Los Angeles Research Articles

Efficacy and Safety of Potassium-competitive Acid Blockers Versus Proton Pump Inhibitors in Treating Erosive Esophagitis: A Meta-analysis Based on Randomized Controlled Trials.

This meta-analysis aimed to investigate the efficacy and safety of potassium-competitive acid blockers (P-CABs) and proton pump inhibitors (PPIs) in treating erosive esophagitis (EE). PubMed, Embase, Cochrane Library, and Web of Science were systematically searched using predefined search terms up to January 2024. Relevant randomized controlled trials were included. The outcoming were the EE healing rate and treatment-related adverse events incidence. Nine randomized controlled trials involving 4012 patients were included. Patients receiving P-CAB exhibited a significantly better overall healing rate compared with PPI at week 2 [risk ratio (RR) = 1.06], but no statistical difference was observed at week 4 and week 8. Subgroup analysis revealed that P-CAB demonstrated a higher healing rate for patients with Los Angeles (LA) grade C/D, regardless of the assessment at week 2 (RR = 1.17), week 4 (RR = 1.10), or week 8 (RR = 1.08). However, no significant difference was found between PPI and P-CAB for patients with LA grade A/B at week 2, week 4, or week 8. Furthermore, patients treated with P-CAB had lower recurrence rates during maintenance therapy compared with PPI (RR = 0.79). In terms of safety, P-CAB was associated with a lower incidence of headache compared with PPI (RR = 0.32), with no statistical difference found in any treatment-related adverse events between the two groups. P-CAB was found to be safe and effective for EE treatment compared with PPI, particularly in 2-week short-term treatment, severe EE (LA grade C/D) treatment, or maintenance therapy. Limitations such as potential heterogeneity among included trials should be considered in the interpretation of these findings.

Channel restoration in urbanized systems: Guiding design using ecological flow targets and future management scenarios

AbstractRestoration of urban rivers must simultaneously design for ecological habitat while accounting for altered flow regimes associated with urban runoff, flood protection, and industrial/wastewater discharge. The goal of this study was to use ecological flow targets to guide channel restoration of the Los Angeles (LA) River across potential future flow regimes. Using a one‐dimensional hydraulic model, we simulated a range of channel cross section configurations subject to different flow management decisions (wastewater reuse, low‐flow [LF] treatment, and baseflow augmentation). Hydraulic results were assessed relative to ecohydraulic targets for desirable aquatic species in the LA River (willow, steelhead trout, and Santa Ana sucker). Results suggest that, along the mainstem of the LA River, restoration designs that include narrow LF channels may support Santa Ana sucker habitat and steelhead migration if management decisions decrease instream flows (e.g., by reusing treated wastewater). However, the same channel design and management decisions may not provide conditions needed to propagate floodplain vegetation such as willows. In tributary reaches, flows are too low to support habitat conditions for Santa Ana sucker or steelhead but may be able to support riparian habitat if a soft‐bottom LF channel and active floodplain are present. In general, results illustrate the trade‐offs between water management goals and habitat requirements for target species.

Abstract A137: Enrolling a diverse sample of community health center patients for a multi-level intervention to increase colorectal cancer screening uptake and follow-up

