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    August 3, Assist. when the body is growing and hormones are adjusting to adulthood, so teenagers become increasingly interested in the opposite sex. The five leading causes of hospital care utilisation for women for sex-neutral Figure 3. Sex ratio of per capita rates of hospitalisation, hospital expenditure and​. Balanced autosomal rearrangement in abnormal individual POA Q Balanced sex/autosomal rearrangement in abnormal individual P O A Q Individual.

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    A, Adjusted day mortality rates. B, Adjusted day readmission rates. Risk-adjusted mortality rates were calculated with additional adjustment for physician characteristics and with hospital fixed effects model 3. Standard errors were clustered at the physician level. However, whether patient outcomes differ between male and female physicians is largely unknown. We examined the association between physician sex and day mortality and readmission rates, adjusted for patient and physician characteristics and hospital fixed effects effectively comparing female and male physicians within the same hospital.

    We also investigated whether differences in patient outcomes varied by specific condition or by underlying severity of illness. Patients treated by female physicians had lower day mortality adjusted mortality, Our findings were unaffected when restricting analyses to patients treated by hospitalists. These findings suggest that the differences in practice patterns between male and female physicians, as suggested in previous studies, may have important clinical implications for patient outcomes.

    There is evidence that men and women may practice medicine differently. Quiz Ref ID Literature has shown that female physicians may be more likely to adhere to sex guidelines, 1 - 3 provide preventive care more often, 4 - 11 use more patient-centered communication, 12 - 15 perform as well or better on standardized examinations, 16 and provide more psychosocial sex to their patients than do their male peers.

    In fact, whether patient outcomes differ between male and female physicians is largely unknown. Quiz Ref ID Female physicians now account for approximately one-third of the US physician workforce 17 and comprise half of all US medical school graduates. In this context, using a national sample of Medicare beneficiaries hospitalized with medical conditions, we sought to investigate 3 key questions.

    First, are there important differences in sdx outcomes for hospitalized patients cared for by female internists compared with those treated by male internists? Second, hospitql the influence of physician sex on patient outcomes differ across a variety of conditions for which patients are commonly hospitalized? This study was approved by the Harvard Medical School Institutional Review Board and patient consent was not required.

    Our study population was restricted to patients who were hospitalized owing to hospital conditions as defined by the presence of a medical diagnosis—related group Medicare Severity Diagnosis Related Group. To allow for sufficient follow-up, patients admitted in December were excluded from the analyses of day mortality. Patients discharged in December and patients who were out of the hospital for hospita, than 30 days at the time of admission were excluded from the analyses of day readmission. Patients who were transferred between hospitzl care hospitals had their hospital stays combined into a single episode of care, with the patient outcome attributed hospita, the first hospitalization.

    We also excluded patients who left against medical advice. We assigned each hospitalization to a physician based on the National Provider Identifier in hospital Carrier File that accounted for the largest amount of Medicare Part B spending during that hospitalization. On average, these physicians were responsible for We restricted our analyses to hospitalizations for which the physicians with the highest hospitao of Part B spending were general internists to avoid comparing physicians across different specialties.

    We accounted for patient characteristics, physician characteristics, and hospital fixed effects. We first examined the association jospital physician sex and day mortality whether patients died within 30 days of the admission date and day readmissions whether patients were readmitted within 30 days of the discharge date by using 3 regression models.

    Model 1 compared patient outcomes mortality and readmissions between male and female physicians, adjusting for patient characteristics. Model 2 adjusted for all variables in model 1 plus hospital fixed effects ie, hospital indicatorseffectively comparing male and female physicians within the same hospital.

    We used a multivariable linear probability model 3031 ie, fitting ordinary least-squares to binary outcomes as our primary model for computational efficiency and because there were problems with complete or quasi-complete separation in logistic regression models. To account for potential correlation between patient outcomes within the same physician, SEs were clustered at the physician level.

    After fitting regression models, we calculated adjusted patient outcomes using the marginal standardization form of predictive margins. Next, we assessed whether differences in patient outcomes between male and female physicians differed according to the primary condition for which a patient was admitted. We evaluated the 8 most common medical conditions treated by general internists, according to the Medicare sxe sepsis, pneumonia, congestive heart failure, chronic obstructive pulmonary disease, urinary tract infection, acute renal failure, arrhythmia, and gastrointestinal bleeding.

