Ventura County Research Articles

Psychiatric Community Crisis Services for Youth.

Each year, increasing numbers of children and families seek care for psychiatric crises; unfortunately, most communities offer limited services to meet these needs. Youth in crisis often present to emergency departments, but may not need or benefit from that level of care. Instead, data reflect improved clinical and financial outcomes when communities offer a continuum of crisis services. In this article, the authors present care models from two communities - Ventura County, California, and the state of Connecticut - and review program development, implementation, and monitoring. The authors also highlight principles for leaders to consider in developing these services.

Health Care Disparities Between Men and Women With Type 2 Diabetes.

IntroductionRegular medical checkups indicate a patient’s level of adherence to health care treatment, and the frequency of cancelled appointments or no-shows can indicate adherence. This study investigated the use of health care services by men and women and its impact on the control of their type 2 diabetes.MethodsThis study observed 100 patients with type 2 diabetes aged 45 years or older who lived in Ventura County, California, during January 1, 2015, to January 31, 2016. The data were collected by Magnolia Family Medical Center. A Pearson χ2 test compared differences between men and women in whether they received a glycated hemoglobin A1c (HbA1c) test in previous 6 months, a low-density lipoprotein cholesterol test in previous year, and a retinal examination in previous year. A Wilcoxon signed-rank test compared attendance to medical appointments and HbA1c values for men and women.ResultsWomen had a higher rate of scheduling, cancelling or rescheduling, and showing up to their medical appointments than did men, and men had a higher median HbA1c value than did women; all the Wilcoxon signed-rank tests showed a significant difference (P < .001). None of the χ2 tests were significant.ConclusionAlthough men and women had similar health care services for diabetes, men had less control of their disease and took less advantage of medical appointments than did women.

Effects of Site and Cultivar on Consumer Acceptance of Pomegranate.

Consumer sensory panels are important to determine scientifically which cultivars are desired by the public. These panels allowed for the determination of which pomegranate cultivars are liked or disliked by consumers and why. If the pomegranate growers know the most desirable cultivars for consumers, they are more likely to adopt and plant them, thus potentially increasing the diversity in the marketplace, as has been with apples, peaches, plums, pears, mangoes, strawberries, raspberries, blueberries, and citrus.

Environmental evaluation of high-value agricultural produce with diverse water sources: case study from Southern California

Meeting agricultural demand in the face of a changing climate will be one of the major challenges of the 21st century. California is the single largest agricultural producer in the United States but is prone to extreme hydrologic events, including multi-year droughts. Ventura County is one of California’s most productive growing regions but faces water shortages and deteriorating water quality. The future of California’s agriculture is dependent on our ability to identify and implement alternative irrigation water sources and technologies. Two such alternative water sources are recycled and desalinated water. The proximity of high-value crops in Ventura County to both dense population centers and the Pacific Ocean makes it a prime candidate for alternative water sources. This study uses highly localized spatial and temporal data to assess life-cycle energy use, life-cycle greenhouse gas emissions, operational costs, applied water demand, and on-farm labor requirements for four high-value crops. A complete switch from conventional irrigation with groundwater and surface water to recycled water would increase the life-cycle greenhouse gas emissions associated with strawberry, lemon, celery, and avocado production by approximately 14%, 7%, 59%, and 9%, respectively. Switching from groundwater and surface water to desalinated water would increase life-cycle greenhouse gas emissions by 33%, 210%, 140%, and 270%, respectively. The use of recycled or desalinated water for irrigation is most financially tenable for strawberries due to their relatively high value and close proximity to water treatment facilities. However, changing strawberry packaging has a greater potential impact on life-cycle energy use and greenhouse gas emissions than switching the water source. While this analysis does not consider the impact of water quality on crop yields, previous studies suggest that switching to recycled water could result in significant yield increases due to its lower salinity.

