially medical cannabis use among primary care patients, are limited. Objective: To describe the prevalence of, factors associated with, and reasons for past-3 month cannabis use reported by primary care patients. Design, Setting, and Participants: This cross-sectional study used electronic health record data from patients aged 18 years and older who had an annual wellness visit between January 2021 and May 2023 from a primary care clinic within a university-based health system in Los Angeles, California. Exposures: Factors of interest included age, race and ethnicity, sex, employment status, and neighborhood Area Deprivation Index (ADI). Main Outcomes and Measures: Cannabis use was assessed using the Alcohol Substance Involvement Screening Test (ASSIST). Patients were also asked about reasons for use, symptoms for which they used cannabis, and mode of use. Results: Among the 175 734 patients screened, the median (range) age was 47 (18-102) years; 101 657 (58.0%) were female; 25 278 (15.7%) were Asian, 21 971 (13.7%) were Hispanic, and 51 063 (31.7%) were White. Cannabis use was reported by 29 898 (17.0%), with 10 360 (34.7%) having ASSIST scores indicative of moderate to high risk for cannabis use disorder (CUD). Prevalence of cannabis use was higher among male patients than female patients (14 939 [20.0%] vs 14 916 [14.7%]) and younger patients (18-29 years, 7592 [31.0%]; ≥60 years, 4200 [8.5%]), and lower among those who lived in the most disadvantaged neighborhoods (ADI decile 9-10, 189 [13.8%]; ADI decile 1-2, 12 431 [17.4%]). The most common modes of use included edibles (18 201 [61.6%]), smoking (15 256 [51.7%]), and vaporizing (8555 [29.0%]). While 4375 patients who reported using cannabis (15.6%) did so for medical reasons only, 21 986 patients (75.7%) reported using cannabis to manage symptoms including pain (9196 [31.7%]), stress (14 542 [50.2%]), and sleep (16 221 [56.0%]). The median (IQR) number of symptoms managed was 2 (1-4), which was higher among patients who were at moderate to high risk for CUD (4 [2-6] symptoms). Conclusions and Relevance: In this study, cannabis use and risk of CUD were common, and more than three-quarters of patients who reported any cannabis use reported doing so to manage a health-related symptom. These findings suggest that integration of information regarding cannabis use for symptom management could help provide a crucial point-of-care opportunity for clinicians to understand their patients' risk for CUD.

In flux: Associations of substance use with instability in housing, employment, and income among young adults experiencing homelessness.

Young adults experiencing homelessness (YAEH) are faced with instabilities in many areas of their lives, including their living situation, employment, and income. Little is known about how the experience of instability in these different domains might be associated with substance use. Leveraging data collected on 276 YAEH in Los Angeles County, regression analyses examine associations between three distinct types of instability (housing, employment, income) and participants' self-reported alcohol use, alcohol consequences, non-cannabis drug use, and substance use symptoms. Results indicated that recent instability in income, employment, and secure housing for those with access to it (but not housing in general or non-secure housing) were significantly associated with greater alcohol/drug use or substance use symptoms. Depression was also found to moderate the association between employment instability and alcohol use. Our findings suggest that efforts to reduce instability in income, employment, and secure housing may have positive benefits for substance using YAEH, especially those with depressive symptoms.

Maternal Urinary Fluoride and Child Neurobehavior at Age 36 Months.

