COVID-19 clinical trial participation and awareness in Texas

The COVID-19 pandemic required the rapid development of COVID-19 vaccines and treatments, necessitating quick yet representative clinical trial enrollment to evaluate these preventive measures. However, misinformation around the COVID-19 pandemic and general concerns about clinical trial participation in the U.S. hindered clinical trial enrollment. This study assessed awareness of, willingness to participate in, and enrollment in COVID-19 vaccine and treatment clinical trials in Texas. A quota sample of 1,089 Texas residents was collected online from June - July 2022. Respondents were asked if they were aware of, willing to participate in, and had enrolled in clinical trials for COVID-19 vaccines or treatments. Overall, 45.8% of respondents reported being aware of clinical trials for COVID-19 treatments or vaccines, but only 21.7% knew how to enroll and only 13.2% had enrolled in a COVID-19 clinical trial. Respondents with bachelor's or graduate degrees were more likely to be aware of clinical trials, more likely to have enrolled in trials, and more willing to participate in treatment trials. Women were less willing to participate and less likely to have enrolled in COVID-19 clinical trials than men. Respondents aged 55 years and older were more willing to participate, but less likely to have enrolled in COVID-19 clinical trials than 18-to-24-year-olds. Common reasons given for not participating in clinical trials included concerns that COVID-19 treatments may not be safe, government distrust, and uncertainty about what clinical trial participation would entail. Substantial progress is needed to build community awareness and increase enrollment in clinical trials.

Tracing histoplasmosis genomic epidemiology and species occurrence across the USA

ABSTRACTHistoplasmosis is an endemic mycosis in North America frequently reported along the Ohio and Mississippi River Valleys, although autochthonous cases occur in non-endemic areas. In the United States, the disease is provoked by two genetically distinct clades of Histoplasma capsulatum sensu lato, Histoplasma mississippiense (Nam1) and H. ohiense (Nam2). To bridge the molecular epidemiological gap, we genotyped 93 Histoplasma isolates (62 novel genomes) including clinical, environmental, and veterinarian samples from a broader geographical range by whole-genome sequencing, followed by evolutionary and species niche modelling analyses. We show that histoplasmosis is caused by two major lineages, H. ohiense and H. mississippiense; with sporadic cases caused by H. suramericanum in California and Texas. While H. ohiense is prevalent in eastern states, H. mississipiense was found to be prevalent in the central and western portions of the United States, but also geographically overlapping in some areas suggesting that these species might co-occur. Species Niche Modelling revealed that H. ohiense thrives in places with warmer and drier conditions, while H. mississippiense is endemic to areas with cooler temperatures and more precipitation. In addition, we predicted multiple areas of secondary contact zones where the two species co-occur, potentially facilitating gene exchange and hybridization. This study provides the most comprehensive understanding of the genomic epidemiology of histoplasmosis in the USA and lays a blueprint for the study of invasive fungal diseases.

Hazard and Injury Experiences of Latino Day Laborers in Houston, Texas

Latino day laborers in the United States provide skilled labor to businesses and homeowners through informal work arrangements. We conducted exploratory qualitative research with Latino day laborers in Houston, Texas, to investigate their perceptions of safety risks and circumstances related to work-related injuries. We conducted focus groups with 34 participants and used risk mapping and body mapping activities to elicit greater engagement by the Latino day laborers in the conversations. Participants described physical, occupational, and psychosocial hazards that affected their risk for workplace injuries. They indicated a significant risk for injury was employers failing to provide proper tools or equipment for the job being done. The themes that emerged from the analysis were lack of control over employment conditions and the risk of performing unsafe work in order to meet financial needs. This formative qualitative research informed a pilot test and subsequent clinical trial of injury risk reduction strategies for Latino day laborers. Interventions to protect day laborers from work-related injuries should be informed by recognizing the employment and social dilemmas they confront.

Mixed-Methods Study of Disability Self-Management in Mexican Americans With Osteoarthritis

BACKGROUND

Health disparities in osteoarthritis (OA) outcomes exist both in the occurrence and treatment of functional limitation and disability for Mexican Americans. Although the effect of self-management of chronic illness is well established, studies demonstrate little attention to self-management of function or disability, despite the strong potential effect on both and, consequently, on patients' lives.

OBJECTIVE

The purpose of this study pilot was to develop and test key variable relationships for a measure of disability self-management among Mexican Americans.

METHODS

In this sequential, two-phased, mixed-methods, biobehavioral pilot study of Mexican American women and men with OA, a culturally tailored measure of disability self-management was created, and initial relationships among key variables were explored.

RESULTS

First, a qualitative study of 19 adults of Mexican American descent born in Texas (United States) or Mexico was conducted. The Mexican American Disability Self-Management Scale was created using a descriptive content analysis of interview data. The scale was tested and refined, resulting in 18 items and a descriptive frequency of therapeutic management efforts. Second, correlations between study variables were estimated: Disability and function were negatively correlated. Disability correlated positively with social support and activity effort. Disability correlated negatively with disability self-management, pain, and C-reactive protein. Function was positively correlated with age, pain, and depression. Liver enzymes (alanine transaminase) correlated positively with pain and anxiety.

DISCUSSION

This mixed-methods study indicates directions for further testing and interventions for disability outcomes among Mexican Americans.

Assessing clinicians' and trainees' knowledge and practice of the IDSA guidelines for asymptomatic bacteriuria in older adults

A survey of advanced practice clinicians (APCs), physicians, residents, and medical students at an academic medical center and community practices in southeastern Texas revealed a gap in knowledge and practice related to testing and treatment for asymptomatic bacteriuria (ASB) in older adults.

Ernst Bertner: A Surgeon with Prescient Vision for the Largest Medical Center in the World

More than 75 years ago, surgeon Ernst Bertner envisioned the Texas Medical Center (TMC) as "breathtaking in the scope and breadth of its conception," that would be "one of the largest in the world"; a gigantic medical enterprise that would "attract the greatest scientists of the world" and would combine patient care, research, and education, on a scale that was "second to none." During the next 3 years, Bertner accomplished important pieces of the Herculean task to bring onto the campus 11 major buildings, including the University of Texas MD Anderson Hospital for Cancer Research, for which he was the interim director. This was an extraordinary accomplishment because at the outset he had only a strategic plan, the deed to 134 acres of forest, and financial support from the MD Anderson Foundation! Bertner further forecasted world-class clinical and educational programs in the TMC, stating: "We envision the time when the Medical Center will become a great magnet, drawing leaders in education, medicine, and dental professions. It will provide the physical facilities and the environment in which research will flourish and bring forth for all of us new discoveries in the field of medicine." So how did his bold vision and passionate leadership culminate in the TMC today? By any criteria of scale and program excellence, the TMC today can be regarded as the largest medical center in the world. Occupying a contiguous campus of 1345 acres (2.1 square miles), it comprises 162 buildings, 60+ member institutions, 21 hospitals (> 9200 beds), 21 academic institutions, 4 medical schools, 7 nursing schools, 3 public health schools, 2 pharmacy schools, and a dental school. More than 106,000 patients and visitors come daily to the TMC, which has more than 120,000 employees, including 5000 physicians, 5700 researchers, and 11,000 registered nurses. Ernst Bertner is credited for transforming the original vision of the TMC into a workable program, and whose dynamic devotion to the idea captured the devotion of others to accomplish this extraordinary feat. Thus, during this short interval from 1946 to 1950, Bertner transitioned the leadership of the MD Anderson Cancer Hospital to Dr. R. Lee Clark, conducted a busy general surgery and gynecologic practice, facilitated the monumental transfer of the Baylor Medical School from Dallas to Houston, helped to recruit Dr. Michael DeBakey from New Orleans, and fought a heroic battle against rhabdomyosarcoma, a very rare and aggressive cancer.

Mediation of Psychological Capital in Youth Experiencing Homelessness

BACKGROUND

Youth who experience homelessness engage in behaviors that place them at high risk for disease and injury. Despite their health risk behaviors, these youth display psychological capital, positive attributes of hope, efficacy, resilience, and optimism that motivate them to engage in health-promoting behaviors such as safer sex. However, this array of positive psychological attributes has not been studied in this vulnerable population.

OBJECTIVES

The specific aim of this analysis was to determine whether factors of psychological capital mediated the relationship between background risk factors (e.g., race/ethnicity, educational attainment, reason for being homeless, sexual abuse history, and HIV status) and outcomes of condom intention, safer sex behaviors, and life satisfaction among youth who participated in a longitudinal intervention study.

METHODS

Using a Solomon four-group design, 602 youth were recruited from drop-in centers in two large cities (Columbus, Ohio, and Austin, Texas) to participate in a brief intervention that included outcomes of enhanced communication skills, goal setting, safer sex behaviors, drug refusal skills, and life satisfaction. Using an autoregressive, cross-lagged, longitudinal mediation model, we tested the direct and indirect effects of background factors, psychological capital, and intervention outcomes. Models were tested for the intervention group alone and the total sample.