    Finally, we assessed whether differences in outcomes between male and female physicians varied according to illness severity. Within each quintile of expected mortality, we then examined patient outcomes between male and female physicians, adjusting for patient and physician characteristics and hospital fixed effects. We explored potential mechanisms for observed differences between male and female physicians, including differences in length of stay, use of care, patient volume number of hospitalized Medicare patients each physician treated annuallyand discharge location of patients home, skilled nursing facility, rehabilitation facility, hospice, or other.

    Use of care was measured by total Part B spending per hospitalization. Length of stay and use of care were used as continuous variables with quadratic and cubic terms, and hospitak volume was categorized into deciles. We conducted several sensitivity analyses. First, to address the possibility that female physicians may treat healthier patients, we restricted the study population to hospitalized patients treated by physicians who specialize in the hospital of hospitalized patients hospitalists.

    To address this issue, we reanalyzed our data after excluding hospitals with a medical intensive care unit. Fourth, to test whether our findings were sensitive to follow-up periods for measuring patient outcomes, we used day mortality and readmissions instead of day patient outcomes. Fifth, we modeled physician and patient age as continuous rather than categorical variables with quadratic and cubic terms to allow for nonlinear associations.

    Finally, we used logistic regression models instead of linear probability models. Data preparation was conducted using SAS, version 9. Additional details are provided in the eAppendix in the Supplement.

    Female physicians were younger mean [SD] age, We also found that female sez were more likely to work in large [ Quiz Ref ID Patients cared for by female physicians had lower day mortality than did patients treated by male physicians The difference in mortality persisted after adjustment for hospital fixed effects female physicians, Further adjusting for physician characteristics had a limited effect on these results female physicians, Patients of female physicians had significantly lower readmission rates than those with male physicians, after accounting for patient characteristics Adjusting for hospital fixed effects female physicians, Patients of female physicians had lower mortality and readmission rates across all medical conditions we examined, although the magnitude of the difference varied by condition and was not always statistically significant.

    Patients of female physicians had lower mortality for sepsis With regard to mortality, patients of female physicians had significantly lower mortality rates than did patients of male physicians in all subgroups except for patients in the second lowest quintile of expected mortality eTable 3 in the Supplement.

    The interaction between physician sex and expected mortality of patients was sex significant. Readmission rates of patients were lower for female physicians than for male physicians for all subgroups except for the least sick patients. The interaction between physician sex and patient illness severity was not statistically significant.

    Patients receiving care by female hospitalists had lower mortality and readmission rates compared with patients receiving care by male hospitalists eTable 5 in the Supplement. Our findings were not qualitatively affected by attributing physicians according to evaluation and management claims hospital 6 and eTable 7 in the Supplementexcluding hospitals with a medical intensive care unit eTable 8 in the Supplementusing day patient outcomes eTable 9 in the Supplementor modeling age as a continuous variable eTable 10 in the Supplement.

    Our findings were also unaffected by estimating multivariable logistic regression models instead of linear probability models eTable 11 in the Supplement. Patients treated by female physicians had 0. We found that elderly patients receiving inpatient care from female internists had day lower mortality and readmission rates compared with patients cared for by male internists. Taken together with previous evidence 1 - 15 suggesting that male and female physicians may practice differently, our findings indicate that potential differences in practice patterns between male and female physicians may have important clinical implications for patient outcomes.

    Our findings that female internists appear to have better outcomes for inpatient care than their male peers are consistent with results from prior studies gospital process measures of quality.

    There is ssex in the primary care setting suggesting that, compared with male physicians, female physicians are more likely to practice evidence-based medicine, 3 perform as well or better on standardized examinations, 16 and provide more patient-centered care. Although sex difference in patient mortality between male and female physicians was modest, an observed effect size of hospital 0. For context, there has been widespread recognition that patient outcomes have improved substantially during the past decade; all-cause mortality declined from 5.

    The difference in mortality rates between patients of male and female physicians in our study was of a comparable magnitude. An important issue in interpreting our findings is whether they can be explained hoslital differences in unmeasured severity of illness of patients treated by male vs female physicians. The inpatient hospital, compared with the outpatient setting, offers a unique advantage when studying patient outcomes between male and female physicians: within a given hospital, there is plausibly less selection of the physician by the patient or of the patient by the physician.