Abstract Colorectal cancer (CRC) screening is underutilized, especially in community health centers (CHCs) that provide care to marginalized communities, including low-income, uninsured, and racial/ethnic minority populations. Stool-based tests, such as the fecal immunochemical test (FIT) and FIT-DNA, can be effective CRC screening methods if individuals with abnormal results undergo colonoscopy. The Community Collaboration to Advance Racial/Ethnic Equity in CRC Screening (CARES) study aims to enroll a diverse sample of individuals at average risk for CRC for a multi-level intervention to increase CRC screening uptake and colonoscopic follow-up after abnormal FIT or FIT-DNA results in CHCs in 3 U.S. regions. Our overall goal is to conduct a two-arm, pragmatic randomized trial that includes patients in 4 Boston and 4 Los Angeles (LA) CHCs. Two clinics in the Great Plains Tribal Leaders Health Board in South Dakota (SD) will be included in a parallel pilot study. Pre-implementation activities included qualitative interviews with providers and administrators at each CHC to understand barriers to screening and current clinic workflows, development of a central database, and tailoring intervention components for each site: study invitation letters, text message reminders, infographics, instructional videos, QR codes to informational videos, and navigation for patients with abnormal results. In the 63 semi-structured pre-implementation interviews, stakeholders reported patient barriers to screening included lack of motivation due to the absence of symptoms and difficultly understanding test instructions, while provider barriers were lack of electronic health record (EHR) past-due screening reminders, and system-level barriers included challenges referring patients for colonoscopy in outside facilities. For each clinic, we queried EHR data to identify patients ages 45-75 with a recent primary care visit and an indicated preference for English or Spanish language. In the Boston clinics, 38.3% were Non-Hispanic White, 62.1% preferred English, and 65.1% were privately insured. In LA, 91.3% were Hispanic, 86.8% preferred Spanish, and 72.4% were Medicaid insured. The mean baseline CRC screening rate was significantly higher in the Boston clinics than in the LA clinics (69.1% v. 21.2%; p<0.0001). Of those screened, the most common screening modality was colonoscopy in Boston (84.3%) and FIT in LA (92.2%) (p<0.001). Higher baseline screening and colonoscopy rates in Boston may be due to multiple factors, including differences in patient demographics, prevalence of immigrant populations, language barriers, and/or healthcare access and capacity. We randomized each CHC to either mailed FIT or FIT-DNA and enrolled 2429 patients in the FIT-arm (Boston: n=936; LA: n=1493) and 2798 patients in the FIT-DNA arm (Boston: n=1303; LA: n=1495). We intend to enroll 800 patients in a similar manner in SD. To increase CRC screening through targeted interventions among populations with limited resources, it is crucial to consider local systems, barriers and facilitators to care. Citation Format: Folasade P. May, Jessica J. Tuan, Suzanne Brodney, Sapna Syngal, Andrew T. Chan, Beth Glenn, Gina Johnson, Yuchiao Chang, David A. Drew, Beverly Moy, Nicolette J. Rodriguez, Erica T. Warner, Adjoa Anyane-Yeboa, Chinedu Ukaegbu, Anjelica Q Davis, Kimberly Schoolcraft, Samantha Kuney, Kelley Le Beaux, Catherine Jeffries, Jennifer S. Haas. Enrolling a diverse sample of community health center patients for a multi-level intervention to increase colorectal cancer screening uptake and follow-up [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr A137.

Correlation of gastrointestinal symptom rating scale and frequency scale for the symptoms of gastroesophageal reflux disease with endoscopic findings

Background Gastroesophageal Reflux Disease (GERD) is caused by the reflux of gastric contents into the esophagus and has a 13% global prevalence that is increasing. GERD symptoms negatively impact physical, social, and emotional quality of life. The Frequency Scale for the Symptoms of GERD (FSSG) and the Gastrointestinal Symptom Rating Scale (GSRS) determine the efficacy of treatment but may not correlate with endoscopically estimated esophageal mucosal injury severity. We aimed to probe the correlation between FSSG, GSRS, and esophageal injury severity to evaluate whether these scores can predict GERD severity. Methods A total of 2962 patients who underwent physical examinations, including upper gastrointestinal endoscopy, at the Kyoto Kuramaguchi Medical Center, Japan, were enrolled in this study. Upper gastrointestinal endoscopy was used to diagnose fundic mucosal atrophy, reflux esophagitis based on the Los Angeles (LA) classification, gastroesophageal flap value function (GEFV) based on Hill’s classification, and Barrett’s esophagus. Endoscopic diagnoses were examined for correlations with FSSG and GSRS scores. Results In reflux esophagitis, FSSG and GSRS scores correlated with LA-B and LA-C endoscopic diagnosis but not with LA-M and LA-A endoscopic findings. Multiple regression analysis results were similar. FSSG scores reflected advanced fundic gland mucosal atrophy, while GSRS scores associated with high grade of GEFV. Conclusions This is the first report to examine the correlation between FSSG and GSRS scores and endoscopic findings in a relatively large patient population. Our findings suggest that these scores can diagnose the severity of reflux esophagitis.

Clinical features of gastroesophageal reflux disease and erosive esophagitis: Insights from patients undergoing esophagogastroduodenoscopy in resource-limited Ethiopia.