Importance: Recent studies in Canadian and Mexican populations suggest an association of higher prenatal fluoride exposure with poorer neurobehavioral development, but whether this association holds for US-based populations is unknown. Objective: To examine associations of third trimester maternal urinary fluoride (MUF) with child neurobehavior at age 3 years in the US. Design, Setting, and Participants: This prospective cohort study utilized urine samples archived from 2017 to 2020 and neurobehavioral data assessed from 2020 to 2023 from the Maternal and Developmental Risks from Environmental and Social Stressors (MADRES) pregnancy cohort, which consisted of predominately Hispanic women residing in Los Angeles, California. Cohort eligibility criteria at recruitment included being 18 years of age or older, less than 30 weeks' gestation, and a fluent English or Spanish speaker. Exclusion criteria included having a disability preventing participation or provision of informed consent, being HIV positive or incarcerated, and having a multiple gestation pregnancy. There were 263 mother-child pairs who completed the 3-year study visit. In this analysis, women who reported prenatal smoking were excluded. Data analysis was conducted from October 2022 to March 2024. Exposure: Specific gravity-adjusted MUF (MUFSG), a biomarker of prenatal fluoride exposure. Main Outcomes and Measures: Neurobehavior was quantified using the Preschool Child Behavior Checklist (CBCL), which included composite scores for Total Problems, Internalizing Problems, and Externalizing Problems. CBCL composite T scores range from 28 to 100. T scores from 60 to 63 are in the borderline clinical range, whereas scores above 63 are in the clinical range. Linear and logistic regression models adjusted for covariates were conducted. Results: A total of 229 mother-child pairs (mean [SD] maternal age, 29.45 [5.67] years; 116 female children [50.7%] and 113 male children [49.3%]) who had MUFSG measured were included in the study. Median (IQR) MUFSG was 0.76 (0.51-1.19) mg/L, and 32 participants (14.0%) had a Total Problems T score in the borderline clinical or clinical range. A 1-IQR (0.68 mg/L) increase in MUFSG was associated with nearly double the odds of the Total Problems T score being in the borderline clinical or clinical range (odds ratio, 1.83; 95% CI, 1.17-2.86; P = .008), as well as with a 2.29-point increase in T score for the Internalizing Problems composite (B = 2.29; 95% CI, 0.47-4.11; P = .01) and a 2.14-point increase in T score for the Total Problems composite (B = 2.14; 95% CI, 0.29-3.98; P = .02). Conclusions and Relevance: In this prospective cohort study of mother-child pairs in Los Angeles, California, prenatal fluoride exposure was associated with increased neurobehavioral problems. These findings suggest that there may be a need to establish recommendations for limiting fluoride exposure during the prenatal period.

Generalizability of PGS313 for breast cancer risk in a Los Angeles biobank.

Polygenic scores (PGSs) summarize the combined effect of common risk variants and are associated with breast cancer risk in patients without identifiable monogenic risk factors. One of the most well-validated PGSs in breast cancer to date is PGS313, which was developed from a Northern European biobank but has shown attenuated performance in non-European ancestries. We further investigate the generalizability of the PGS313 for American women of European (EA), African (AFR), Asian (EAA), and Latinx (HL) ancestry within one institution with a singular electronic health record (EHR) system, genotyping platform, and quality control process. We found that the PGS313 achieved overlapping areas under the receiver operator characteristic (ROC) curve (AUCs) in females of HL (AUC = 0.68, 95% confidence interval [CI] = 0.65-0.71) and EA ancestry (AUC = 0.70, 95% CI = 0.69-0.71) but lower AUCs for the AFR and EAA populations (AFR: AUC = 0.61, 95% CI = 0.56-0.65; EAA: AUC = 0.64, 95% CI = 0.60-0.680). While PGS313 is associated with hormone-receptor-positive (HR+) disease in EA Americans (odds ratio [OR] = 1.42, 95% CI = 1.16-1.64), this association is lost in African, Latinx, and Asian Americans. In summary, we found that PGS313 was significantly associated with breast cancer but with attenuated accuracy in women of AFR and EAA descent within a singular health system in Los Angeles. Our work further highlights the need for additional validation in diverse cohorts prior to the clinical implementation of PGSs.

Neurodevelopmental delay in children exposed to maternal SARS-CoV-2 in-utero.

It is unclear if SARS CoV-2 infection during pregnancy is associated with adverse neurodevelopmental repercussions to infants. We assessed pediatric neurodevelopmental outcomes in children born to mothers with laboratory-confirmed SARS CoV-2 infection during pregnancy. Neurodevelopmental outcomes of in-utero exposed children were compared to that of pre-pandemic control children in Los Angeles (LA), CA, USA and Rio de Janeiro, Brazil. Bayley Scales of Infant and Toddler Development, 3rd edition (Bayley-III), the gold standard tool for evaluating neurodevelopment until 36 months of age and Ages and Stages Questionnaires (ASQ-3), a frequently used screening instrument for evaluating neurodevelopment in this same age group were the assessment tools used. Developmental delay (DD) was defined as having a score < - 2 SD below the norm (< 70) in at least one of three Bayley-III domains, (cognitive, motor or language) or a score below the cut-off (dark zone) in at least one of five ASQ-3 domains (communication, gross motor, fine motor, problem solving, personal-social). Exposed children were born between April 2020 and December 2022 while control children were born between January 2016 to December 2019. Neurodevelopmental testing was performed in 300 children total: 172 COVID-19 exposed children between 5-30 months of age and 128 control children between 6-38 months of age. Bayley-III results demonstrated that 12 of 128 exposed children (9.4%) had DD versus 2 of 128 controls (1.6%), p = 0.0007. Eight of 44 additional exposed children had DD on ASQ-3 testing. Fully, 20 of 172 exposed children (11.6%) and 2 of 128 control children (1.6%), p = 0.0006 had DD. In Rio, 12% of exposed children versus 2.6% of controls, p = 0.02 had DD. In LA, 5.7% of exposed children versus 0 controls, p = 0.12 had DD. Severe/critical maternal COVID-19 predicted below average neurodevelopment in the exposed cohort (OR 2.6, 95% CI 1.1-6.4). Children exposed to antenatal COVID-19 have a tenfold higher frequency of DD as compared to controls and should be offered neurodevelopmental follow-up.

