E-commerce, Warehousing and Distribution Facilities in California: A Dynamic Landscape and the Impacts on Disadvantaged Communities

This work addresses the distribution of warehouses and distribution centers (W&DCs) influenced by e-commerce, through spatial analysis and econometric modelling. Specifically, this work analyzes the concentration of W&DCs in various metropolitan planning organizations (MPOs) in California between 1989 and 2016-18; and studies the spatial relationships between W&DC distribution and other demographic and environmental factors through econometric modeling techniques. The work conducts analyses to uncover common trends in W&DC distribution. The analyses used aggregate establishment, employment, and other socio-economic information, complemented with transportation related variables. The results: 1) confirm that the weighted geometric centers of W&DCs have shifted slightly towards city central areas in all five MPOs; 2) W&DCs show a non-decreasing trend between 2008 and 2016; and 3) areas with more serious environmental problems are more likely to have W&DCs. A disaggregate analyses of properties sold and leased in one of the study regions shows a trend where businesses are buying or leasing smaller facilities, closer to the core of consumer demand. Among other factors, the growth of e-commerce sales, and expedited delivery services, which require proximity to the customers, may explain these trends. The study results provide insights for planners and policy decision makers, and will be of interest to practitioners, public and private entities, and academia. Caltrans, MPOs, and affiliated institutions of the National Center for Sustainable Transportation will directly benefit from the results as they want to avoid equity issues brought by the fast development of e-commerce, and its potential impact on W&DC distribution

Patterns Of Academic Help-Seeking In Undergraduate Computing Students

Knowing when and how to seek academic help is crucial to the success of undergraduate computing students. While individual help-seeking resources have been studied, little is understood about the factors influencing students to use or avoid certain re- sources. Understanding students’ patterns of help-seeking can help identify factors contributing to utilization or avoidance of help resources by different groups, an important step toward improving the quality and accessibility of resources. We present a mixed-methods study investigating the help-seeking behavior of undergraduate computing students. We collected survey data (n = 138) about students’ frequency of using several resources followed by one-on-one student interviews (n = 15) to better understand why they use those resources. Several notable patterns were found. Women sought help in office hours more frequently than men did and computing majors sought help from their peers more often than non-computing majors. Additionally, interview data revealed a common progression in which students started from easily accessible but low utility resources (online sources and peers) before moving on to less easily accessible, high utility resources (like instructor office hours). Finally, while no differences between racial groups was observed, the lack of diversity in our sample limits these findings

Surveillance of non-fatal agricultural injuries among farm operators in the Central States region of the United States

Agriculture is a major industry in the U.S. with high rates of fatal and non-fatal occupational injuries. The dynamic nature of the U.S. agriculture industry, regional variations in farming practices, and the diverse workforce make surveillance of injuries challenging. A recent National Academies (U.S.) evaluation reported that data for non-fatal agricultural injury are scarce, and mainly available through national surveys. Limited data are available for employees in the agriculture sector, especially farm owners and operators. The objectives of this study were to- 1) review and evaluate existing survey-based systems for surveillance of non-fatal agricultural injuries on U.S. farms, and 2) determine the incidence of non-fatal agricultural injuries, and risk factors of injuries among farm operators in seven Midwestern states (Iowa, Kansas, Minnesota, Missouri, Nebraska, North Dakota and South Dakota), aka Central States region. This study evaluated six national-level surveys for non-fatal agricultural injuries using the updated Center for Disease Control and Prevention guidelines for evaluating public health surveillance systems. The system evaluation used information from published reports, peer-reviewed articles, and surveillance system websites. The incidence of injuries and risk factors of injuries were evaluated using data from an annual Central States Farm and Ranch Injury Survey (CS-FRIS) linked with Census of Agriculture data. The CS-FRIS collected data from farm operators in the Central States region in 2011 (n=6953), 2012 (n=6912), and 2013 (n=7000). The evaluation of surveillance systems identified critical gaps- 1) under coverage of the farm population, 2) insufficient data quality and 3) lack of interoperability among systems reviewed, and with other data sources. The analysis of CS-FRIS data estimated an average 44,887 non-fatal agricultural injuries (6.8/100 operators) per year among farm operators in the Central States during 2011-13. About 88% of injuries were work-related, and 73% required professional medical care. Male gender, age between 35 and 64 years, farming occupation, and cattle and hog farming increased the risk of injury. In conclusion, the national-level survey-based systems in the U.S. have limited usability attributed to data limitations. The analyses of CS-FRIS data identified males, middle-aged groups (35-64), full-time farmers, and livestock farmers as high-risk groups for farm injuries, and injury prevention efforts for farm operators in the Central States region should consider these findings

Primer on adult patient satisfaction in perioperative settings.