RESULTS

There were no significant direct or indirect effects of background factors on intervention outcomes among the intervention group, and the model fit was poor. There were also no significant mediating paths via factors of psychological capital and poor model fit for the combined group.

DISCUSSION

Findings provide important information about intrinsic strengths of youth experiencing homelessness and psychological capital as a significant construct for understanding health behaviors among disadvantaged and underserved youth. The lack of significant mediation effects may have been due, in part, to the lack of a robust measure of psychological capital. Further study with various background factors and outcomes would contribute further to our understanding of how best to support this population.

(Apicomplexa: Eimeriidae) from the laughing gull Leucophaeus atricilla (Linnaeus) (Aves: Charadriiformes: Laridae) in Port Isabel, Texas

A new coccidian species, Eimeria atricillae n. sp. (Apicomplexa: Eimeriidae) collected from the laughing gull Leucophaeus atricilla, is reported from Port Isabel, Texas, USA. Sporulated oöcysts of the new species are spherical to subspherical, 16.0-18.1 × 14.4-16.6 (17.1 × 15.4) μm, with a length/width (L/W) ratio of 1.0-1.1; polar granules are present, but micropyle and oöcyst residuum are absent. Sporocysts are ovoid, 9.1-9.7 × 6.1-7.1 (9.4 × 6.6) μm, with a L/W ratio of 1.3-1.5; Stieda body present, but sub-Stieda and para-Stieda bodies are absent; sporocyst residuum diffuse.

Outcomes for a Heat Illness Prevention Program in Outdoor Workers: A 9-Year Overview

OBJECTIVE

To describe the outcomes effect of removing the medical surveillance component from a heat illness prevention program (HIPP) for outdoor workers from a Central Texas municipality.

METHODS

Heat-related illness (HRI) frequency and workers' compensation (WC) cost were assessed retrospectively in a cohort of 329 workers from 2011-2019. During 2011-2017, the HIPP included training, acclimatization, and medical surveillance. In 2018-2019, a modified (mHIPP) was implemented that included training and acclimatization, but without medical surveillance.

RESULTS

The HRI rate during HIPP averaged 19.5 per 1000 workers during the first 4 years, dropped to 1.01 per 1,000 workers over the next 3 years, (2015-2017), and increased during mHIPP, to 7.6 per 1,000 workers.

DISCUSSION

Although the case increase during the mHIPP was small, medical surveillance may be an important component in lowering workforce HRI.

The Impact of Cultural Health Capital on Market Choice Along the Texas-Mexico Border

Transnational cultural health capital (CHC) includes individual resources such as skills and behaviors patients use to manage healthcare exclusion and negotiate care. This study examines the impact of CHC on decisions by Hispanic people who live in El Paso, Texas, to utilize one or more markets for healthcare. We expand on the current literature and present novel findings by quantifying several aspects of CHC that may contribute to cross-border health-seeking behaviors in this vulnerable group which tends to suffer various health disparities and limited access to health insurance. Results support the hypotheses related to how the various cultural, social, and economic resources that comprise CHC affect market choices. This research has significant implications for understanding how border residents may mitigate a lack of accessibility and affordability for healthcare, developing transnational health policy, and aiding healthcare providers to understand their patients' choice(s) of healthcare markets.

School Safety and Mental Health Awareness: Recommendations from K-12 Texas Public School Teachers

BACKGROUND

Mass school shootings have created fear in the American public. The results of this fear have been the hardening of schools, lockdowns, and active shooter drills, yet the mass shootings have not ended. The goal of this study was to analyze the mental health awareness of K-12 public schools teachers in Texas with a goal to identify the connections between mental health awareness and school safety.

METHODS

Data were used from an archival database of K-12 teacher responses in the 2020 Texas Educators' Needs Assessment Regarding School Safety and Victims Services to assess the current state of student mental health concerns and the connection of these concerns to school safety. This needs assessment included one mixed methods survey that was collected from Texas K-12 educators and Texas educators working in higher education in 2020. The original study included 25,161 usable responses (6.1%). For the purpose of this study, only K-12 teacher responses were used in the analysis. The K-12 teacher participants (n = 19,888) included the following institutional levels: (a) special setting, 2,919 (14.7%); (b) elementary school, 6,813 (34.3%); (c) middle/intermediate school, 4,189 (21.1%); (d) high school, 5,864 (29.5%); and (e) district level, 103 (0.5%). A total of 8,053 participant's qualitative responses and 10 of the original quantitative survey questions from the archival data were used to identify all findings in the study.

RESULTS

Collected qualitative and quantitative participant responses' outlined a need to improve student mental health by strengthening the focus on supporting all stakeholders (e.g., teachers, parents, counselors, and students) in mental health awareness and education. Participant comments focused on the lack of training, counselor support, and community support regarding the mental health needs of their students.

CONCLUSION

Recommendations to improve student mental health that were developed from this study identified key goals in school counselor role and responsibility to student mental health, increased involvement of community agencies, and improvement to in-school mental health counseling. Final recommendations of this study were focused on the need to improve student mental health if stakeholders want to develop a positive school environment. The failure to build an environment that is focused on student mental health will continue to affect the goal to improve overall school safety.

The osteology of Shuvosaurus inexpectatus, a shuvosaurid pseudosuchian from the Upper Triassic Post Quarry, Dockum Group of Texas, USA

A vast array of pseudosuchian body plans evolved during the diversification of the group in the Triassic Period, but few can compare to the toothless, long-necked, and bipedal shuvosaurids. Members of this clade possess theropod-like character states mapped on top of more plesiomorphic pseudosuchian character states, complicating our understanding of the evolutionary history of the skeleton. One taxon in this clade, Shuvosaurus inexpectatus has been assigned to various theropod dinosaur groups based on a partial skull and referred material and its postcranium was assigned to a different taxon in Pseudosuchia. After the discovery of a skeleton of a shuvosaurid with a Shuvosaurus-like skull and a pseudosuchian postcranial skeleton, it became clear Shuvosaurus inexpectatus was a pseudosuchian. Nevertheless, a number of questions have arisen about what skeletal elements belonged to Shuvosaurus inexpectatus, the identification of skull bones, and the resulting implication for pseudosuchian evolution. Here, we detail the anatomy of the skeleton Shuvosaurus inexpectatus through a critical lens, parse out the bones that belong to the taxon or those that clearly do not or may not belong to the taxon, rediagnose the taxon based on these revisions, and compare the taxon to other archosaurs. We find that Shuvosaurus inexpectatus possesses similar anatomy to other shuvosaurids but parts of the skeleton of the taxon clarifies the anatomy of the group given that they are preserved in Shuvosaurus inexpectatus but not in others. Shuvosaurus inexpectatus is represented by at least 14 individuals from the West Texas Post Quarry (Adamanian holochronozone) and all Shuvosaurus inexpectatus skeletal material from the locality pertains to skeletally immature individuals. All of the skeletons are missing most of the neural arches, ribs, and most of the forelimb. We only recognize Shuvosaurus inexpectatus from the Post Quarry and all other material assigned to the taxon previously is better assigned to the broader group Shuvosauridae.

nov., a new aetosaur (Archosauria: Pseudosuchia) from the Late Triassic (middle Norian) middle Cooper Canyon Formation, Dockum Group, Texas, USA, and its implications on our understanding of the morphological disparity of the aetosaurian dorsal carapace

The Late Triassic Dockum Group in northwestern Texas preserves a rich diversity of pseudosuchian taxa, particularly of aetosaurs. In this contribution, we present Garzapelta muelleri gen. et sp. nov., a new aetosaur from the Late Triassic middle Cooper Canyon Formation (latest Adamanian-earliest Revueltian teilzones) in Garza County, Texas, based on an associated specimen that preserves a significant portion of its dorsal carapace. The carapace of G. muelleri exhibits a striking degree of similarity between that of the paratypothoracin Rioarribasuchus chamaensis and desmatosuchins. We quantitatively assessed the relationships of G. muelleri using several iterations of the matrix. Scoring the paramedian and lateral osteoderms of G. muelleri independently results in conflicting topologies. Thus, it is evident that our current matrix is limited in its ability to discern the convergence within this new taxon and that our current character lists are not fully accounting for the morphological disparity of the aetosaurian carapace. Qualitative comparisons suggest that G. muelleri is a Rioarribasuchus-like paratypothoracin with lateral osteoderms that are convergent with those of desmatosuchins. Although the shape of the dorsal eminence, and the presence of a dorsal flange that is rectangular and proportionately longer than the lateral flange are desmatosuchin-like features of G. muelleri, the taxon does not exhibit the articulation style between the paramedian and lateral osteoderms which diagnose the Desmatosuchini (i.e., a rigid interlocking contact, and an anteromedial edge of the lateral osteoderm that overlaps the adjacent paramedian osteoderm).