Gastroesophageal reflux disease (GERD) is a common disease worldwide with varying clinical presentations and risk factors. Prevalence data for Africa is lacking, but an increasing trend is expected due to demographic and epidemiological transitions. Although endoscopic studies for general gastrointestinal disorders have shown some patients with erosive esophagitis (EE), no studies in Ethiopia have investigated the clinical characteristics, risk factors, and severity of GERD using esophagogastroduodenoscopy (EGD). To assess the clinical features of GERD in Ethiopian patients who underwent EGD and determine the severity and risk factors of EE. We conducted a multicenter, retrospective cross-sectional study of 221 patients diagnosed with GERD and endoscopic findings of EE at Trauma Associated Severe Hemorrhage and Amniotic Membrane Stem Cell between January 2019 and August 2022. Data were collected from electronic medical records and phone call interviews. We used descriptive statistics and binary logistic regression analysis with SPSS version 26 to identify the association between variables with a statistical significance set at P value < 0.05. The mean ± SD age of the patients was 44.8 (± 15.9) years, with a male-to-female ratio of 1.6:1. The most commonly reported symptom was epigastric pain (80.5%), followed by heartburn (43%). Los Angeles (LA)-A EE was diagnosed in 71.1% of patients, followed by LA-B (14.9%), LA-C (7.7%), and LA-D (5.9%). Multivariate analysis showed that age 50 or above, presence of bleeding, and endoscopic findings of duodenitis/duodenopathy were significantly associated with severe EE (P < 0.05). Stricture and Barrett's esophagus were observed in 4.5% and 1.36% of patients with EE, respectively. Most of the patients had milder EE with fewer complications. However, severe EE was more prevalent in older patients and those with duodenitis/duodenopathy.

Value of endoscopic grading of gastroesophageal flap valve in gastroesophageal reflux disease.

To investigate the significance of endoscopic grading (Hill's classification) of gastroesophageal flap valve (GEFV) in the examination of patients with gastroesophageal reflux disease (GERD). One hundred and sixty-two patients undergoing gastroscopy in the Department of Gastroenterology, Xingyi People's Hospital between Apr. 2022 and Sept. 2022 were selected by convenient sampling, and data such as GEFV grade, and findings of esophageal high-resolution manometry (HRM) and esophageal 24-h pH/impedance reflux monitoring, and Los Angeles (LA) classification of reflux esophagitis (RE) were collected and compared. Statistically significant differences in age (F = 9.711, P < 0.001) and hiatal hernia (χ = 35.729, P < 0.001) were observed in patients with different GEFV grades. The resting LES pressures were 12.12 ± 2.79, 10.73 ± 2.68, 9.70 ± 2.29, and 8.20 ± 2.77mmHg (F = 4.571, P < 0.001) and LES lengths were 3.30 ± 0.70, 3.16 ± 0.68, 2.35 ± 0.83, and 2.45 ± 0.62 (F = 3.789, P = 0.011), respectively, in patients with GEFV grades I-IV. DeMeester score (Z = 5.452, P < 0.001), AET4 (Z = 5.614, P < 0.001), acid reflux score (upright) (Z = 7.452, P < 0.001), weak acid reflux score (upright) (Z = 3.121, P = 0.038), liquid reflux score (upright) (Z = 3.321, P = 0.031), acid reflux score (supine) (Z = 6.462, P < 0.001), mixed reflux score (supine) (Z= 3.324, P = 0.031), gas reflux score (supine) (Z= 3.521, P = 0.024) were different in patients with different GEFV grades, with statistically significant differences. Pearson correlation analysis revealed a positive correlation between RE grade and LA classification of GERD (r = 0.662, P < 0.001), and the severity of RE increased gradually with the increase of the Hill grades of GEFV. The Hill grade of GEFV is related to age, hiatal hernia, LES pressure, and the consequent development and severity of acid reflux and RE. Evaluation of esophageal motility and reflux based on the Hill grade of GEFV is of significance for the diagnosis and treatment of GERD.

