Vegetable output and cost savings of community gardens in San Jose, California.

Urban dwellers across the United States increasingly access a variety of fresh vegetables through participation in neighborhood-level community gardens. Here we document vegetable output and cost savings of community gardens in the city of San Jose, CA, to better understand the capacity of community gardens to affect food affordability in an urban setting. A convenience sample of 83 community gardeners in San Jose completed a background survey during spring and summer 2012. On average, gardeners were aged 57 years and had a monthly income of $4,900; 25% had completed college. A representative subset of 10 gardeners was recruited to weigh vegetable output of their plots using portable electronic scales at three separate garden sites. Accuracy of each portable scale was verified by comparing the weight of a sample vegetable to weights obtained using a lab scale precise to 0.2 oz. Garden yields and cost savings were tabulated overall for each plot. Results indicate that community garden practices are more similar to biointensive high-production farming, producing 0.75 lb vegetables/sq ft, rather than conventional agricultural practices, producing 0.60 lb/sq ft. Gardens produced on average 2.55 lb/plant and saved $435 per plot for the season. Results indicate that cost savings are greatest if vertical high value crops such as tomatoes and peppers are grown in community gardens, although yields depend on growing conditions, gardener's skill, availability of water, and other factors. Future research is needed to document cost savings and yields for specific crops grown in community gardens.

CrowdED: crowding metrics and data visualization in the emergency department.

OBJECTIVES: Emergency department (ED) crowding metrics were validated in our facility and a new technique of data visualization is proposed. DESIGN: A sequential cross-sectional study was conducted in our ED during October 2007. Data were collected every 2 hours by a research assistant and included patient arrivals and acuity levels, available inpatient and ED beds, ambulance diversion status, staff present, and patient reneging. The charge nurse and an attending physician also completed a single-question crowding instrument. Pearson correlation coefficients were calculated and logistic regression were performed to test the usefulness of the crowding score and test significance of the data visualization trends. SETTING/PARTICIPANTS: Our ED is an adult, level-III, veterans administration ED in urban southern California. It is open 24 hours per day, has 15 treatment beds with 4 cardiac monitors, and typically sees about 30 000 patients per year. MAIN OUTCOME MEASURE(S): The key outcome variables were patient reneging (number of patients who left before being seen by a physician) and ambulance diversion status. RESULTS: Average response rate was 72% (n = 227) of sampling times. Emergency Department Work Index, demand value, lack of inpatient beds, census, patients seen in alternate locations, and patient reneging correlated significantly (P < .01) with the crowding instrument. Staff workload ranks predicted patient reneging (odds ratio 6.0, 95% confidence interval 2.3-15.4). The data visualization focused on common ED overcrowding metrics and was supported by logistic regression modeling. CONCLUSIONS: The demand value, ED Work Index, and patient reneging are valid measures of crowding in the studied ED, with staff workload rank being an easy, 1-question response. Data visualization may provide the site-specific crowding component analysis needed to guide quality improvement projects to reduce ED crowding and its impact on patient outcome measures.

2007 San Diego wildfires and asthmatics.

CONTEXT: This case series reports the changes in the respiratory health of eight asthmatic subjects and the relationship with air quality associated with the October 2007 firestorm in San Diego County of California. CASE PRESENTATION: Participants were eight subjects with asthma enrolled in Asthma Clinical Research Network (ACRN) (NIH# U10-HL074218) studies at the University of California San Diego (UCSD), School of Medicine, who had study data collected immediately prior, during and 1 month after the 5-day firestorm in San Diego County. Air quality deteriorated to an extreme average of 71.5 mg/m(3) small particulate matter less than 2.5 µm (PM(2.5)) during the firestorm. Respiratory health data included morning and evening peak expiratory flow rates (PEFR), morning and evening Forced Expiratory Volume in one second (FEV(1)), rescue medication usage, and sputum eosinophils. Morning and evening PEFR and FEV(1) rates remained stable. The two subjects tested during the fires had elevated eosinophil counts and rescue medication usage was increased in five of the eight subjects. DISCUSSION: Pulmonary function test values were stable during the wildfires for all eight subjects but there was a statistically significant increase in rescue medication usage during the wildfires that correlated with PM(2.5) values. The two subjects tested during the fires showed increases in sputum eosinophil counts consistent with increased airways inflammation. RELEVANCE: These findings suggest that poor air quality associated with wildfires resulted in an increase in airways inflammation in these asthmatic subjects, but pulmonary function tests remained stable, possibly due to increased rescue medication usage. This is especially pertinent as there is an increase in incidence of wildfires this decade.

Predictors of body mass index in patients with moderate to severe emphysema.

People with Chronic Obstructive Pulmonary Disease are at risk for low body weight and the subsequent sequelae of cachexia. The goal of this study was to define the relationship between of degree of emphysema as measured by high resolution chest computerized tomography, body mass index and caloric intake. Subjects from San Diego County were recruited to participate in a multi-center randomized clinical trial to test the Feasibility of Retinoids in the Treatment of Emphysema (FORTE). Forty subjects with Chronic Obstructive Pulmonary Disease, participated in a nutrition substudy and were ex-smokers with FEV(1) between 20%-80% predicted. Body mass index was correlated with the degree of emphysema as measured by high resolution chest tomography (CT), r(2) = 0.171 p < 0.01 across the full spectrum of disease severity. Dietary intake averaged over four days using 24-hour recalls was inversely correlated with BMI, r(2) = 0.471, p < 0.001, indicating a higher energy intake in subjects with low BMI. Pulmonary function tests of percent predicated FEV(1) was mildly related to BMI (r(2) = 0.086, p < 0.06). A regression model was developed to define the relationship of BMI and degree of emphysema and calorie per kilogram body weight, which accounted for 60% of the variability, p < 0.001. Low body weight in the COPD is related to the degree of emphysema, not due to decreased caloric intake. Subjects with low body weight have compensated by increasing their caloric intake and are meeting their nutritional needs.

Barriers to participation in the food stamp program among food pantry clients in Los Angeles.

Substantial numbers of food pantry clients are eligible for food stamps but do not receive them. Background characteristics of 14317 food pantry users in Los Angeles were analyzed to provide information helpful in food stamp outreach programs. Ninety percent of food pantry users were living well below poverty level, 59% were Hispanic, and 44% were homeless. Only 15% of the food pantry clients received food stamps, with homelessness and limited English language skills acting as barriers to food stamp program participation.

Comparison of clinic-based home assessment to a home visit in demented elderly patients.

Home visits assessing demented elderly patients yield important information but are perceived to be expensive. We investigated the utility of a home assessment during a clinic visit. A total of 200 demented subjects attending an outpatient geriatric assessment program were enrolled in a prospective, repeated-measures design study comparing the yield of a structured clinic-based home assessment with the yield of a home visit (the criterion standard). A total of 172 subjects completed the protocol. The average age was 76 +/- 7 years, 68% were female, 48% married, and the average Mini-Mental Status Examination score was 21 +/- 7 points. Only 3 subjects had complete agreement by site, 162 subjects had at least one problem identified only at the home visit, and 7 subjects had at least one problem identified only at the clinic. There were 376 problems identified at both sites, 422 identified only by the home visit, and 478 identified only in the clinic. Problems related to patient safety and caregiver issues were the two most common general categories. Eighty-four percent of the problems identified only at the home visit were potentially serious and 24% of problems identified at both sites were rated as more serious at the home visit. A clinic-based home assessment is not comparable to a home visit for assessing the home environment of demented elderly patients.