Geographic Disparities of Cervical Cancer Survival in California, United States

Background/Aim: Mapping crude and adjusted geographic distributions of disease outcomes is a useful tool for identifying risk factors of public health concern. The crude spatial pattern of disease is often what is observed by public health practitioners, but these patterns may be due to important spatially-varying predictors such as socioeconomic status, race/ethnicity, or environmental exposures. Individual-level spatial analyses can provide insight regarding geographic disparities in disease risk by adjusting for these variables without aggregation bias. Methods: We conducted a spatial analysis of cervical cancer survival among 17,541 cases diagnosed throughout California United States from 1995-2009 using MapGAM, an R package that estimates spatial hazard ratios (HR) and corresponding 95% confidence intervals (CI) in a generalized additive model framework with a non-parametric bivariate smooth term of location. Survival models were adjusted for patient age, tumor characteristics, race, socioeconomic status, care at a high-volume hospital (HVH), non-adherence to treatment guidelines, distance to receive care, and distance to closest HVH. Results were mapped in R also using MapGAM. Results: After controlling for patient and tumor characteristics, we observed significant areas of low HR in the San Francisco Bay area, Ventura and Los Angeles Counties. When distance and quality care variables were included in the model, HR northeast of Sacramento became elevated and significant due to reverse spatial confounding. Living within 30 miles of a HVH was protective [HR:0.86, 95% CI:0.77,0.97]. The fully adjusted spatial analysis reveals geographic disparities not due to quality of care. Conclusions: Quality of care indicators were the most influential on geographic disparities, but areas of poorer cervical cancer survival may be related to spatially-varying social or environmental stressors that warrant further investigation. The use of a bivariate smoother of location within the survival model allows for more advanced spatial analyses for exploring potential predictors of geographic disparities.

New Additions to the Flora of San Nicolas Island, Ventura County, California

Ongoing collecting efforts on San Nicolas Island have substantially increased the number of plant species documented from the island. Here we report thirty-one plants previously unrecorded from the island. The list includes six eudicots, one monocot, four liverworts and twenty mosses. Five of these species are understood to be introduced on San Nicolas and the remainder are believed to be native. The native vascular plants are Logfia filaginoides, Cistanthe maritima and Muhlenbergia microsperma. Of the twenty-four new bryophytes, one—Asterella bolanderi—is the first record from the Channel Islands. Specific ecological and locality information are provided for the new vascular plant finds and general patterns of bryophyte richness and ecological preferences are discussed.

Coming Home

Coming Home

Surgical Site Infection Reduction Bundle: Implementation and Challenges at Ventura County Medical Center

Surgical Site Infections (SSIs) are a significant cause of morbidity and increased cost in the postoperative patient occurring in 2-5 per cent of those undergoing inpatient surgery. Ventura County Medical Center (VCMC) initiated an SSI reduction bundle in 2013, to try to reduce the incidence of SSI. The bundle is a series of best practices including preoperative, perioperative, intraoperative, and postoperative components, as well as items focused on the staff and electronic medical record. VCMC started with a 6.1 per cent SSI rate in 2013. A consistent reduction in SSI rate followed each quarter after that for a rate of less than 2.0 per cent in early 2016. The most critical aspect of this process was the necessary collaboration between disparate departments and the ongoing investment of the staff to this challenging process; the people at the heart of the collaborative process were the key to its success.