Geotechnical Instabilities in Road Embankments: Analysis of a Landslide in Schistose Road Cut-and-Fill on the Taza-Al Hoceima Expressway, Northern Morocco

This article delves into the vital issue of geotechnical stability in road embankments, a crucial element for the integrity of road infrastructures and the safety of its users. It focuses on a specific case of landslide along the Taza-Al-Hoceima highway at kilometer point 67+800. This case is particularly significant due to the embankment's composition, which predominantly consists of schistose cut and fill, in addition to the topographic and hydrographic complexity of the area. The main ambition of this study is to delineate the various factors and underlying mechanisms that precipitate such geotechnical instabilities. To this end, the research integrates field investigations with laboratory analyses. A major aspect of this research involves examining the characteristics of the schists at the site. These schists are identified as fragmentable clayey rocks (R34), demonstrating a range of Micro-Deval (MDE) coefficients between 67 to 100 and Los Angeles (LA) coefficients from 33 to 57. Upon alteration, these schists are reclassified as fine soils (A2), consisting of 35-40% fine particulate matter, with plasticity indices ranging from 13 to 22 and a high permeability rate (Kp=10-3 m/s). The study underscores the schists' vulnerability, particularly their susceptibility to evolutionary changes and water sensitivity. It also reveals that local geomorphological and hydrodynamic conditions exacerbate water infiltration. Heavy rainfall is pinpointed as the trigger for the landslide incident. Although the current road drainage system effectively manages surface water, the findings of the analysis emphasize the critical need to enhance this system to address the significant water infiltration problem identified.

Issues in the Use of Aggregates from Demolition Sites, in Construction, with a View to Protecting the Environment

Construction professionals are increasingly confronted with issues related to the preservation of the environment. For several years, they have been facing a double problem. In highly urbanized regions, the number of buildings is increasing, and with them the need for raw materials. Concrete is one of the most used materials in modern works, the need for aggregates, one of its components is very high. However, the quarries of aggregates are running out. Potentially usable spaces are becoming scarce, and construction professionals are facing supply difficulties. On the other hand, in the building sector, millions of tons of waste from demolitions are still too often deposited in storage facilities. It is becoming clear that the recovery of this waste is a major environmental issue, and that their reuse in the form of aggregates would be a beneficial alternative for the environment. It would allow pollution by landfill to be limited. In order to determine a relevant use of recycled aggregates in construction, we have done the tests for determining the density, los angeles, water absorption, proctor test on its aggregates. We got the following conclusions: recycled concrete aggregates are generally more absorbent and less dense than ordinary aggregates. The form of recycled aggregates is similar to that of crushed stone. The concretes made with these aggregates have acceptable workability. Due to their composition, these recycled aggregates have different characteristics from natural aggregates, and their mechanical behavior is distinct. Indeed, recycled aggregates are more porous, have a higher water absorption coefficient, contain hydrates, and have interfacial transition zones, which are weak zones for the mechanical strength of the concrete. Recycled aggregates are also suitable for road foundation work.

The Linguistic Landscape of Los Angeles Chinatowns

This paper presents a multi-level analysis of the signage in Los Angeles (LA) Chinatowns. Through a combined method of ethnographic observations, interviews and textual and visual analysis of language orthographies, the processes in which signage is designed, perceived, and interpreted are examined. A discussion of the range of interpretive readings of Chinese orthography and romanization is presented, with a focus on the relationship between the linguistic landscape and people’s language perception, and the changing social indexicalities of different linguistic variables displayed in LA Chinatowns. The paper concludes that the linguistic landscape can be taken as a form of informal language input which impacts Chinese immigrants’ language perception. Moreover, linguistic variables displayed on public signage not only contribute to the construction of the sociolinguistic context but also to the immigrants’ identity transformation.

The Linguistic Landscape of Los Angeles Chinatowns

This paper presents a multi-level analysis of the signage in Los Angeles (LA) Chinatowns. Through a combined method of ethnographic observations, interviews and textual and visual analysis of language orthographies, the processes in which signage is designed, perceived, and interpreted are examined. A discussion of the range of interpretive readings of Chinese orthography and romanization is presented, with a focus on the relationship between the linguistic landscape and people’s language perception, and the changing social indexicalities of different linguistic variables displayed in LA Chinatowns. The paper concludes that the linguistic landscape can be taken as a form of informal language input which impacts Chinese immigrants’ language perception. Moreover, linguistic variables displayed on public signage not only contribute to the construction of the sociolinguistic context but also to the immigrants’ identity transformation.

Relationship between adolescent internet addiction and adolescent non-suicidal self-injury: a moderated mediation model.