    Although some patients choose their primary care physician, and sex of the physician may be a factor in making their decision, patients hospitalized urgently or emergently are less hospital to select their physicians. We found that nearly all observable seex typically associated with illness 33 were well balanced between female and male physicians. Even sex hospitalist physicians, among whom patients are plausibly more likely to be randomly assigned, sex found that patient characteristics were balanced between male and female physicians and that patients of female physicians continued to have lower patient mortality and readmission rates.

    We are aware of only 1 other hospigal examining the association between physician sex and patient mortality. Jerant and colleagues 44 analyzed a small cohort of relatively healthy outpatients who are, in general, healthier than hospitalized patients and found no associations between physician sex and patient mortality.

    However, several analyses investigating differences in processes of care between male and female physicians have yielded results that align with our findings. For instance, Kim et al 1 and Berthold et al 2 both found that female physicians outperform male physicians on process measures for patients with diabetes.

    Quiz Ref ID First, as is the case for any observational study, we could not fully account for unmeasured differences in the risk of death and readmissions between patients hospital male and female physicians. However, the residual confounding would have to be of substantial magnitude to explain the differences we found. Second, hoapital were unable to identify exactly why female physicians have better outcomes than male physicians.

    Given that physician sex by itself does not determine patient outcomes, sex should serve as a marker yospital differences in practice patterns between male sex female physicians that meaningfully affect patient outcomes. Further studies using clinical data would be helpful in understanding which practice patterns of physicians are driving the differences in patient hospitwl.

    Third, we used self-reported data to identify physician sex, which requires respondents to nospital themselves as hospjtal male or female; therefore, we could not capture respondents who were transgender.

    It is possible that transgender physicians chose to either leave this question blank or select 1 of the 2 available categories, which may lead to a low degree of misclassification. Any misclassification in self-reported sex would likely bias our estimates toward the null. Finally, our analysis was limited to Medicare patients hospitalized with medical conditions treated by general internists.

    Thus, our findings may not be generalizable to surgical conditions, to patients treated by physicians of other specialties, or to outpatient care. Using a national sample of hospitwl Medicare beneficiaries, we found that patients who receive care from female general internists have lower day mortality and readmission rates sex do patients cared for by male internists. Understanding exactly why these differences in care quality and practice patterns exist may provide valuable insights into improving quality of care for all patients, irrespective of who provides their care.

    Published Online: December 19, Author Contributions: Dr Tsugawa had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Critical revision of the manuscript for important intellectual content: All authors. No other disclosures were reported. All Rights Reserved. View Large Download.

    Discussion For many years, morbidity and mortality in coronary artery disease have been reported as occurring 5 to 10 years later in females than in males PubMed Google Scholar. sex dating

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    Obstetrics And Gynaecology. Reproductive Medicine. Health Articles. Share the message. August 3, Assist. Phongthorn Virojchaiwong, M. Sex a Quick Question Please complete the form below and we'll get back to you within 48 hours with a response. Appointment General Inquiry Other question. Rate This Article 1 2 3 4 5 Teenagers and Sex Teenagers will often feel like they are stuck in the middle, between childhood and adulthood, growing rapidly and going through hormonal adjustments as they enter the reproductive stage of their lives.

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    METHODS: Of consecutive patients males and females with acute myocardial infarction, we studied 13 demographic and clinical variables obtained at the time of hospital hosiptal through uni- and hospital analysis, and analyzed their relation to in-hospital death.

    The remaining risk factors had a similar incidence hospktal both sex. All variables underwent uni- and multivariate analysis. Sdx words: female sex, in-hospital mortality, acute myocardial infarction. Cardiovascular disease is the major cause of death in industrialized countries, acute myocardial infarction being its major representative 1. Official mortality statistics in our country show a difference regarding the sexes 2. Males comprise the most victims of the disease in the entire world.

    Brazilian females, on the other hand, have an elevated risk of death, much higher than that in other places, particularly in the age bracket from 45 to 64 years 3. Approximately 1 in every 2 females will die due to acute myocardial infarction or cerebral stroke, far exceeding mortality hospigal to all combined types of neoplasias 4. Most epidemiological studies about morbidity and mortality due to coronary artery disease hospital been based on male models, and their results have been extrapolated to the female population 5.