Social Determinants of Outcomes Disparity among Pediatric Patients with Solid Tumor

BACKGROUND

Socioeconomic factors have a significant impact on healthcare outcomes. Metrics such as area deprivation index (ADI) are used to quantify the anticipated influence of these factors. Here, we sought to assess the impact of socioeconomic factors on clinical outcomes among pediatric patients with solid tumor in our region.

STUDY DESIGN

We identified 3,863 pediatric patients who were diagnosed with a malignant solid tumor in the Texas Cancer Registry between 1995 and 2019. ADI was used to quantify socioeconomic determinants of health. These outcome variables were determined: stage of disease at diagnosis, time between diagnosis and treatment initiation, and overall mortality. Statistical analysis was performed using logistic regression, linear regression, Cox proportional hazards regression, and Kaplan-Meier survival curves.

RESULTS

A total of 53.5% of patients were male and the average age at diagnosis was 4.5 years. Forty-seven percent of patients were White, 13.3% were Black, 36.2% were Hispanic, 1.7% were Asian, and other rare minority groups made up 1.8%. On multivariable analysis, increased risk of death was associated with Black race, rare minority race, residence in a border county, and increasing ADI score, with the risk of death at 5 years rising 4% with each increasing ADI point.

CONCLUSIONS

Social determinants of health are associated with disparate outcomes among pediatric patients with solid tumor. Our results suggest that patients who are part of racial minority groups and those who reside in socioeconomically disadvantaged neighborhoods or regions near the Texas-Mexico border are at an increased risk of death. This information may be useful in strategizing outreach and expanding resources to improve outcomes in at-risk communities.

Cranial anatomy of Libognathus sheddi Small, 1997 (Parareptilia, Procolophonidae) from the Upper Triassic Dockum Group of West Texas, USA

Libognathus sheddi, a leptopleuronine procolophonid from the Upper Triassic Cooper Canyon Formation, Dockum Group, West Texas, was based on an isolated left dentary and partial coronoid. New material referable to Libognathus sheddi, from the Cooper Canyon Formation, provides new information on the cranial anatomy. This new cranial material includes the antorbital portion of a skull, a left maxilla and premaxilla, quadratojugals, and dentaries, including intact tooth rows in the upper and lower jaws. Libognathus shows autapomorphies including; dentary deep with ventral margin oblique to tooth row immediately from the symphysis at ≥23°; anterior projecting coronoid contacting the lingual surface of the dentary underlying the last two dentary teeth; reduced contact between the lacrimal and the nasal; suborbital foramen formed by the maxilla and ectopterygoid, excluding the palatine; a posterior supralabial foramen shared by the maxilla and jugal; a Y-shaped antorbital pillar formed by the palatine, and massive orbitonasale and facial foramina (shared with unnamed southwest USA leptopleuronines). Phylogenetic analysis indicates that Libognathus is a highly derived leptopleuronine procolophonid, closely related to Hypsognathus fenneri and other southwest USA Revueltian leptopleuronines, which fall out as sister taxa to Hypsognathus, a relationship supported by a maxillary dentition restricted anterior to the orbital margin, a possibly synapomorphic orbitonasale septum in the form of an "antorbital pillar" created by the palatine, an anteroventral process of the jugal, and the presence of a small diastema between the first dentary tooth and the more posterior dentition. Libognathus exhibits a possible ankylosed protothecodont tooth implantation with frequent replacement, differing from some other proposed procolophonid implantation and replacement models. Chinle Formation and Dockum Group leptopleuronines are restricted to the Revueltian teilzone/holochronozone, making them possible Revueltian index taxa.

Impact of Applicants' Characteristics and Geographic Connections to Residency Programs on Preference Signaling Outcomes in the Match

PURPOSE

To assess the impact of applicant and residency program characteristics on preference signaling outcomes in the Match during the first 2 years of implementation across 6 specialties.

METHOD

Data were obtained from the Texas Seeking Transparency in Application to Residency survey for applicants applying into otolaryngology during the 2020-2021 and 2021-2022 application cycles and into dermatology, internal medicine (categorical and preliminary year), general surgery, and urology during the 2021-2022 application cycle. The primary outcome was signal yield, defined as the number of interviews at signaled programs divided by the total number of signals sent. Associations with applicant-reported characteristics and geographic connections to residency programs were assessed using Wilcoxon rank sum testing, Spearman's rank correlation testing, and ordinary least squares regression.

RESULTS

1,749 applicants with preference signaling data were included from internal medicine (n = 884), general surgery (n = 291), otolaryngology (n = 217), dermatology (n = 147), urology (n = 124), and internal medicine preliminary year (n = 86). On average 60.9% (standard deviation 32.3%) of signals resulted in an interview (signal yield). There was a stepwise increase in signal yield with the percentage of signals sent to programs with a geographic connection (57.3% for no signals vs. 68.9% for 5 signals, P < .01). Signal yield was positively associated with applicant characteristics, such as United States Medical Licensing Exam Step 1 and 2 scores, honors society membership, and number of publications ( P < .01). Applicants reporting a lower class rank quartile were significantly more likely to have a higher percentage of their interviews come from signaled programs ( P < .01).

CONCLUSIONS

Signal yield is significantly associated with geographic connections to residency programs and applicant competitiveness based on traditional metrics. These findings can inform applicants, programs, and specialties as preference signaling grows.

A Coordinated School Health Program Effect on Cardiorespiratory Fitness of South Texas Preschool Children: A Cluster Randomized Trial

BACKGROUND

The purpose of this study was to assess the effects of the Bienestar/NEEMA Coordinated School Health Program (BN CSHP) on cardiorespiratory fitness (CRF) of preschool children.

METHODS

A cluster randomized trial was conducted of preschools in South Texas. Of 48 eligible schools, 28 were randomly assigned (14 intervention, 14 control). Family demographics and household health characteristics were collected from parents and CRF from children. Generalized linear mixed model (GLMM) was used to analyze the data.

RESULTS

Family demographics, household health characteristics, and children's weight, obesity prevalence, and sedentary activity of the control group were similar to the intervention group at baseline. After adjusting for covariates, the number of laps ran by children in the control group increased by 23% (CI: -5% to 60%) per each data collection period compared with 53% (CI: 7% to 119%) in the intervention group.

IMPLICATIONS FOR SCHOOL HEALTH POLICY, PRACTICE, AND EQUITY

State mandates, parent engagement, and funding are key for designing effective health and Physical Education (PE) programs.

CONCLUSION

Children in the BN CSHP, compared to those in the control group, had a significantly higher increase in their CRF. This finding is important because of the health benefits of CRF in children.

CLINICALTRIALS

gov Identifier: NCT05501392.

Changes in landscape and climate in Mexico and Texas reveal small effects on migratory habitat of monarch butterflies (Danaus plexippus)

The decline of the iconic monarch butterfly (Danaus plexippus) in North America has motivated research on the impacts of land use and land cover (LULC) change and climate variability on monarch habitat and population dynamics. We investigated spring and fall trends in LULC, milkweed and nectar resources over a 20-year period, and ~ 30 years of climate variables in Mexico and Texas, U.S. This region supports spring breeding, and spring and fall migration during the annual life cycle of the monarch. We estimated a - 2.9% decline in milkweed in Texas, but little to no change in Mexico. Fall and spring nectar resources declined < 1% in both study extents. Vegetation greenness increased in the fall and spring in Mexico while the other climate variables did not change in both Mexico and Texas. Monarch habitat in Mexico and Texas appears relatively more intact than in the midwestern, agricultural landscapes of the U.S. Given the relatively modest observed changes in nectar and milkweed, the relatively stable climate conditions, and increased vegetation greenness in Mexico, it seems unlikely that habitat loss (quantity or quality) in Mexico and Texas has caused large declines in population size or survival during migration.