The topic of patient satisfaction has gained increasing importance over the past decade. Due to the impact of patient satisfaction on health care quality, understanding factors that predict satisfaction is vital. The purpose of this review is to examine the literature and identify factors related to patient perioperative satisfaction as well as predictive variables that, if modified, can enhance satisfaction scores of patients undergoing surgery. Our review reports that patient satisfaction scores are affected by modifiable factors such as clinician-patient communication, information provision to patients, and operational function of a hospital. Non-modifiable factors affecting patient satisfaction scores include patient demographics such as gender, age, and education. In order to enhance patient perioperative satisfaction, we suggest that anesthesiologists and surgeons focus their efforts on enhancing their communication skills and providing information that is appropriately tailored to the understanding of their patients

Invited Paper: Four Important Strategic Issues for Computer Information Systems Education

This paper invites Computer Information System (CIS) program stakeholders to consider several strategic issues. They include: Curriculum & Pedagogy, Business Model & Value Proposition, Increasingly Diverse Student Body, and Student Success & Completion. These strategic issues are those in which faculty have the ability to provide the most influence and make the most impact; areas in which the faculty can make significant contributions without requiring higher-level organizational commitment. In addition, attention to these four areas can help to address the shortage of individual entry-level employees in the field. The paper does not offer prescriptive solutions; rather, it broadly frames some strategic issues and suggests areas for stakeholder consideration. Ideally, each program should weigh strategic issues against the backdrop of the environmental factors, i.e., opportunities and threats, within which it operates, and in the context of its own strengths and weaknesses. Moreover, each program should consider its own relevant strategic issues from the perspective of its mission, values, and aspirations

Opioid Administration and Prescribing in Older Adults in U.S. Emergency Departments (2005-2015).

Introduction: We assess trends in opioid administration and prescribing from 2005-2015 in older adults in United States (U.S.) emergency departments (ED). Methods: We analyzed data from the National Hospital Ambulatory Medical Care Survey (NHAMCS) survey from 2005 to 2015. ED visits for painful conditions were selected and stratified by age (18-64, 65-74, 75-84, ≥ 85 years). We analyzed trends in opioid administration in the ED and prescribing at discharge to encounters ≥ 65 and assessed predictors of use using survey-weighted chi-square tests and logistic regression. Trends in the use of five commonly prescribed opioids were also explored. Results: Opioid administration in the ED and prescribing at discharge for encounters with patients ≥ 65 years fell overall, but not significantly. By contrast, opioid administration in the ED and prescribing at discharge significantly declined for adult encounters 18-64 by 20% and 32%, respectively. A similar proportion of adult encounters ≥ 65 were administered opioids in the ED as 18-64, but adult encounters ≥ 85 had the lowest rates of administration. A smaller proportion of adult encounters ≥ 65 years with painful conditions were prescribed opioids at discharge compared to Conclusion: From 2005-15, 1 in 4 to 1 in 10 ED patients with painful conditions were administered or prescribed an opioid in U.S. EDs. Opioids prescribing increased from 2005-11 and then declined from 2012-15, more so among visits in the 18-64 age group compared to ≥ 65 years. Opioid administrating demonstrated a gradual rise and decline in all adult age groups. Age consistently appears to be an important consideration, where opioid prescribing declines with advancing age. Given the nationwide opioid crisis, ED providers should remain vigilant in limiting opioids, particularly in older adults who are at higher risk for adverse effects

Ten-year trends in traumatic brain injury: a retrospective cohort study of California emergency department and hospital revisits and readmissions.

OBJECTIVE:To describe visits and visit rates of adults presenting to emergency departments (EDs) with a diagnosis of traumatic brain injury (TBI). TBI is a major cause of death and disability in the USA; yet, current literature is limited because few studies examine longer-term ED revisits and hospital readmission patterns of TBI patients across a broad spectrum of injury severity, which can help inform potential unmet healthcare needs. DESIGN:We performed a retrospective cohort study. SETTING:We analysed non-public patient-level data from California's Office of Statewide Health Planning and Development for years 2005 to 2014. PARTICIPANTS:We identified 1.2 million adult patients aged ≥18 years presenting to California EDs and hospitals with an index diagnosis of TBI. PRIMARY AND SECONDARY OUTCOME MEASURES:Our main outcomes included revisits, readmissions and mortality over time. We also examined demographics, mechanism and severity of injury and disposition at discharge. RESULTS:We found a 57.7% increase in the number of TBI ED visits, representing a 40.5% increase in TBI visit rates over the 10-year period (346-487 per 100 000 residents). During this time, there was also a 33.8% decrease in the proportion of patients admitted to the hospital. Older, publicly insured and black populations had the highest visit rates, and falls were the most common mechanism of injury (45.5% of visits). Of all patients with an index TBI visit, 40.5% of them had a revisit during the first year, with 46.7% of them seeking care at a different hospital from their initial hospital or ED visit. Additionally, of revisits within the first year, 13.4% of them resulted in hospital readmission. CONCLUSIONS:The large proportion of patients with TBI who are discharged directly from the ED, along with the high rates of revisits and readmissions, suggest a role for an established system for follow-up, treatment and care of TBI