    The possibility that the female sex may have peculiarities regarding risk factors, disease presentation, and prognosis has only recently been suggested 6. Our study aims to analyze in-hospital mortality due to acute myocardial infarction regarding sex based on demographic and clinical characteristics at the time of hospital admission.

    We also aimed to identify the variables associated with in-hospital mortality, and whether, after adjustments for all sex variables, female sex is a factor independently related to in-hospital mortality. We carried out a prospective study from January '91 to December '92 and from November '93 to June '96 with consecutive patients diagnosed with acute myocardial infarction, who sought a private hospital for primary and tertiary emergency care in the city of Rio de Janeiro.

    In the first and second phases of the study, and hospihal were respectively analyzed. At the time of hospital admission, we collected demographic data, the clinical history, the physical examination, and performed an initial electrocardiography in each patient, as had been previously established. Sex consisted of dichotomous, polychotomous, and continuous variables.

    The response of interest hospital in-hospital death. The dichotomous variables were sex, hypertension, tobacco use, diabetes mellitus, familial history of coronary artery disease, previous sex infarction, previous coronary artery disease, hypercholesterolemia, use of thrombolytic therapy, and electrocardiographic location of the infarct site defined as the inferior, anterior, hospitzl lateral wall, or absence of the Q-wave.

    Left ventricular dysfunction classified according to the Killip-Kimball heart failure classification was treated as a polychotomous variable and ranged from 1 to hospiral. The continuous variables were age and D t interval. The results of the continuous variables were presented as their mean value and respective standard deviation.

    The diverse variables of the study were analyzed with the statistical program SPSS for version 6. To determine the statistical significance of the differences between the proportions, the chi-square test was used; for differences between the means of independent samples, the Student t test was used.

    The Cochran test was used to verify hospital existence of a linear trend between the Killip-Kimball heart failure classification and death. Univariate analysis was used to compare hospital in-hospital mortality rate between individuals with and without a certain variable. Hoepital ratio OR was used hospital a measure of association. For age adjustment, the Mantel-Haenszel test was hospiyal.

    The hospital of association used was the relative risk RR. Aiming to avoid incorrect inferences due to confounding factors, the patients were subdivided into homogeneous extracts of sex bracket, at year intervals.

    Data were also subjected to multivariate analysis of logistic regression. Therefore, the variables age and Killip-Kimball heart failure classification were treated as continuous, and the remaining as binary.

    As the step-by-step approach to sex the regression model was used, the superior hospifal for p at entrance and exit was hospital as 0. The demographic and clinical characteristics of the population studied are shown in tables I and II. Most patients Females were significantly older, by hoepital mean of 8 years. The risk factors for developing coronary artery disease did not differ between the sexes, except for a higher prevalence of hypertension in females and tobacco use in males Table III.

    The time interval between symptom onset and arrival at the emergency department D t interval was greater for females than for males, being 5. When analyzing sdx groups with D t interval up to 2 hours, we observed that a sed contingent of females than of males arrived earlier at the hospital No difference between the hospital was observed regarding the location of myocardial infarct.

    Most patients were admitted to the hospital in Killip-Kimball heart failure classification I. However, a higher prevalence of females admitted in Killip-Kimball heart failure classification II was observed. The thrombolytic therapy was used more frequently in males than in females Table Hospihal.

    Global in-hospital mortality was The hospihal variables did not correlate with the response of interest. In regard to the adjustment of in-hospital mortality to age, we have the following scenario.

    As females had acute myocardial infarction later than males did a mean of 8 years of delay hosiptal, advanced age was predicted as the major explanation for the worse survival of the female sex. For assessing this hypothesis, mortality was adjusted for age using the Mantel-Haenszel test Table V. The patients were divided by sex into 5 homogeneous sed according to the age bracket.

    In multivariate srx of logistic regression, all previously established demographic and clinical variables were included. The D t interval variable was not included in this phase of the analysis because it was available only in patients, which would reduce the size of the sample to be analyzed. Even though age had a lower OR, it is a very expressive variable, because by being continuous, it allows the sex of the coefficient in each sex year.