Homelessness as a Positive Influence on Pulmonary Health in COPD

SESSION TITLE: Pulmonary Rehabilitation SESSION TYPE: Original Investigation Slide PRESENTED ON: Monday, October 30, 2017 at 07:30 AM - 08:30 AM PURPOSE: Homelessness is a growing problem in the United States that may significantly impair physical health. The homeless have a high prevalence of cigarette smoking, poor nutrition, and adverse environmental exposures, which could contribute to obstructive lung disease. Under our COPD Access To Community Health (CATCH), a CMS Innovations grant, we bring a team of physicians, nurses, nurse case managers to affect the population health of Ventura County California. We have aggressively recruited over 2000 adults from all social strata. They complete spirometry, have a medical home identified, data entered into the CATCH registry, enrolled in smoking cessation, enrolled in cellphone based education, and are presented at multi-disciplinary weekly conference. We have spent over two years lobbying for inclusion of pulmonary rehabilitation coverage by our MediCaid managed care plan. Patients may be met at coffee houses rather than encampments to maintain a safe environment where spirometry and registry data are obtained METHODS: Registry data includes Ethnicity, City, Postal Code, Language, Benefit Plan Name, Text Message, Types Of Care Messages, Smoker, Pack Years. Referred to Smoking Cessation, If Not Referred, Quit Date, Newly Diagnosed, Date of 1st PFT, Initial Stage, Initial Severity, FEV, 1Session Quality, Oxygen (Y/N)If yes, O2 machine name, and Level of Activity were collected in all CATCH Registry patients. At time of case review specific behavioral screening, GOLD Staging, nutrition screening, smoking cessation opportunities, identification of cases needing intensification of case management including fall prevention and hospice care are reviewed and entered into the electronic health care record or information provided to the primary care physician if in another system of care. RESULTS: Although subvariate analysis is ongoing and a genomic subgroup may be responsible, what emerged is a group of male patients ranging in age from 30 to 72 years who qualified as homeless, and as a consequence of the lack of transportation system available to them walked or bicycled more than three miles daily for social and other needs. Patients were identified by pack years smoking and enforced transportation and exercise activity. 45 pack years Bicycles; 25 pack years Surfer/ hiker;60 pack years Walks/ bikes; 7 pack years Walking 3 miles a day; 2 pack years Walks 3-4 miles a day; 60 pack years Walks and bikes; 26 Pack years Walks; 10 pack years Walk 4 miles a day; Former smoker 25 pack years Mountain bikes/ cuts wood; and 30 pack years Walks. All patients were GOLD 0 with no bronchodilator response. CONCLUSIONS: Rates of diagnosed respiratory health conditions and lung disease are generally dramatically higher than the general population due to the high rates of smoking tobacco and illicit substances. The importance of establishing the amounts of weekly exercise and increasing that amount, appears to result in unexpected protention of lung health. CLINICAL IMPLICATIONS: Increasing activity for all Americans is a clearly designated health goal and one that, in this population of male homeless patients, has resulted in startling outcome. DISCLOSURE: The following authors have nothing to disclose: Chris Landon No Product/Research Disclosure Information

A geostatistical model for combined analysis of point-level and area-level data using INLA and SPDE

In this paper a Bayesian geostatistical model is presented for fusion of data obtained at point and areal resolutions. The model is fitted using the INLA and SPDE approaches. In the SPDE approach, a continuously indexed Gaussian random field is represented as a discretely indexed Gaussian Markov random field (GMRF) by means of a finite basis function defined on a triangulation of the region of study. In order to allow the combination of point and areal data, a new projection matrix for mapping the GMRF from the observation locations to the triangulation nodes is proposed which takes into account the types of data to be combined. The performance of the model is examined and compared with the performance of the method RAMPS via simulation when it is fitted to (i) point, (ii) areal, and (iii) point and areal data to predict several simulated surfaces that can appear in real settings. The model is applied to predict the concentration of fine particulate matter (PM2.5), in Los Angeles and Ventura counties, United States, during 2011.

Effects of Added Lipids on Digestibility and Nitrogen Balance in Oiled Common Murres ( Uria aalge ) and Western Grebes ( Aechmophorus occidentalis ) Fed Four Formulations of a Critical Care Diet.

Nutritional support is a primary therapy administered to oiled animals during responses to oil spills, but data informing nutritional decision-making during events are limited. In this study, 44 common murres ( Uria aalge ) and 6 Western grebes ( Aechmophorus occidentalis ), naturally oiled by oceanic seeps off the coast of Ventura and Santa Barbara Counties, CA, USA, were assigned to 1 of 4 groups fed diets with varying levels (6.8% [no added oil], 11%, and 20%) and types (salmon, corn) of oil added to a partially purified basal diet. Birds used in the study ranged from extremely emaciated to thin body condition (62%-80% wild bird mean body mass). Acid-insoluble ash was used as an indigestible dietary marker to quantify nitrogen retention, apparent nitrogen digestibility, nitrogen-corrected apparent metabolizable energy, energy digestibility, fat retention, fat digestibility, and estimated fat excretion. Fat excretion is important in these species because once birds have been cleaned they are at risk of plumage recontamination from excreted fat during care. Lower fat diets resulted in lower fat excretion but higher nitrogen retention, higher apparent nitrogen digestibility, and higher apparent metabolizable energy. Decreases in nitrogen retention were significantly related to increases in fat excretion. Regardless of diet, energy digestibility significantly declined with declines in body mass, suggesting severity of emaciation reduced a birds' ability to extract energy from food. Energy digestibility was highest in the 11% (low) salmon oil diet; hence, this diet had the highest effective energy content despite a lower gross kcal/kg diet. Diets fed during oil spills historically have had high fat concentrations to provide maximum caloric support. Results of this study suggest that lower fat diets may be more efficacious for nutritionally depleted seabirds. This study provides valuable data to guide clinical decision making regarding nutritional support during oil spills and other mass stranding events.