Both Internet addiction (IA) and non-suicidal self-injury (NSSI) are major public health concerns among adolescents, association between internet addiction and non-suicidal self-injury have been observed among adolescents. However, it is unclear how, and under what conditions, internet addiction relates to non-suicidal self-injury. According to our hypothesis, there is a positive relationship between IA and NSSI among Chinese adolescents, but this relationship is affected by the mediating role of loneliness and the moderating role of cognitive reappraisal. A cross-sectional survey was conducted on 1046 Chinese adolescents from 3 middle schools. Measurements: Adolescent Self-Harm Scale; Young's Internet Addiction Test (IAT); University of California at Los Angels (UCLA) Loneliness Scale; Emotional Regulation Questionnaire (ERQ), They were asked to complete self-report questionnaires. In our sample, the detection rate of NSSI was 12.3%. IA was positively associated with NSSI, and loneliness partially mediated the association between them. In addition, cognitive reappraisal moderated the first half path of the mediation model. Specifically, the higher the level of cognitive reappraisal, the weaker the positive effect of IA on NSSI through loneliness. Interventions targeted to reduce loneliness and increase cognitive reappraisal strategies may reduce the risk of NSSI in adolescents with Internet addiction.

Analisis Wacana Kritis Norman Fairclough Pada Film Barbie 2023 Sebagai Representasi Budaya Patriarki

Film is part of audio-visual mass media communication and aims to convey social messages to the audience in accordance with the reality that is growing and developing in society. One of the films that has this purpose is the film Barbie Live Action 2023. The purpose of this research is to dissect the discourse in three dimensions, namely textual, discourse practice, and sociocultural practice. In this research, the type of research used is qualitative-descriptive research. The paradigm used in this research is the critical paradigm. The appropriate research method used for this research is Norman Fairclough's Critical Discourse Analysis method. In the textual dimension, the linguistic tools of Diction, Cohesion, Modality and figure of speech metaphor are obtained. In the discourse practice dimension, at the production level the Barbie film is produced with two backgrounds, namely Barbieland and the real world, namely the city of Los Angles, United States with English language dialogue. At a text consumption level, the film is the highest-grossing box office film of all time with earnings of $1.45 billion. Sociocultural practices have 3 levels, namely situational, institutional and social levels. Situational Barbie script was written during the pandemic. For example, the film Barbie was a box office success in almost the entire world and became the hope of the global community regarding the end of the pandemic. Furthermore, at the institutional level, which includes the media, is Greta Gerwig herself as a film filmmaker. Warner Bros. is the production house for the 2023 Barbie Live Action film. Then there is Mattel as the company behind the production of Barbie dolls. Finally, at the social level, this film shows how patriarchy persists in reality, the social and cultural system of American society still adheres to patriarchal culture and neglects women's rights and protection.

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

ABSTRACT 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.

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.

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. 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). 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. Our results highlight the potential impact of interventions to enhance the implementation of existing evidence-based interventions for the prevention and diagnosis of HIV.

Comparative evaluation of endoscopic anti-reflux mucosectomy and stretta radiofrequency ablation in the management of gastroesophageal reflux disease: insights from a retrospective multicenter cohort study.

Treatment options for gastroesophageal reflux disease (GERD) that is unresponsive to proton pump inhibitors (PPIs) remain limited. Therefore, we compared the therapeutic effects of anti-reflux mucosectomy (ARMS) and Stretta radiofrequency (SRF) for intractable GERD in over 400 individuals who underwent either procedure. We conducted a retrospective study between 2016 and 2023 to evaluate the effectiveness of SRF and ARMS treatments for refractory GERD. The primary measure of success was the change in the GERD questionnaire (GERDQ) score. The secondary outcomes were various GERD-related indicators, including endoscopic Los Angeles (LA) classification, Hill's type-based flap valve grade (FVG), EndoFLIP™ distensibility index (DI), rate of PPI discontinuation, resolution rate of Barrett's esophagus, and incidence of adverse events. The ARMS group included patients with high GERDQ scores, FVG, LA grade, and Barrett's esophagus. Both groups had similar rates of improvements in GERDQ score (P = 0.884) and PPI withdrawal (P = 0.866); however, the ARMS group had significantly more side effects and improvements in the median change in GERDQ score (P = 0.011), FVG (P < 0.001), LA grade (P < 0.001), EndoFLIP™ DI (P < 0.001), and resolution of Barrett's esophagus (P < 0.001). The ARMS group had a greater GERDQ score improvement than the SRF group but had symptom relief and PPI discontinuation rates similar to those of the SRF group. However, objective measures, including EndoFLIP™ DI and endoscopic evaluations, were better in the ARMS group than in the SRF group.