Formaldehyde Exposure Racial Disparities in Southeast Texas

Formaldehyde (HCHO) exposures during a full year were calculated for different race/ethnicity groups living in Southeast Texas using a chemical transport model tagged to track nine emission categories. Petroleum and industrial emissions were the largest anthropogenic sources of HCHO exposure in Southeast Texas, accounting for 44% of the total HCHO population exposure. Approximately 50% of the HCHO exposures associated with petroleum and industrial sources were directly emitted (primary), while the other 50% formed in the atmosphere (secondary) from precursor emissions of reactive compounds such as ethylene and propylene. Biogenic emissions also formed secondary HCHO that accounted for 11% of the total population-weighted exposure across the study domain. Off-road equipment contributed 3.7% to total population-weighted exposure in Houston, while natural gas combustion contributed 5% in Beaumont. Mobile sources accounted for 3.7% of the total HCHO population exposure, with less than 10% secondary contribution. Exposure disparity patterns changed with the location. Hispanic and Latino residents were exposed to HCHO concentrations +1.75% above average in Houston due to petroleum and industrial sources and natural gas sources. Black and African American residents in Beaumont were exposed to HCHO concentrations +7% above average due to petroleum and industrial sources, off-road equipment, and food cooking. Asian residents in Beaumont were exposed to HCHO concentrations that were +2.5% above average due to HCHO associated with petroleum and industrial sources, off-road vehicles, and food cooking. White residents were exposed to below average HCHO concentrations in all domains because their homes were located further from primary HCHO emission sources. Given the unique features of the exposure disparities in each region, tailored solutions should be developed by local stakeholders. Potential options to consider in the development of those solutions include modifying processes to reduce emissions, installing control equipment to capture emissions, or increasing the distance between industrial sources and residential neighborhoods.

Early national trends in non-abortion reproductive care access after Roe

Background

Roe was overturned in 2022. No peer-reviewed evidence exists for the indirect spillover effects of overturning Roe on non-abortion reproductive care access for diverse patient populations.

Methods

National data were from 2013-2023 HHS Title X Directory, 2013-2020 CDC Artificial Reproductive Technologies (ART) Surveillance and 2021-2023 manual collection, and Guttmacher Institute. Outcome measures included numbers of ART clinics and Title X entities. Title X entities are those that receive federal funds to establish and operate voluntary family planning projects, especially for low-income patients. We reported pre-and post-Roe changes, associations between changes in measures and abortions, and characteristics of changed measures by region and political geography.

Results

Post-Roe America witnessed national declines of 1.03% in ART clinics and 18.34% in Title X entities, and average state decreases of 0.08 ART clinics (p < 0.05) and 18 Title X entities (p < 0.001). State-level ART clinic closures and abortion reductions had little association except for Texas, Oklahoma, Arizona, New York, and California. Plummets in Title X entities and abortions were positively associated: Reducing 100 abortions was associated with defunding two Title X entities (p < 0.05). The South experienced the largest losses of both, while 83.39% of lost Title X entities were in states that voted Republican in the 2020 presidential election, disproportionate to the 49.02% of states that voted Republican and the 42.52% of US population residing in these states.

Conclusion

We provide one of the first few evidence of spillover impacts of overturning Roe on non-abortion care access for diverse populations: low-income men and women, single parents by choice, and biologically and socially infertile patients. Early evidence warns of worsening challenges of inequities and calls for immediate policy actions.

Efficacy of a Primary Care eHealth Obesity Treatment Pilot Intervention Developed for Vulnerable Pediatric Patients

Background: Challenges to treat excess weight in primary care settings include time constraints during encounters and barriers to multiple visits for patient families, especially those from vulnerable backgrounds. Dynamo Kids! (DK), a bilingual (English/Spanish) e-health intervention, was created to address these system-level challenges. This pilot study assessed the effect of DK use on parent-reported healthy habits and child BMI. Methods: In this 3-month, quasi-experimental cohort design, DK was offered to parents with children aged 6-12 years with BMI ≥85th percentile in three public primary care sites in Dallas, Texas. DK included three educational modules, one tracking tool, recipes, and links to internet resources. Parents completed an online survey before and after 3 months. Pre-post changes in family nutrition and physical activity (FNPA) scores, clinic-measured child %BMIp95, and self-reported parent BMI were assessed using mixed-effects linear regression modeling. Results: A total of 73 families (mean child age = 9.3 years; 87% Hispanic, 12% non-Hispanic Black, and 77% Spanish-speaking families) completed the baseline survey (participants) and 46 (63%) used the DK site (users). Among users, pre-post changes (mean [standard deviation]) showed an increase in FNPA scores (3.0 [6.3], p = 0.01); decrease in child %BMIp95 (-1.03% [5.79], p = 0.22); and decrease in parent BMI (-0.69 [1.76], p = 0.04). Adjusted models showed -0.02% [95% confidence interval: -0.03 to -0.01] change in child %BMIp95 for each minute spent on the DK website. Conclusions: DK demonstrated a significant increase in parent FNPA scores and decrease in self-reported parent BMI. e-Health interventions may overcome barriers and require a lower dosage than in-person interventions.

Development and demonstration of a data visualization platform of short-term guidelines for ambient air levels of benzene during disaster response in Houston, Texas

Industrial disasters have caused hazardous air pollution and public health impacts. Response officials have developed limited exposure guidelines to direct them during the event; often, guidelines are outdated and may not represent relevant elevated-exposure periods. The 2019 Intercontinental Terminals Company (ITC) fire in Houston, Texas led to large-scale releases of benzene and presented a public health threat. This incident highlights the need for effective response and nimble, rapid public health communication. We developed a data-driven visualization tool to store, display, and interpret ambient benzene concentrations to assist health officials during environmental emergencies. Guidance values to interpret risk from acute exposure to benzene were updated using recent literature that also considers exposure periodicity. The visualization platform can process data from different sampling instruments and air monitors automatically, and displays information publicly in real time, along with the associated risk information and action recommendations. The protocol was validated by applying it retrospectively to the ITC event. The new guidance values are 6-30 times lower than those derived by the Texas regulatory agency. Fixed-site monitoring data, assessed using the protocol and revised thresholds, indicated that eight shelter-in-place and 17 air-quality alerts may have been considered. At least one of these shelter-in-place alerts corresponded to prolonged, elevated benzene concentrations (~1000 ppb). This new tool addresses essential gaps in the timely communication of air pollution measurements, provides context to understand potential health risks from exposure to benzene, and provides a clear protocol for local officials in responding to industrial air releases of benzene. Integr Environ Assess Manag 2024;20:533-546. © 2023 The Authors. Integrated Environmental Assessment and Management published by Wiley Periodicals LLC on behalf of Society of Environmental Toxicology & Chemistry (SETAC).

Data-driven subgrouping of youths with depression reveals that resilience is associated with higher physical functioning despite high symptom burden in the Texas Youth Depression and Suicide Research Network (TX-YDSRN)

BACKGROUND

The Patient-Reported Outcomes Measurement Information System (PROMIS) measure, which assesses past week status of seven domains (physical function mobility, anxiety, depressive symptoms, fatigue, peer relationships, pain interference, and pain intensity), represents a new paradigm using patient-reported outcomes. We used a data-driven approach with PROMIS to identify subgroups of youths receiving depression treatment.

METHODS

Youths (n = 721) enrolled in the Texas Youth Depression and Suicide Research Network who completed the PROMIS were analyzed. Latent class analyses (LCAs) identified subgroups and compared their baseline clinical/sociodemographic features.

RESULTS

Compared to population norms, our sample had worse than average physical function, anxiety, depression, fatigue, and pain interference. Using LCA, four subgroups were identified: 1) lower symptom severity and higher physical functioning (14.6 %); 2) higher symptom burden, higher pain interference/intensity, and lower physical functioning (52.7 %); 3) higher symptom burden, higher pain interference/intensity, but with higher physical functioning (9.2 %); and 4) higher symptom burden, but lower physical functioning and pain interference/intensity (23.6 %). Group 3 demonstrated higher resilience than Group 2. In contrast, Group 2 had higher anxiety than Group 4.

LIMITATIONS

Individuals may have different symptom profiles due to the observational nature of the study. Replication of these subgroups may be difficult, as future samples may differ in these characteristics. Further work may demonstrate the stability of these groups.

CONCLUSIONS

A data-driven analysis identified a small but significant subgroup with high physical functioning despite high symptom burden and pain, and this group reported higher resilience. Resilience-enhancing interventions may help improve functional outcomes in depressed youth.

Surrogate Decision-Making After Stroke in a Community Setting: The OASIS Project

BACKGROUND

Patients with severe stroke often rely on surrogate decision-makers for life-sustaining treatment decisions. We investigated ethnic differences between Mexican Americans (MAs) and non-Hispanic White (NHW) individuals in surrogate reports of physician quality of communication and shared decision-making from the OASIS study (Outcomes Among Surrogate Decision Makers in Stroke) project.

METHODS

Patients had ischemic stroke or intracerebral hemorrhage in Nueces County, TX. Surrogates self-identified as being involved in decisions about do-not-resuscitate orders, brain surgery, ventilator, feeding tube, or hospice/comfort care. Surrogate reports of physician quality of communication (scale score, range from 0 to 10) and shared decision-making (CollaboRATE scale score, binary score 1 versus 0) were compared by ethnicity with linear or logistic regression using generalized estimating equations, adjusted for prespecified demographics, clinical factors, and confounders.