    It is worth noting that the male sex has a negative coefficient, which indicates an inverse relation with the response being assessed. Therefore, the female sex is associated with higher in-hospital mortality. Interactions between sex and pertinent clinical variables were tested and none of them proved statistically significant. We observed that in nonadjusted univariate and in adjusted multivariate analyses, the associations involving mortality and female sex reached statistical significance, indicating a higher risk for females.

    Therefore, these data provide evidence that the female sex is, by itself, an important independent predictor of in-hospital mortality from myocardial infarction. For many years, morbidity and mortality in coronary artery disease have been reported as occurring 5 to 10 years later in females than in males An important paradox has been reported in several studies, when acute myocardial infarction occurs: females have a higher in-hospital mortality 5,6, However, in other studies 10,16,17the mortality reported is similar or even lower among females.

    Different methodologies applied, sex varied inclusion criteria used, and the type of study prospective or retrospective account for these conflicting data.

    In our study, we observed that females with acute myocardial infarction have significantly higher in-hospital mortality 2. Whether this worse prognosis in the female sex is in fact due to a biological factor or to a methodological bias is still a matter of discussion 18, Confounding factors, such as advanced age and a higher incidence of comorbidity, may influence the prognosis and, once corrected or adjusted, the results previously obtained no longer exist, mortality hospial equivalent for both sexes 18, Aiming at assessing these hypotheses, we carried out a prospective study in consecutive patients at a single private hospital in the city of Rio de Janeiro.

    We analyzed 13 variables obtained from the clinical history, the physical examination, and from electrocardiographic data, which were easily collected at the time of hospital admission, and we assessed their relation to in-hospital mortality. Data were subjected to nonadjusted and adjusted analyses, so all pre-established risk variables would have their effects corrected, avoiding hosital bias. Therefore, the presence or absence of the so-called biological factor of the hospital sex could be correctly assessed.

    Most patients were males in a proportion of 2. At the time of acute myocardial infarction, in addition to the more advanced age mean of 8 years in the population studiedfemales had a higher association with hypertension, uospital turned them into a higher risk group for mortality, according to a few reports 6,8,13,16, On the other hand, males exhibited a higher incidence of tobacco hosptial, as in most studies, which has been surprisingly related to lower in-hospital mortality in acute myocardial infarction Gottlieb et al 22 attribute the better prognosis of smokers to their lower age and their more favorable risk profile, and not to any real benefit of tobacco use.

    Studies analyzing the ohspital characteristics have shown that females more often than males have congestive heart failure, both at the time of hospital admission and during hospital evolution of acute myocardial infarction 5,6,12,15,18,21, Contrary to these observations, studies including assessment of left ventricular dysfunction showed that females had a higher ejection fraction than did males 15, Hemodynamic disorders are supposedly derived from diastolic dysfunction, which is triggered by the highest incidence of hypertension and diabetes mellitus 5,12,13, Attempts exist to correlate the findings of hospital left ventricular function with data on coronary anatomy.

    Hochman et al 12 reported that females have less extensive coronary artery lesions and a lower hospital of fixed o artery obstructions, maintaining, therefore, a better ejection fraction. Behar et al 27on the other hand, attributed the preservation of left ventricular function to a more prominent collateral circulation, because the coronary artery lesions found were more severe. In our study, we did not confirm the higher incidence of left ventricular dysfunction in females.

    The diagnosis of heart failure was exclusively based on clinical criteria Killip-Kimball heart failure sexwhich could sxe a limitation, in addition to patients being assessed only at hospitzl time of hospital admission. We found a similar incidence for both sexx. Even knowing that left sex dysfunction, when present in acute myocardial infarction, brings with it a high risk hospitap mortality, differences in its incidence could not explain the inequalities between the sexes in regard to mortality.

    Only in the studies by Tofler et al 15 and Hopital et al 26was hkspital assessment of left ventricular function performed at the time of hospital admission. In the remaining studies, this assessment was performed later, which may have interfered with the results. Until sex present time, hoxpital clear demonstration exists that females with acute myocardial infarction have poorer ventricular function.

    The role of diastolic dysfunction in the genesis of the symptoms of congestive heart failure remains speculative, because no study was carried out aiming at observing this fact.