Modeling the Impacts of Volatile Chemical Product Emissions on Atmospheric Photochemistry and Ozone Formation in Los Angeles

AbstractThe dominant fraction of anthropogenic volatile organic compound (VOC) emissions shifted from transportation fuels to volatile chemical products (VCP) in Los Angeles (LA) in 2010. This shift in VOC composition raises the question about the importance of VCP emissions for ozone (O3) formation. In this study, O3 chemistry during the CalNex 2010 was modeled using the Master Chemical Mechanism (MCM) version 3.3.1 and a detailed representation of VCP emissions based on measurements combined with inventory estimates. The model calculations indicate that VCP emissions contributed to 23% of the mean daily maximum 8‐hr average O3 (DMA8 O3) during the O3 episodes. The simulated OH reactivity, including the contribution from VCP emissions, aligns with observations. Additionally, this framework was employed using four lumped mechanisms with simplified representations of emissions and chemistry. RACM2‐VCP showed the closest agreement with MCM, with a slight 4% increase in average DMA8 O3 (65 ± 13 ppb), whereas RACM2 (58 ± 13 ppb) and SAPRC07B (59 ± 14 ppb) exhibited slightly lower levels. CB6r2, however, recorded reduced concentrations (37 ± 10 ppb). Although emissions of O3 precursors have declined in LA since 2010, O3 levels have not decreased significantly. Model results ascribed this trend to the rapid reduction in NOX emissions. Moreover, given the impact of COVID‐19, an analysis of 2020 reveals a shift to a NOX‐limited O3 formation regime in LA, thereby diminishing the influence of VCPs. This study provides new insights into the impact of VCP emissions on O3 pollution from an in‐depth photochemical perspective.

Efficacy of a culturally tailored screening campaign to tackle cervical cancer disparities among Hispanic patients.

e13697 Background: Cultural barriers have been identified as drivers of cervical cancer disparities. Hispanic patients specifically experience a higher incidence of cervical cancer and are more likely to be diagnosed at advanced stages than non-Hispanic White patients, mediated by multiple factors including cultural perceptions. To tackle cultural barriers in cervical cancer screening, this study assessed the efficacy of a community-based media campaign to increase Pap tests within a predominantly Hispanic community in east Los Angeles (LA). Methods: The campaign was implemented through a collaboration of local community members, design and communication experts, and cancer researchers. Prior to campaign design, focus groups were conducted with at-risk Hispanic women aged 18-45. Learnings from these focus groups and additional study of the visual culture of east LA led to selection of the jacaranda tree, which blooms for a short time in LA each spring, as a visual cue to pursue screening. This imagery was accompanied by a scheduling phone number and messaging (“It’s time.” and “You can prevent cervical cancer.”) in Spanish and English. Campaign materials were displayed on bus benches, billboards, and light post banners throughout east LA. To analyze campaign efficacy, intercept surveys were conducted from 2015-2018 by trained interviewers at locations throughout the community. In their preferred language, female participants (n=770) were asked standardized questions assessing campaign recall, message interpretation, and likelihood of scheduling a Pap test after viewing the campaign. Results: Among participants, mean age was 47.4 years, 88.7% primarily spoke Spanish at home, 25.2% were uninsured, 80.6% had not been vaccinated against HPV, and 12.5% had not had a Pap test in the last 3 years. 25.7% of participants recalled having seen campaign materials prior to survey, with 71.7% interpreting the message as a call to prevent and/or get screened for cervical cancer. 89.3% of participants stated that they were Likely or Extremely Likely to schedule a Pap test after viewing the campaign, including 87.2% of those who had not had a Pap test in the last 3 years. Conclusions: These findings support the efficacy of a community-based strategy to increase cervical cancer screening. This campaign showed high screening intent in a sample of participants who were disproportionately uninsured (25.2% v. 8.5% overall in the US in 2018), with similar efficacy among those who were overdue for recommended screenings. These results emphasize the benefit of culturally tailored messaging to improve screening uptake within underserved populations.