Modeling Transport of Oil from the Refugio Beach Oil Spill

2017-288 ABSTRACTThe Refugio Beach oil spill originated from a pipeline break on 19 May 2015 near Refugio State Beach, which is located approximately 20 miles west of Santa Barbara, California. An estimated 500 barrels (21,000 gallons) of crude oil flowed from the shore side of Highway 101 into the Pacific Ocean. Trajectory and fate modeling of the oil were provided to the Incident Command to support the response. Several factors were particularly challenging for oil spill modeling in this incident. The spill entered the ocean through the surf zone, a distinct dynamical region with variability on small spatial and temporal scales, which coastal circulation models generally do not resolve. The regional winds were also highly variable and in some locations forecast models did not reflect the on-scene observations. A final complication was the presence of numerous natural oil seeps in the region. This posed challenges both for model initialization and validation of modeling results.In the days following the spill, above-background levels of tarballs were observed coming ashore on various beaches remote from the spill. Chemical analyses indicate that some of the tarballs likely originated from the spill. Hindcast modeling of the spill was conducted to examine transport between these locations and the spill source. Modeling simulations showed regional connectivity in approximately the correct time frame between the spill site and beaches in Ventura County and Santa Monica Bay.

High-resolution seismic reflection to improve accuracy of hydrogeologic models in Ventura County, California, USA

A high-resolution seismic-reflection investigation mapped reflectors and identified characteristics influencing the hydrogeology underlying a portion of the Oxnard Plain in Ventura County, California. Design and implementation of this study was heavily influenced by high levels of cultural noise from vehicles, power lines, roads, manufacturing facilities, and underground utilities/vaults. An abundance of very high quality reflections within the optimum window on shot gathers allowed accurate velocity analysis and statics corrections, which resulted in consistent and coherent common-midpoint (CMP)-stacked reflections with minimal wavelet degradation. Acquisition and processing flows were tailored to this noisy environment and relatively shallow target interval. Layering within both upper and lower aquifer systems was delineated at a vertical resolution potential of about 2.5 m at 350 m depth. Discontinuities in bedding with significant impact on the groundwater flow, particularly related to saltwater intrusion from agricultural pumping near the coast, were delineated on CMP-stacked sections and correlated to widely separated boring data, thereby providing continuity and realism to hydrologic models.

Revised chloropicrin use requirements impact strawberry growers unequally

Buffer zone requirements are by nature spatial and their effects are site-specific, with some fields — because of their location — more impacted than others. Using a set of strawberry fields in Ventura County that were preplant soil fumigated in 2013 as a baseline, we examined how much acreage eligible for chloropicrin fumigation would have been lost if either of two buffer zone distance regulations had been in effect: any one of the four sets of alternative distances proposed in May 2013 by the California Department of Pesticide Regulation (DPR) or the buffer zone distances DPR released in January 2015. Buffer zone distances are based on several factors including the anticipated protection of human health, referred to as the percentile of protection. We find that the effects are highly dependent on the percentile of protection. From 4% to 29% of the fumigated blocks analyzed would have had an increase in buffer zone acreage depending on the percentile of protection. In those blocks, the share of total acreage that would no longer have been eligible for fumigation with chloropicrin varied from 3% to 45%. We also identify strategies that growers employed to reduce required buffer zone distances under use requirements in effect in 2013. The most frequently used strategies were using a tarp type with the lowest buffer zone requirements (“60% tarp”), extending a buffer onto a neighboring property, road and/or farm path, and reducing application rates. The results have an important policy implication: spatially defined use regulations have very different effects for different fields; aggregated industry-level analyses will miss the range of impacts on growers.