RESULTS

Between April 2016 and September 2020, 320 surrogates for 257 patients with stroke enrolled (MA, 158; NHW, 85; and other, 14). Overall quality of communication score was better among surrogates of MA patients than NHW individuals after adjustment for demographics, stroke severity, and patient survival though the ethnic difference was attenuated (β, 0.47 [95% CI, -0.17 to 1.12]; P=0.15) after adjustment for trust in the medical profession and frequency of personal prayer. High CollaboRATE scale scores were more common among surrogates of MA patients than NHW individuals (unadjusted odds ratio, 1.75 [95% CI, 1.04-2.95]). This association persisted after adjustment for demographic and clinical factors though there was an interaction between patient age and ethnicity (P=0.04), suggesting that this difference was primarily in older patients.

CONCLUSIONS

Surrogate decision-makers of MA patients generally reported better outcomes on validated measures of quality of communication and shared decision-making than NHW individuals. Further study of outcomes among diverse populations of stroke surrogate decision-makers may help to identify sources of strength and resiliency that may be broadly applicable.

A case for the health welfare of Texans-A nurse practitioner state regulation policy analysis

ABSTRACT

Restrictive nurse practitioner (NP) practice regulation at the state level continues to obstruct patient access to quality affordable care because primary care provider shortages heighten across the nation. Evidence-based research supports NPs as cost-effective providers without conceding quality of care. A patchwork of highly variable state policies subjectively determines the degree of collaborative oversight required for NPs to practice in each state. An objective review of policies influencing NP capacity to deliver care promotes evidence-informed policy adaptation. A policy analysis was completed using Bardach and Patashnik's framework to evaluate policy options for NP practice regulation in Texas. Full practice authority (FPA) policy effect was quantitively evaluated through difference-in-differences regression models using selected measures of all 50 states and the District of Columbia. Health welfare outcomes were calculated using emergency department utilization, average household health expenditures, poor physical health days, and NP-specific adverse action reports (AAR). Overall, FPA policy did not have a statistically significant effect on state-clustered emergency department utilization, average household health expenditures, or poor physical health days. Full practice authority was associated with decreased NP AAR. The analysis supports FPA as a viable policy option for states such as Texas and counters claims FPA policy adoption results in detrimental sequalae in the health of the population.

Barriers to adoption of electric vehicles in Texas

Sustainable mobility options such as electric vehicles (EVs) have the potential to improve the quality of life for Americans as well as those in other countries, as they can enhance the quality of the air we breathe, while reducing greenhouse gas emissions, fossil fuel consumption, and the adverse impacts of global warming. Despite their many benefits, however, the demand for EVs remains low. Therefore, this study aims to identify the barriers that affect the widespread EV adoption in the United States. Seventeen barriers were identified from the literature, and a questionnaire survey was designed and distributed to potential consumers of EVs. The survey yielded 733 responses, and various statistical tests like cluster analysis and chi-squared tests were performed. The results revealed that the high purchase price of the vehicle, high battery replacement cost, and the lack of public infrastructures for charging them were the primary concerns. The results also revealed that middle-aged men with high education and income are more enthusiastic about adopting EVs. The results presented in this study indicate a range of developments that different stakeholders could implement. To surmount the economic barriers to EV adoption, policymakers should strengthen incentives countrywide, and automakers should introduce more affordable EVs to the market. To overcome the challenges associated with charging, it is necessary to make investments in rapid charging infrastructure along the primary toll routes.

Derived psychoactive cannabis products and 4/20 specials: An assessment of popular brands and retail price discounts in Fort Worth, Texas, 2023

BACKGROUND

Retail sales of derived psychoactive cannabis products (DPCPs) have increased in the U.S. since passing the 2018 Farm Bill and is unregulated in most states. This study investigated the types and commonly sold brands of DPCPs as well as promotional pricing on April 20th, a day associated with cannabis use.

METHODS

On April 19-20, 2023, investigators conducted telephone surveys with 98 retail stores that sold DPCPs in Fort Worth, Texas (where the market was largely unregulated).

RESULTS

Delta-8, Delta-9, and Delta-10 THC products were widely available, with 97%, 72%, and 82% of stores selling each type, respectively. Fifteen additional DPCPs were identified, and selling blends containing multiple types of THC was common. Frequently sold brands included Cake, Medusa/Modus, Torch, Urb, Kik, Tyson, 3Chi, Casper, Hidden Hills, Esco Bars, Happi, Hometown Hero, STNR, Bomb Bars, Baked, Hi On Nature, Looper, and Space God. Overall, 45% reported having 4/20 specials discounting prices on DPCPs, smoking devices/accessories, or everything in the store. Several stores also sponsored 4/20 promotional events including free THC gummies and "live delta demos where people can test cartridges and try smoking flower in the store."

CONCLUSIONS

Findings highlight the growing complexity of the DPCP market, including numerous different intoxicating compounds and blends. Policymakers, researchers, and public health professionals should consider these complexities, as well as the commonly sold brands, when developing strategies to regulate DPCPs and protect consumer safety. Pricing policies may be an especially important form of harm reduction during events associated with heavy cannabis use, including 4/20.

Nationwide Aquatic Envenomations Reported to US Poison Control Centers from 2011 to 2020

INTRODUCTION

Aquatic envenomations are common injuries along the coastal United States that pose a public health risk and can cause significant morbidity. We examined aquatic envenomation exposures that were called in to poison control centers (PCC) in the United States from 2011 to 2020.

METHODS

The Association of Poison Control Center's (AAPCC) National Poison Data System was queried for all aquatic envenomations reported during the 10 y period from January 1, 2011, to December 31, 2020. Data collected included date, exposure and geographic location, patient age and sex, signs and symptoms, management setting, treatments, and clinical outcome. Duplicated records, confirmed nonexposure, and reports not originating within the United States were excluded.

RESULTS

There were 8517 human aquatic envenomations reported during the study period, 62% (5243) of whom were male; 56% (4264) of patients were 30 y or younger. There were an average of 852 calls per year, with 46% of calls occurring during June to August. California, Texas, and Florida had the highest number of envenomations during the study period. Fish (61%; 5159) and Cnidaria (30%; 2519) envenomations were the most common exposures. Overall, 37% (3151) of exposures were treated in healthcare facilities, with no deaths reported.

CONCLUSIONS

The highest proportion of aquatic envenomations occurred among younger males (≤30 y) during the summer months. While rarely leading to major adverse events, aquatic envenomations were commonly reported injuries to PCC and occurred in all 50 states. Poison control centers continue to be real-time sources of information and data regarding aquatic envenomation trends.

Embracing ethical research: Implementing the 3R principles into fracture healing research for sustainable scientific progress

As scientific advancements continue to reshape the world, it becomes increasingly crucial to uphold ethical standards and minimize the potentially adverse impact of research activities. In this context, the implementation of the 3R principles-Replacement, Reduction, and Refinement-has emerged as a prominent framework for promoting ethical research practices in the use of animals. This article aims to explore recent advances in integrating the 3R principles into fracture healing research, highlighting their potential to enhance animal welfare, scientific validity, and societal trust. The review focuses on in vitro, in silico, ex vivo, and refined in vivo methods, which have the potential to replace, reduce, and refine animal experiments in musculoskeletal, bone, and fracture healing research. Here, we review material that was presented at the workshop "Implementing 3R Principles into Fracture Healing Research" at the 2023 Orthopedic Research Society (ORS) Annual Meeting in Dallas, Texas.

Exploration of the effects of incarceration on the health of Latina women and their children using the life course theory

OBJECTIVE

Use the Life Course Theory (LCT) to explore the effects of involvement with the justice system on the health of Latina women and their children.

DESIGN

A supplementary analysis was conducted using data collected from the original study to answer a new research question.

SETTING

South Central Texas.

PARTICIPANTS

A primary qualitative data set from 12 Latina women involved with the justice system.

METHODS

We applied LCT principles and used thematic content analysis as such we employed categoric distinction: lifespan development, time and place in individuals' lives, the timing of lives, human agency, and linked lives to analyze participants' narratives.

RESULTS

Five themes emerged that aligned with LCT principles: (1) It feels like I'm living in my own prison; (2) What do I have to live for now; (3) It is like double punishment; (4) They made my choices; and (5) People didn't really understand. Participants felt helpless with few options to overcome their prior adversities, which affected their ability to make positive future choices.

CONCLUSIONS

Findings highlight the potential, long-term, negative health consequences that may result from incarceration. Considering that justice system involvement can lead to more profound maternal and child health disparities, our findings suggest that greater advocacy from the nursing profession would increase accessibility to equitable and respectful maternity and women's health care services. Key points Involvement with the justice system can result in negative health consequences for women and their children. Maternal and child health disparities are often more profound after involvement with the justice system. Greater advocacy is needed from the nursing profession to ensure access to equitable and respectful maternity and women's health care services.