Educating a diverse group of women in Los Angeles County on ovarian and uterine cancers and clinical trials.

e23105 Background: Ovarian and uterine cancers are among the deadliest cancers for women and due to vague symptoms, diagnosis is often delayed. In addition, there are ethnic disparities in time to diagnosis, treatment, and outcome for these cancers. The purpose of this study was to assess a diverse group of Los Angeles (LA) County women’s understanding of both ovarian and uterine cancers and assess the impact of intervention by community health organizations. Methods: A Qualtrics survey was administered online and in-person to 185 women aged 18 and older in LA County between May 3rd and July 15th 2023. The survey aimed to investigate participants’ knowledge, awareness, and attitudes on women’s cancers’ risk factors, symptoms, screening, treatment options, and clinical trials. Information on participant demographics was also collected. Chi-square analysis, descriptive statistics, filtering and sub-setting, correlation analysis were utilized using R-Studio. MiOra Health Educators provided face-to-face education on ovarian and uterine cancers as well as clinical trials to this sample of participants. Results: Out of 185 respondents, 117 (63.2%) were Hispanic or Latina and 65 (35.1%) reported completing 4 year of college education. 137 (74.0%) reported attending their annual women’s wellness visit. Women with insurance (143, 77.0%) were more likely to report having women’s cancer screening compared to those who were uninsured (71, 38.0%). 93 women (50.3%) reported going to their primary physicians for advice on sexual and/or genital organ health rather than visiting a gynecologist; however older women (aged 41-50) reported seeing their gynecologist more often than the women in younger groups. Moreover, 127 women (68.6%) were aware of clinical trials (the majority being college-educated) however, a majority of the total participants (154, 83.2%) did not know where to locate clinical trials or that one may leave a clinical trial at any time (123, 66.5 %). Prior to educational intervention, only 104 women (56.2%) reported being “somewhat knowledgeable” about women’s cancers’ risk factors and symptoms. Following educational intervention, 143 (77.7%) reported feeling more knowledgeable about women’s cancers’ risk factors and symptoms and 122 (66.6%) reported feeling more knowledgeable about clinical trials and comfortable participating in one. Conclusions: In this pilot study we found that a majority of diverse LA County women attend their annual wellness visits; however, only a small portion receive women’s cancer screening. Lack of insurance appears to be a significant barrier for access to screening tests. In addition to awareness of clinical trials, the ability to locate a clinical trial appears to influence participation in one. Although primary care providers and obstetricians are the most trusted health resources, community health educators may be effective in educating women to close these gaps.

The development of recommendations for the assessment and management of sesamoiditis by podiatrists: A Delphi and content validity study.

Sesamoiditis is a common, and often painful, musculoskeletal pathology frequently encountered by podiatrists. However, there are currently no recommendations to guide podiatrists in the assessment and management of people with sesamoiditis. The aim of this study was to develop consensus-driven clinical recommendations on the assessment and management of people with sesamoiditis. A four-round online Delphi survey was conducted with a panel of New Zealand and Australian podiatrists. In the first round, panellists answered open-ended questions that were used to create statements. In round two, the panellists scored the statements from 1 to 9 (1=not at all important, 9=absolutely essential). Consensus was defined using the RAND/University of California Los Angles Disagreement Index. Panellists were asked to reconsider statements that did not achieve consensus in round three. In the final round, content validity and acceptability of the statements for inclusion in clinical recommendations were determined using content validity ratios and the Content Validity Index (CVI). Eighteen panellists completed round one with 16 (89%) completing all four rounds. A total of 118 statements were generated following round one. Following rounds two and three, 78 statements were accepted by panellists as being important, with 62 statements achieving sufficient content validity for inclusion in clinical recommendations. The CVI for these 62 statements was 0.58. These recommendations provide guidance on subjective assessment (pain characteristics/symptomology, activity/sports/training history and medical history) objective assessment (establishing a diagnosis, identifying contributing biomechanical factors, footwear/orthoses, ruling out differential diagnoses) and management (temporary padding/strapping, education, footwear, foot orthoses and when to consider referral). This consensus exercise has provided a set of consensus-based recommendations for the assessment and management of people with sesamoiditis. In the current absence of research-based evidence in this area, these recommendations are intended to support clinicians. The recommendations may also serve as a basis for future clinical trials evaluating the efficacy of conservative interventions for people with sesamoiditis.

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.