Berry research at Hansen Agricultural REC helps growers increase yields

News from the RECs At Hansen Agricultural REC, better blackberries and a soil disinfestation alternative Hazel White A t 27 acres, Hansen Agricultural Research and Extension Center (HAREC), in Ventura County, is small. It is exposed to the Santa Ana winds and has heavy clay loam soil infested with one of the highest levels of Verticillium wilt fungus recorded anywhere in the state. And yet it’s proving a major resource for Central Coast growers interested in producing a very profitable blackberry crop or in managing soil pests in strawberries without fumigation. HAREC has developed a growing program for a firm, sweet, large blackberry to produce a good yield during a high-prices sales window in late summer and fall. UC Cooperative Extension (UCCE) Farm Advisor Oleg Daugovish, in charge of berry research, is also contributing to the in- ternational knowledge bank on anaerobic soil disinfestation (ASD), an alternative to chemical fu- migation that uses waste carbon products, such as rice bran. Growers of high-value organic strawber- ries in the Central Coast region have taken up ASD enthusiastically. Prime-Ark 45 blackberry In fall 2011, a new, publicly available primocane blackberry variety, Prime-Ark 45, from the Uni- versity of Arkansas fruit breeding program was planted at HAREC. “It looked good, tasted good, and yielded well,” Daugovish recalls. Since then he has established how to manipulate the timing of the harvest, working with UCCE researchers with blackberry trials under way in other parts of the coast: Mark Bolda, UCCE Director and Farm Advisor in Santa Cruz County, and Mark Gaskell, UC Small Farms Program Advisor in San Luis Obispo and Santa Barbara counties (Gaskell and Daugovish 2016). “Our results are consistent and add up to the same story,” says Daugovish. “This is a high-quality crop, easy to manage, and fruiting can be optimized for the lucrative window in late summer.” Oleg Daugovish Timing the California blackberry harvest for late summer, when berries from other sources are scarce, helps growers maximize returns. 104 CALIFORNIA AGRICULTURE • VOLUME 70 , NUMBER 3

Groundwater recharge assessment in an upland sandstone aquifer of southern California

The Chloride Mass Balance (CMB) method was used to obtain long-term recharge values for the Santa Susana Field Laboratory (SSFL) site, which features a groundwater flow system beneath an upland ridge formed of sandstone and shale beds in the Simi Hills, Ventura County, southern California. This application relied on the availability of on-site measurements of bulk atmospheric chloride deposition comprised of dry fallout and wet concentration, a large number of groundwater samples (∼1490) collected over three decades from 206 wells spanning a depth range from 10 to 360m, and measurements of chloride in surface runoff during rain events. The use of the CMB method is suited to the assessment of recharge for the study area because the mean chloride values in groundwater show minimal spatial trends, indicating no sources other than atmospheric. In addition, the Cl/Br ratio was used to exclude wells with possible anthropogenic chloride. The site-wide average recharge ranges between 1.8 and 9.5% of the mean annual precipitation (455mm) with a mean value of 4.2%. The measured surface runoff varies from 2.3 to 10.2% with mean value of 6.1% (28 mm) and, therefore, the volume of water lost to evapotranspiration is between 95.9 and 80.3% with a mean value of 89.6% (408mm). The long-term recharge calculated using the CMB method is consistent with tritium distribution based on a subset of groundwater monitoring wells and with an analysis of steady flow in the groundwater mound beneath the SSFL. Furthermore, the recharge value matches those in the literature for sandstone aquifers in arid and semi-arid climates. This recharge estimate has important relevance for site characterization in terms of constraining the volumetric groundwater flow rates and water balance and understanding the mechanisms of transport towards the water table. Moreover, this is the first application of the CMB in an upland area of California. Hence, the method is demonstrated to be robust and applicable to many upland bedrock areas in southern California and similar regions around the world, and can be used to quantify groundwater flow rates and supplies relevant to water resource management.