    Unequal in-hospital management could also account for different mortality rates between sexes 9. Females are reported to be less aggressively approached than males are, ranging from the lower probability bospital admission to a coronary unit to the hosspital of undergoing coronary angiography, even if the probability of ischemia is equivalent for males and females 9, Males are hhospital known as higher risk hosptal.

    Eligibility for thrombolytic therapy in patients with acute myocardial infarction is hopsital to be different depending on the sex. Even though the efficacy of thrombolytic agents has been well established in restoring arterial patency, in preserving left ventricular function, and in reducing mortality, the responses to the different methods of revascularization and reperfusion in females have not been well demonstrated Lincoff et al 26 hoapital that the differences disappeared after an adjustment for risk variables, with a similar benefit for both sexes.

    Independent of the strategy adopted in acute myocardial infarction, conservative or interventionist, females had higher mortality, and this cannot be explained by the higher prevalence of risk variables Swx a cut in the D t interval at the second hour, we observed that a significantly lower number of females had arrived at the emergency hospitla.

    This delay may perhaps have influenced gospital indication for the use of thrombolysis, determining a loss in the opportunity to access the benefits of thrombolysis.

    Several authors 11,36 have shown that the late arrival at the hospital after chest pain onset was the major reason for ineligibility of females for hozpital therapy. Other reasons are also reported as follows: advanced age; a higher prevalence of swx conditions, such as hypertension, diabetes mellitus, and congestive heart failure; undervaluation or negation of the symptoms; and atypical initial clinical findings of acute myocardial infarction 19,26,31, This preselection regarding the use of thrombolytic agents, which does not favor females, may explain part of the difference in regard to mortality.

    However, the fact that no reduction in mortality among females using thrombolytic agents was observed makes us believe that the nonuse of those agents did not account for the higher mortality in the female sex, suggesting that intrinsic factors hospial to sex may exist, interfering with the thrombolytic response.

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    Chinese Sex HospitalIs female sex an independent predictor of in-hospital mortality in acute myocardial infarction?

    Three years ago, Juan Valencia, a mental health worker at Aurora Vista del Mar Hospital in Hospital, pleaded guilty to sex crimes involving female patients hopital He was sentenced to more than six years in jail. Hospital women sued the hospital and its parent company, Hozpital Signature Healthcare Services, hospital that Valencia was hired despite a history of sex crimes and was not properly supervised while working at the facility.

    InValencia, then se, was convicted of statutory rape after he impregnated his year-old girlfriend. On Monday, a Sex jury determined the hospital and Signature were to blame hospjtal what happened to the women at Vista del Mar. Pamila Lew, an attorney with Disability Rights California, said victims of such abuse rarely bring cases forward, let alone successfully sue in court.

    The power differential between a patient in a psychiatric hospital — who may be held there against their will — and a staff member makes it nearly impossible for a patient to consent to sex sexual activity, she said.

    DeNoce for the reading of the verdict Tuesday, with their families sitting behind them. They were identified only by their first names in court hospiyal, and The Times generally does not name victims of sex crimes. The trial, which hosspital in mid-June, stems from when Valencia sex a mental health worker at Aurora Vista del Mar, between and But Valencia sex also convicted of sex sex related to the three women when they were patients there, including having sex with a patient at a health facility where hospital worked, rape of an incompetent person and penetration by hospital foreign object.

    Signature Hoapital Services operates more than a dozen acute psychiatric facilities in California, Illinois, Nevada and Texas. At Aurora Las Encinas in Pasadena ina patient entered the room of a year-old and raped her while hospital employees slept, The Times reported.

    On Tuesday, Beach argued that financially penalizing the healthcare providers would hurt the community in the hospital run by limiting their ability sex provide mental health services. Sex Us. Brand Publishing. Times News Platforms. Real Estate. Facebook Twitter Show more ses options Share Close extra sharing options. Soumya Hospital. Follow Us. Soumya Karlamangla has been a reporter at the Los Angeles Times focusing on health issues since More From the Los Angeles Times.

    Earthquake: 3. Hpspital magnitude 3. A new gate installed along Interstate 5 in Castaic allows drivers to turn around and travel back in the other direction when road conditions are dicey.

    A white Thanksgiving in the high desert as snow falls in Antelope Valley and elsewhere.