Clamp for Safety: Improving Intravesical Chemotherapy Practices.

Processes for intravesical chemotherapy after transurethral resection of nonmuscle invasive bladder tumors may lack standardization. In 2019, at a large health care system in Los Angeles, California, five incident reports involving chemotherapeutic agent spills from urinary catheters after bladder tumor procedures necessitated a quality improvement project. The project lead determined that a cost-effective alternative device for securing the chemotherapeutic agent in the bladder was needed at four surgical locations of the health care system. In addition, a review of the literature and an observational assessment revealed lack of adherence to standard and recommended processes for using personal protective equipment (PPE) when handling hazardous medications. After revising existing processes, acquiring a cost-effective clamp and recommended chemotherapy PPE, instructing personnel on the clamping process and use of PPE, and implementing use of the clamp, there have been no spills associated with intravesical chemotherapy across the four surgical locations.

Using unstructured crowd-sourced data to evaluate urban tolerance of terrestrial native animal species within a California Mega-City.

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.

Community Engagement, Jurisdictional Experience, and Previous Tobacco-Related Ordinances in Neighboring Communities as Drivers of Flavored Tobacco Bans in Los Angeles County.

We examined whether a community engagement approach and jurisdictional attributes were associated with local action to restrict the sale of flavored tobacco products in Los Angeles County during 2019-2022. We estimated crude and adjusted risk ratios to examine these associations. Jurisdictions that used an active community engagement approach to adopt a flavored tobacco ban ordinance, those with previous experience adopting other tobacco-related ordinances, and those located next to communities that have an existing tobacco retail license ordinance were more likely than jurisdictions without these attributes to adopt a new ordinance to restrict the sale of flavored tobacco products. Efforts to adopt such an ordinance were generally more successful in jurisdictions where community members were engaged and policy makers were familiar with the adoption of public health ordinances.

A qualitative analysis of post-hoc interviews with multilevel participants of a randomized controlled trial of a community-based intervention.

INTRODUCTION: Community-based health interventions often demonstrate efficacy in clinical trial settings but fail to be implemented in the real-world. We sought to identify the key operational and contextual elements of the Los Angeles Barbershop Blood Pressure Study (LABBPS), an objectively successful community-based health intervention primed for real-world implementation. LABBPS was a cluster randomized control trial that paired the barbers of Black-owned barbershops with clinical pharmacists to manage uncontrolled hypertension in Black male patrons, demonstrating a substantial 21.6 mmHg reduction in systolic blood pressure. Despite this success, the LABBPS intervention has not expanded beyond the original clinical trial setting. The aim of this study was to determine the facilitating and limiting factors to expansion of the LABBPS intervention. METHODS: We undertook a qualitative assessment of semi-structured interviews with study participants performed after trial completion. Interviews included a total of 31 participants including 20 (6%) of the 319 LABBPS program participants ("patrons"), 10 (19%) barbers, and one (50%) clinical pharmacist. The semi-structured interviews were focused on perceptions of the medical system, study intervention, and influence of social factors on health. RESULTS: Several common themes emerged from thematic analysis of interview responses including: importance of care provided in a convenient and safe environment, individual responsibility for health and health-related behaviors, and engagement of trusted community members. In particular, patrons reported that receiving the intervention from their barber in a familiar environment positively influenced the formation of relationships with clinical pharmacists around shared efforts to improve medication adherence and healthy habits. All interviewee groups identified the trust diad, comprising the familiar environment and respected community member, as instrumental in increasing health-related behaviors to a degree not usually achieved by traditional healthcare providers. DISCUSSION: In conclusion, participants of an objectively successful community-based intervention trial consistently identified key features that could facilitate wider implementation and efficacy: social trust relationships, soliciting insights of trust bearers, and consistent engagement in a familiar community setting. These findings can help to inform the design and operations of future community-based studies and programs aiming to achieve a broad and sustainable impact.