Forge strong ties between staff, students to enhance campus safety

When Joel Justice accepted the position of chief of police at the Ventura County Community College District, he brought with him 29 years of experience from the Los Angeles Police Department. The transition came with some marked differences in law enforcement views for him. “In municipal law enforcement, everything is black and white — you either broke the law or you didn't. In higher education, we have different levels — because we're dealing with students, oftentimes [if it's not a violent crime] they deserve another chance,” Justice said.

Modeling duration of time lived in a residence, a community and mobility in rural areas of Merced and Ventura, California to assess potential health risks to airborne contaminants

A de novo population mobility survey of 800 households (random digit dialing-based phone interviews) was conducted in high demand areas of the agricultural fumigant, 1,3-dichloropropene (1,3-D) in Merced and Ventura counties of California. The survey included approximately 20 questions relating to the length of time individuals had lived in the high demand areas in each county, and also relating to weekly and annual mobility patterns. Lifetime inhalation exposures to 1,3-D are determined, in part, by the number of years individuals spend in an area where the fumigant is used. The purpose of the survey was to provide location-specific data for probabilistic modeling of long-term inhalation exposures to 1,3-D. The survey found that the majority of residents do not live in a high demand area or in the same house (99.99%) for 70years (a default assumption used by some regulatory agencies). It was also observed that residents move frequently and are mobile day-to-day and week-to-week, within the use area. Finally, estimates of total residency duration, derived from the survey results indicate that median times spent within a high demand area (which could include more than one residential location) were 18 and 26years for Ventura and Merced high demand areas, respectively. The average time spent in the high demand areas was 22 and 27years for the Ventura and Merced community, respectively. Less than 0.01% of the populations in either of the high demand areas spend 70years in the same house.

Hippotherapy: Remuneration issues impair the offering of this therapeutic strategy at Southern California rehabilitation centers.

Hippotherapy is the use of equine movement in physical, occupational, or speech therapy in order to obtain functional improvements in patients. Studies show improvement in motor function and sensory processing for patients with a variety of neuromuscular disabilities, developmental disorders, or skeletal impairments as a result of using hippotherapy. The primary objective of this study is to identify the pervasiveness of hippotherapy in Southern California, and any factors that impair its utilization. One hundred and fifty-two rehabilitation centers in the Southern California counties of Los Angeles, San Diego, Orange, Riverside, San Bernardino, San Diego, San Luis Obispo, Santa Barbara, Ventura, and Kern County were identified, and surveyed to ascertain if hippotherapy is utilized, and if not, why not. Through a review of forty facilities that responded to our inquiry, our study indicates that the majority of rehabilitation centers are familiar with hippotherapy, however, only seven have reported that hippotherapy is indeed available as an option in therapy at their centers. It is concluded that hippotherapy, used in a broad based array of physical and sensory disorders, is limited in its ability to be utilized, primarily due to remuneration issues.

Prioritizing Riparian Conservation: A Methodology Developed for the Santa Clara River, California

Riparian ecosystems perform many important ecological functions, but human activities have seriously altered and degraded these systems. To avoid continued habitat loss and associated losses in biodiversity, lands that contain intact riparian habitat can be acquired and managed for conservation values and degraded riparian areas can be restored. The Nature Conservancy (the Conservancy) is implementing a riparian conservation project on the Santa Clara River in Ventura County, California that includes both approaches. Because larger restoration projects have faster recovery rates and are more self-sustaining, the Conservancy is protecting and restoring as much contiguous riparian habitat as possible using a “conservation nodes” approach. To this end, we have begun acquisition of high-value parcels, and have developed a methodology for prioritizing additional land acquisition and restoration actions on the river. The methodology is based on quantitative measures of five criteria for 68 discrete parcels of real property contained within five nodes designated as high priority for conservation. The criteria were combined into a score for each parcel. We found that the five nodes varied in terms of their average parcel score, and in terms of the completeness of parcel acquisition. Nine of the top 20 scoring parcels have yet to be acquired by a conservation entity. We also found that the potential conservation value to be gained by restoring all of the parcels within a node varies by node. Conservation entities using this prioritization approach can phase implementation of large-scale projects by allowing restoration work to begin while acquisition efforts continue.