Providing doula support to publicly insured women in central Texas: A financial cost-benefit analysis

BACKGROUND

Disparities in birth outcomes continue to exist in the United States, particularly for low-income, publicly insured women. Doula support has been shown to be a cost-effective intervention in predominantly middle-to-upper income White populations, and across all publicly insured women at the state level. This analysis extends previous studies by providing an estimate of benefits that incorporates variations in averted outcomes by race and ethnicity in the context of one region in Texas. The objectives of this study were to determine (1) whether the financial value of benefits provided by doula support exceeds the costs of delivering it; (2) whether the cost-benefit ratio differs by race and ethnicity; and (3) how different doula reimbursement levels affect the cost-benefit results with respect to pregnant people covered by Medicaid in central Texas.

METHODS

We conducted a forward-looking cost-benefit analysis using secondary data carried out over a short-term time horizon taking a public payer perspective. We focused on a narrow set of health outcomes (preterm delivery and cesarean delivery) that was relatively straightforward to monetize. The current, usual care state was used as the comparison condition.

RESULTS

Providing pregnant people covered by Texas Medicaid with access to doulas during their pregnancies was cost-beneficial (benefit-to-cost ratio: 1.15) in the base model, and 65.7% of the time in probabilistic sensitivity analyses covering a feasible range of parameters. The intervention is most cost-beneficial for Black women. Reimbursing doulas at $869 per client or more yielded costs that were greater than benefits, holding other parameters constant.

CONCLUSIONS

Expanding Medicaid pregnancy-related coverage to include doula services would be cost-beneficial and improve health equity in Texas.

Academic and Demographic Characteristics of Pediatric Orthopaedic Division Chiefs in the United States

INTRODUCTION

Division Chiefs (DCs) and department leadership play an integral role within the service. The goal of this study is to assess the demographics and scholarly work of the leadership in pediatric orthopaedics services across the United States and comment on the role of diversity within leadership positions.

METHODS

Academic medical centers and pediatric hospitals were identified using the Electronic Residency Application Service website, the Pediatric Orthopaedic Society of North America website, and the Children's Hospital Association website. Leadership was identified using the hospitals' respective websites where data such as sex, race/ethnicity, fellowship institution, time since graduating fellowship, and academic rank were collected. Scopus database was used to determine h-indices and PubMed was used to determine the number of publications.

RESULTS

Of 196 academic centers and 223 pediatric hospitals identified, 98 had a designated DC of the pediatric orthopaedics division. The majority of the DCs were male (85.7%), and leadership positions at hospitals with academic affiliations had a higher proportion of female DCs than nonacademic centers ( P =0.0317). DCs were mostly white (83.7%), followed by Asian (12.2%), and African American (2.0%). The average time since fellowship was 21.1 years and the average h-index was 15.7. The average age of the DCs was 56.8 years old. Of those in academic settings, 48.5% held the rank of professor. The fellowship programs that trained the most DCs were Boston Children's Hospital (16.3%) and Texas Scottish Rite for Children (14.3%).

DISCUSSION

There is a paucity of available research on leadership characteristics in pediatric orthopaedic surgery. While progress has been made, there is still a lack of diversity that exists among leadership in pediatric orthopaedics, both within the academic setting as well as the private sector. The position of DC is held predominately by white males with a rank of either professor or no academic association. Intentional efforts are needed to continue to increase diversity in leadership positions within pediatric orthopaedic programs in the United States.

LEVEL OF EVIDENCE

IV.

Suitability of containerized toxicant to control Solenopsis invicta (Hymenoptera: Formicidae) threatening cave species in Bexar County, Texas

Several protected troglobitic invertebrate species are known to occur in caves on Joint Base San Antonio-Camp Bullis, Bexar County, Texas, United States. The United States Fish and Wildlife Service (USFWS) identified red-imported fire ant Solenopsis invicta (hereafter RIFA) (Buren 1972) as the primary threat to cave species' nutrient sources, cave crickets, Ceuthophilus secretus (Scudder 1894). Per the service's recommendations, Joint Base San Antonio-Camp Bullis currently implements boiling water mound injections with digging for RIFA control. However, treatment effectiveness is highly variable and largely dependent on the time of day, weather, and personnel diligence. Toxicants have been used for RIFA treatment throughout the world, but concerns exist that traditional applications of toxicant bait around caves might be accessible and inadvertently affect nontarget arthropods, including cricket populations. To mitigate this accessibility, physically limiting access to the toxicant from crickets may be an option. Our objectives were to (i) compare and evaluate the effectiveness of Amdro (Hydramethylnon) and Advion (Indoxacarb) granular baits housed in Ants-No-More Bait Stations (Kness MFG. Inc., Albia, IA) and (ii) evaluate the distance of effectiveness of each bait within a bait station. Ultimately, we observed a 98% reduction in RIFA mound abundance from both baits. Additionally, RIFA mounds within 10 m of the containerized toxicant were reduced by 70%. Our pilot study suggested that Ants-No-More Bait Stations are an effective way to reduce RIFA mounds by 70% if placed 10 m from each other. In practice, this could include bait stations completely covering a particular distance to a cave entrance or fewer bait stations in a ring barrier at a single radial distance to a cave entrance. Containerized toxicants may be a cost-effective and safe RIFA control option around protected cave environments, but further studies are needed to determine potential effects on nontarget arthropods, optimal bait station configuration, and potential effects of biomagnification.

(Acari: Ixodidae) in south Texas pastures

Cattle fever ticks, Boophilus microplus (Canestrini) and Boophilus annulatus (Say), are native to Eurasia and have invaded the New World as vectors of bovine Babesiosis. Due to severe losses in livestock production, an eradication program by the USDA was established. Premises infested with Boophilus ticks are subject to regulatory oversight that includes acaricide treatment and quarantine. The quarantine duration varies between summer through winter and is based on the available information on the persistence of the off-host stages in pastures far from south Texas. The objective of this study was to assess the specific effect of thermal stress measured in degree-days on the longevity of B. annulatus and B. microplus off-host stages in south Texas pastures. Our results demonstrate that the longest off-host persistence for B. annulatus was 142 days under canopied habitat in the winter and 130 days in the summer. On the other hand, B. microplus off-host persistence was 113 days under canopy and 103 days in exposed habitat, both in winter. The results indicate that temperature was a key variable that prolonged the survival of B. annulatus but not B. microplus. In areas such as south Texas at the northernmost extent of B. microplus range, where mild winters prevail, we found a maximum persistence of less than 4 months (113 days), very close to the previous published record of 116 days. A reduction in the Texas pasture quarantine period from 9 months to 6 months would be justified for this species.

Environmental Factors Impacting the Development of Toxic Cyanobacterial Proliferations in a Central Texas Reservoir

Cyanobacterial harmful algal proliferations (cyanoHAPs) are increasingly associated with dog and livestock deaths when benthic mats break free of their substrate and float to the surface. Fatalities have been linked to neurotoxicosis from anatoxins, potent alkaloids produced by certain genera of filamentous cyanobacteria. After numerous reports of dog illnesses and deaths at a popular recreation site on Lady Bird Lake, Austin, Texas in late summer 2019, water and floating mat samples were collected from several sites along the reservoir. Water quality parameters were measured and mat samples were maintained for algal isolation and DNA identification. Samples were also analyzed for cyanobacterial toxins using LC-MS. Dihydroanatoxin-a was detected in mat materials from two of the four sites (0.6-133 ng/g wet weight) while water samples remained toxin-free over the course of the sampling period; no other cyanobacterial toxins were detected. DNA sequencing analysis of cyanobacterial isolates yielded a total of 11 genera, including Geitlerinema, Tyconema, Pseudanabaena, and Phormidium/Microcoleus, taxa known to produce anatoxins, including dihydroanatoxin, among other cyanotoxins. Analyses indicate that low daily upriver dam discharge, higher TP and NO3 concentrations, and day of the year were the main parameters associated with the presence of toxic floating cyanobacterial mats.

Acceptability of Personalized Lung Cancer Screening Program Among Primary Care Providers

Current lung cancer screening (LCS) guidelines rely on age and smoking history. Despite its benefit, only 5%-15% of eligible patients receive LCS. Personalized screening strategies select individuals based on their lung cancer risk and may increase LCS's effectiveness. We assess current LCS practices and the acceptability of personalized LCS among primary care providers (PCP) in Texas. We surveyed 32,983 Texas-based PCPs on an existing network (Protocol 2019-1257; PI: Dr. Shete) and 300 attendees of the 2022 Texas Academy of Family Physicians (TAFP) conference. We analyzed the responses by subgroups of interest. Using nonparametric bootstrap, we derived an enriched dataset to develop logistic regression models to understand current LCS practices and acceptability of personalized LCS. Response rates were 0.3% (n = 91) and 15% (n = 60) for the 2019-1257 and TAFP surveys, respectively. Most (84%) respondents regularly assess LCS in their practice. Half of the respondents were interested in adopting personalized LCS. The majority (66%) of respondents expressed concerns regarding time availability with the personalized LCS. Most respondents would use biomarkers as an adjunct to assess eligibility (58%), or to help guide indeterminate clinical findings (63%). There is a need to enhance the engagement of Texas-based PCPs in LCS. Most of the respondents expressed interest in personalized LCS. Time availability was the main concern related to personalized LCS. Findings from this project highlight the need for better education of Texas-based PCPs on the benefits of LCS, and the development of efficient decision tools to ensure successful implementation of personalized LCS.