Behavioral and Mental Health in Nevada

The Nevada Division of Public and Behavioral Health is responsible for providing public and mental health services to people living in or visiting the State. The Division is organized into four branches: Community Services Branch, Regulatory and Planning Services Branch, Clinical Services Branch and Administrative Services Branch. The Clinical Services Branch provides statewide inpatient, outpatient, and community-based public and mental health services. State employees provide mental health services, and contract providers deliver substance use services. Mental health services are additionally organized by age and geography. Adults with mental disorders are treated statewide through the Division of Public and Behavioral Health. Children with mental disorders are served through the Division of Child and Family Services within the populous urban counties (Washoe, Clark and Carson City) and the Division of Public and Behavioral Health across the 14 rural and frontier counties. Services are supported through Medicaid, the Nevada General Fund, and Federal grants. The Division of Public and Behavioral Health is located within the Nevada Department of Health and Human Services, under the Executive Branch of the State, and serves as its Public Health Authority and Mental Health Commissioner. By statute, the Commission on Behavioral Health is responsible for the following: establishing policies to ensure development and administration of services for persons with mental illness, persons with intellectual disabilities and related conditions, and persons with substance use conditions; reviewing programs and finances of the Division; and providing reports to the Governor and Legislature regarding the quality of care and treatment provided to individuals with mental illness, intellectual disabilities, and substance use disorders [Nevada Revised Statutes (NRS) 433.314]. Historically, the governance structure of Nevada’s behavioral and mental health system has been centralized at the state level with limited involvement at regional and local levels. A policy study conducted during 2014 identified Nevada as one of only four states in the country that directly operates community-based mental health services (Kenny C. Guinn Center for Policy Priorities, Mental Health Governance: A Review of State Models & Guide for Nevada Decisions Makers, December, 2014). During that same year, the State began to consider ways to move from its centralized governance structure to a more localized model involving regional, county and city entities. A key consideration was a growing recognition that increasing the State’s responsiveness to the unique needs of individual communities is crucial. Nevada’s plan to restructure the governance of its state mental health system is not without challenges. For example, the numbers of Nevada residents covered by Medicaid benefits almost doubled when Medicaid coverage was expanded by Governor Brian Sandoval under the Affordable Care Act (ACA) during 2014, increasing from 351,315 persons in 2013 to 654,442 individuals in 2015 (Woodard and Nevada Division of Health Care Financing and Policy, 2016). On its face, the increase in numbers of residents covered by Medicaid benefits is a positive outcome. However, the existing mental health provider network was not adequate to serve the increase in numbers of individuals covered. As detailed in later sections in this chapter, the increase in health care coverage appears to have impacted the frequency with which Nevada residents used health care services, most notably hospital emergency departments and inpatient facilities. Thus, the dual influences of increased health care coverage, and limited access to appropriate and optimal mental health services are reflected in the dramatic increase in residents’ utilization of emergency department services for a wide range of mental health-related conditions during 2015, after the expansion of Medicaid during 2014. Also discussed in later sections is the fact that almost all of the State qualifies as a mental health professional shortage area (Health Resources and Services Administration, HRSA). Therefore, moving from a primarily centralized or state control model to a local control model will require accommodation for the shortages in mental health professionals within communities that lie outside the State’s urban centers

A Gap Analysis of Syphilis Screening During Pregnancy by Prenatal Care Clinicians

abstract: Congenital syphilis (CS) is increasing at an alarming rate in Arizona. The state health department has recommended increased screening to include the third trimester, but providers in individual counties are not following the recommendation. A literature search and appraisal showed increased screening reduces the incidence of CS and presented interventions to increase screening rates. Furthermore, the literature suggests provider education increases screening rates. However, before education could be completed an understanding of providers current knowledge, attitudes, and practice was needed. Using this information, a gap analysis that was completed in an Arizona county (“the County”) of syphilis screening during pregnancy by prenatal care clinicians will be presented guided by the Knowledge-Attitude-Practice (KAP) Model and the ACE Star Model of Knowledge Transformation