PREVENTION RELEVANCE

Personalized LCS facilitated by a risk model and/or a biomarker test is proposed as an alternative to existing programs. Acceptability of personalized approach among PCPs is unknown. The goal of this study is to assess the acceptability of personalized LCS among PCPs.

A Qualitative Exploration of PrEP Interests, Barriers, and Interventions Among Black and Latina Cisgender Women in the U.S

Black and Latina cisgender women (BLCW) are disproportionally affected by HIV, particularly in the southern U.S. In Austin, Texas, Black women contract HIV 18.4 times more and Latinas 2.6 times more compared to White women. Pre-exposure prophylaxis (PrEP) is a medication that prevents contracting HIV; however, PrEP adoption among women is low. The current qualitative study aimed to explore PrEP awareness, interest, preferred PrEP administration methods, barriers to PrEP adoption, and future programs to increase PrEP adoption and adherence among BLCW. A total of 18 BLCW at high risk for HIV were enrolled. Participants completed 3 semi-structured interviews across 3 months. Interviews were transcribed verbatim, coded, and analyzed using thematic content analysis. Results demonstrated that BLCW had low PrEP awareness, high initial PrEP interest, and were interested in a long-acting injectable form of PrEP. Barriers to PrEP adoption included concerns regarding side effects, concerns about adherence to the currently available daily pill, and difficulty with insurance. Participants proposed different ideas for interventions, including support groups, education, community-level programs, and structural interventions. Future studies should focus on increasing PrEP awareness and HIV risk, consider alternative forms of PrEP, educate providers and medical staff on PrEP, and consider tailored interventions to reduce HIV risk among BLCW.

Psychometric properties of the GAD-7 and PROMIS-Anxiety-4a among youth with depression and suicidality: Results from the Texas youth depression and suicide research network

There is a tremendous need for brief, valid, and free assessments of anxiety in child mental healthcare. The goal of this study was to determine the psychometric properties of two such measures, the GAD-7 and PROMIS-Anxiety-4a, in 1000 children, adolescents, and young adults (8-20 years-old) with depression and/or suicidality. The GAD-7, the PROMIS-Anxiety-4a, and other validated assessments of anxiety, physical functioning, and psychiatric diagnoses were completed. Confirmatory factor analyses showed an acceptable fit for a single factor in both measures via all indices but the RMSEA. They demonstrated measurement invariance across pre-adolescents (8-12 years-old) and adolescents and emerging adults (13-20 years-old), though scalar invariance was not observed for the GAD-7. Both measures showed strong convergent validity, GAD-7: r = 0.68; PROMIS-Anxiety-4a: r = 0.75, divergent validity with a measure of physical function, GAD-7: r = -0.24; PROMIS-Anxiety-4a: r = -0.28, good internal consistency, ω = 0.89 for both, and high test-retest reliability, GAD-7: r = 0.69; PROMIS-Anxiety-4a: r = 0.71. Both measures also showed acceptable sensitivity and specificity in detecting the presence of any anxiety disorder, GAD-7 cut-off score of 10: AUC = 0.75; PROMIS-Anxiety-4a cutoff score of 12: AUC = 0.79. The GAD-7 correlated similarly with the Screen for Child Anxiety Related Disorders total score and generalized anxiety subscale, and also showed similar diagnostic sensitivity and specificity when used to detect the presence of any anxiety disorder vs. generalized anxiety disorder specifically. Results suggest that both of these brief, publicly available instruments are valid and reliable assessments of anxiety among youth in treatment for depression and/or suicidality.

Statistical Analysis of Radioactivity: Lamprecht Uranium Mine in Texas

ABSTRACT

The former Lamprecht uranium mine facility in Texas ceased operations well before the new millennium. However, decommissioning activities were never completed by the licensee. Consequently, a legal proceeding was authorized between state and licensee representatives. Meanwhile, state funds were used to hire an independent contractor to perform radiological surveys and assess the magnitude of residual radioactivity across the terrain at the site. The purpose of this study was to apply advanced spatial statistical methods to the survey data measured by contractors at the Lamprecht site to precisely predict remaining radioactive hotspot locations post soil remediation activities. To accomplish this, descriptive statistics such as Google maps and boxplots along with inferential spatial statistical techniques, e.g., kriging and semivariograms, were employed. R coding was also used throughout. Specifically, the descriptive statistical methods included geographical mapping of targeted areas at the site coupled with summary statistics. Inferentially, spatial analytical techniques were employed to pinpoint the locations of elevated radiation levels above regulatory limits. Our results suggest that fewer hotspots were identified after remediation activities were completed at the site. This study provides an additional analytical resource for the State of Texas regarding the release of this former in situ leach uranium mine site to landowners for unrestricted use.

Evaluating the Impact of the Novel Geographic Preferences Section on Interview Rate and Residency Match Outcomes

BACKGROUND

The American Association of Medical Colleges trialed residency application initiatives including geographic preferences and preference signals in 2022.

OBJECTIVE

To assess the impact of geographic preferences on application outcomes during the 2022 residency match year.

DESIGN

Cross-sectional.

PARTICIPANTS

Applicants to categorical and preliminary internal medicine during the 2022 application cycle who completed the Texas Seeking Transparency in Applications to Residency survey.

MAIN MEASURES

The primary outcome was interview rate (interview offers/total applications) and whether an application resulted in a match. The key dependent variables were geographic preferences and program-specific preference signals. We also assessed differences in utilization of geographic preferences between specialties.

KEY RESULTS

A total of 970 applicants into categorical (n = 884) and preliminary (n = 86) internal medicine were included in our study. A total of 704 (72.6%) applicants submitted at least one geographic preference and 424 (43.7%) submitted three preferences. On average, applicants who submitted a geographic preference had a higher interview rate than those who did not (46.0% vs. 41.8%). Applications submitted with both a preference signal and geographic preference were significantly more likely to receive an interview offer (OR: 3.2, p < 0.01) and match (OR: 6.4, p < 0.01) than applications with neither a preference signal nor a geographic preference. Geographic preferences were associated with an increase in the odds of an application receiving an interview offer, even in the setting of a preference signal (OR: 1.4, p < 0.01).

CONCLUSIONS

Both preference signals and geographic preferences have significant associations with odds of an application receiving an interview and matching for both categorical and preliminary internal medicine applicants. This study can be used to inform applicants, advisors, and programs how novel application strategies can affect important application outcomes for US medical school graduates. As more specialties pilot alternative processes, it will be important to study all application outcomes among varying applicant populations.

Financial losses due to fumonisin contamination in the Texas High Plains maize

Fumonisins are one of the main problems affecting maize production in the Texas High Plains (THP), where its agroclimatic conditions make it a perennial hotspot for mycotoxin contamination. In 2017, a fumonisin outbreak in the THP maize motivated stakeholders' request to repeal a subsection of the Texas Administrative Code, §61.61(a)(7) (Fumonisin Rule), and its related Texas Feed Industry Memorandum (Memo 5-20), which previously permitted the blending of maize containing high fumonisin levels with maize containing ≥ 5 mg/kg under state authority, and pivot to FDA fumonisin guidance. Shortly after, the USDA Risk Management Agency (RMA's) reintroduced Discount Factors (DFs) in annual Special Provisions (SP) that outline price reductions related to fumonisin contamination in maize. In this research, we estimate the potential economic burden posed by these changes through a two-part approach. In part one, we construct a decision model that explores the final disposition of fumonisin-contaminated maize based on blending permissions, fumonisin levels, and crop insurance status. In part two, we estimate the economic impact by inserting output values of the decision model into financial equations that consider testing costs, transportation fees, and discounts from crop insurance and grain elevators when applicable. Our economic analysis projects that the financial losses during a THP crop year with high fumonisin levels could range from $15.1 to $135.5 million without the option to blend under conditions of the revised RMA discount schedule. Findings further highlight crop insurance as the most promising risk management strategy for farmers in areas susceptible to fumonisin contamination.

Abortion patients' decision making about where to obtain out-of-state care following Texas' 2021 abortion ban

OBJECTIVE

To assess pregnant Texans' decisions about where to obtain out-of-state abortion care following the September 2021 implementation of Senate Bill 8 (SB8), which prohibited abortions after detectable embryonic cardiac activity.

DATA SOURCE

In-depth telephone interviews with Texas residents ≥15 years of age who obtained out-of-state abortion care after SB8's implementation.

STUDY DESIGN

This qualitative study explored participants' experiences identifying and contacting abortion facilities and their concerns and considerations about traveling out of state. We used inductive and deductive codes in our thematic analysis describing people's decisions about where to obtain care and how they evaluated available options.

DATA COLLECTION

Texas residents self-referred to the study from flyers we provided to abortion facilities in Arkansas, Colorado, Kansas, Louisiana, Mississippi, New Mexico, and Oklahoma. We also enrolled participants from a concurrent online survey of Texans seeking abortion care.

PRINCIPAL FINDINGS

Participants (n = 65) frequently obtained referral lists for out-of-state locations from health-care providers, and a few received referrals to specific facilities; however, referrals rarely included the information people needed to decide where to obtain care. More than half of the participants prioritized getting the soonest appointment and often contacted multiple locations and traveled further to do so; others who could not travel further typically waited longer for an appointment. Although the participants rarely cited state abortion restrictions or cost of care as their main reason for choosing a location, they often made sacrifices to lessen the logistical and economic hardships that state restrictions and out-of-state travel costs created. Informative abortion facility websites and compassionate scheduling staff solidified some participants' facility choice.

CONCLUSIONS

Pregnant Texans made difficult trade-offs and experienced travel-related burdens to obtain out-of-state abortion care. As abortion bans prohibit more people from obtaining in-state care, efforts to strengthen patient navigation are needed to reduce care-seeking burdens as this will support people's reproductive autonomy.

Reasons for participation in abortion research in restrictive settings

OBJECTIVES

Following the implementation of a restrictive abortion law in Texas (Senate Bill 8), we conducted in-depth interviews with pregnant people about their experiences seeking abortion care. In this analysis, we explore participants' motivations for taking part in a research study.

STUDY DESIGN

Between October 2021 and August 2022, we conducted 120 in-depth interviews with Texans (aged ≥15 years) who, after considering abortion, had a facility-based abortion, self-managed their abortion, experienced miscarriage or ectopic pregnancy, or continued their pregnancy. We asked all interviewees, "Why did you decide to participate in the interview?" For analysis, we used inductive and deductive coding approaches to explore motivations for and concerns about participation.

RESULTS

Most commonly, interviewees appreciated the opportunity to share their stories, frequently describing how their experiences highlight the nuance of abortion decision-making and challenge stigmatized views about abortion. Some described an emotional benefit of participating, as they had no one else to whom to disclose their experience without judgment. Many hoped to help others by participating, saying that access to other people's stories would have helped them feel less isolated. Relatedly, many viewed their participation as an opportunity to speak out against restrictive policies that caused them harm, hardship, and distress. Interviewees seldom cited the monetary incentive alone as motivation for participation. A few expressed concerns about participating out of fear of legal repercussions for others involved in their abortion process (e.g., ride-share driver). These themes were consistent across pregnancy outcomes.

CONCLUSIONS

Research volunteers are motivated to participate for altruistic and self-benefiting reasons.

IMPLICATIONS

This study provides insights into what people seeking abortion consider when deciding to participate in qualitative research. Research ethics committees evaluating and researchers conducting abortion research should weigh these motivations, perceived benefits, and concerns. Policies that enhance protections for participant data are needed to support knowledge generation from abortion research.

Apparent tick paralysis by Otobius megnini in a cat

In this study, we report a rare case of tick paralysis in a cat induced by Otobius megnini infestation. An 11-month-old female cat was admitted to a private veterinary clinic in Luling Texas, USA presenting with depression, tachycardia, and flaccid paralysis of the entire body. The four recovered ticks were morphologically and molecularly identified as O. megnini nymphs. Following initial tick removal and treatment with 0.1% milbemycin oxime in the ear canal on the first day of hospitalization, and additional tick removal and topical selamectin treatment on the second day of hospitalization the animal gradually improved. The recovery of the cat after tick removal supports the diagnosis of tick toxicosis. While tick antiserum is not available in North America, prevention of tick infestation and tick-induced paralysis can be effectively accomplished using repellent collars and the compliant use of other ectoparasiticide products year-round.

Factors associated with food security of Texas Woman's University freshmen

OBJECTIVE

To investigate what factors are associated with food insecurity (FI) among freshman students and identify potential solutions.

PARTICIPANTS

73 freshman students.

METHODS

Cross-sectional, Internet survey-based study. Fisher's Exact tests examined factors associated with food security (FS); Cohen's Kappa assessed the agreement between FI scores and self-assessment; thematic analysis used Nvivo 12.

RESULTS

FI was 54.2% among the diverse students (65% non-white). Factors associated with FS included mother with a college degree (p = .018); father employed full-time (p < .001); identifying one's family financial situation as better than others (p = < .001); not obtaining personal student loans (p = 0.022). Students with FI tended to overestimate their FS status. Suggested solutions for FI included: improved finances, improved food accessibility, improved cooking skills.

CONCLUSIONS

Future interventions should target freshmen who obtain personal student loans or have parents with less than a college degree or unstable employment status. (148).

Delta-8 THC Retail Availability, Price, and Minimum Purchase Age

Background: Retail sales of Delta-8 tetrahydrocannabinol (THC) products have increased in the U.S. market since the passing of the 2018 Farm Bill, and there is currently little regulation of marketing/sales and limited related safety standards in many states. After thousands of calls to poison control centers (40% for individuals under 18 years old and 70% requiring health care facility evaluation), the Food and Drug Administration issued warnings on Delta-8 THC products, stating their psychoactive effects and that some manufacturers may synthesize Delta-8 using unsafe household chemicals. The current study describes the Delta-8 THC retail sales environment in Fort Worth, Texas. Given its relatively inexpensive manufacturing and that low prices are a major determinant of cannabis use, the price of Delta-8 THC products was examined. This study also examined whether retail outlets in areas with greater socioeconomic deprivation had higher odds of selling Delta-8 THC products. This is important because if Delta-8 THC retailers are disproportionately located in more socioeconomically deprived communities, residents of these communities can more easily access these products and may have higher risk of adverse consequences. Methods: Potential Delta-8 THC retailers were selected by identifying lists of current retail locations with alcohol, cannabidiol, and/or tobacco licenses in Fort Worth. Trained research assistants called outlets in September and October 2021 to query about sales of products containing Delta-8 THC. The response rate was 69% (n=1,223). Outlets' 9-digit zip codes were merged with Area Deprivation Index scores. Products and purported minimum age were described. Chi-squared and Student's t-tests were used. Results: Eleven percent of outlets (n=133) reported selling Delta-8 THC. Ninety-six percent sold vapes and/or "flower" (i.e., hemp leaves coated with Delta-8 THC distillate) and 76% sold edibles. Among the least expensive products available, edibles cost, on average, $8.58 less than flower/vapes (p<0.001). Outlets that sold Delta-8 THC were located in areas with greater deprivation (p=0.02). Most reported a minimum purchase age of 21; however, 4% reported 18 years or no minimum age. Conclusions: Delta-8 THC retail outlets were disproportionately located in areas with more socioeconomic deprivation. Legal intervention such as zoning, minimum age, and tax laws may help reduce Delta-8 THC-related disparities.

Trajectories of adherence to ACEI/ARB medications following a motivational interviewing intervention among Medicare Advantage beneficiaries in Texas

OBJECTIVES

To assess the impact of student telephone motivational interviewing intervention on angiotensin-converting enzyme inhibitors/angiotensin-receptor blockers (ACEI/ARBs) adherence trajectories and identify predictors of each trajectory.

METHODS

The intervention group included continuously enrolled Medicare Advantage Plan patients non-adherent to ACEI/ARBs vs the control group (1:2 ratio). The intervention was tailored by pre-intervention trajectories and included an initial and five follow-up calls. Adherence was measured 6 months after initial calls using the proportion of days covered (PDC). Monthly PDCs were integrated into a group-based trajectory model and categorized patients into 4-groups. A multinomial logistic regression model was used to evaluate trajectory predictors.

RESULTS

The study comprised 240 intervention patients and 480 controls with four trajectories: adherent trajectory 44.2%, gradual improvement in adherence 13.4%, slow decline in adherence 24.1%, and discontinuation 18.3%. Patients with the intervention were less likely to experience a slow decline in adherence than controls (OR: 0.627 [0.401-0.981]). Patients with specialty prescribers' visits, ≥ 1 previous hospitalization, rapid decline in adherence as pre-intervention trajectory, and higher CMS risk score were associated with discontinuation trajectory.

CONCLUSION

Intervention patients vs controls had a lower likelihood of following a slow decline in adherence pattern.

PRACTICE IMPLICATIONS

This study underscores the importance of individualized interventions and the association between past adherence patterns and post-intervention trajectories.