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National- and state-level education policies are evolving to address teacher shortages that are pervasive across the United States and are particularly problematic in rural special education. In this article, we describe a policy we call "endorsement by exam" in which teachers certified in one subject area can become certified in other areas by passing a content knowledge test. Although such add-on endorsements are not uncommon in some content areas (e.g., chemistry teachers adding certification in biology), some states have extended this practice to include special education certification. The purpose of this article is to explore what state agencies have adopted endorsement by exam for special education. Despite difficulties in obtaining reliable information, we determined approximately eight states have adopted some form of this policy. We discuss results in terms of rurality and conclude by explaining our position that endorsement by exam is a potentially harmful quick fix that may in fact exacerbate teacher shortages in the long term and thus is ill advised.

The turn of the century brought a profound change in the accreditation of teacher preparation programs. This shift--from curriculum-based reviews to standards-based reviews--took place in the context of the accountability movement of the late 20th century. The 21st century ushered in what many refer to as "a culture of evidence." From P-12 to higher education, providing evidence of learning and data-driven decision making became mandatory. This change has affected no group more than teacher candidates and those who prepare them. When the National Council for the Accreditation of Teacher Education (NCATE) adopted new standards in 2000, the National Middle School Association's (NMSA's) Professional Preparation Advisory Board rewrote the 1989 NMSA guidelines, transforming them into two programmatic standards and seven performance-based standards. An institution submitting one or more programs for recognition does so by writing a context statement, responding to the two programmatic standards, and then offering six to eight program assessments that demonstrate how candidates meet the seven performance-based standards. In the authors' collective work, they have developed, enacted, and refined more than 75 assessments and rubrics aligned with NMSA standards. These are drawn from undergraduate, post-baccalaureate, and graduate middle level programs in California, Missouri, North Carolina, and Texas. Most can be adapted for either initial or advanced levels, and many meet more than one standard. For this article, the authors describe two key assessments per standard. These range from conventional to unique and occur in university-based courses as well as field experiences. What they share is the ability to demonstrate candidate knowledge, skills, and dispositions needed for teaching young adolescents. (Contains 1 figure.)

Boosting nitric oxide production during exercise by various means has been found to improve exercise performance. We investigated the effects of a nitric oxide releasing lozenge with added caffeine (70mg) on oxygen consumption during steady-state exercise and cycling time trial performance using a double-blinded randomized, crossover experimental design. 15 moderately trained cyclists (7 females and 8 males) were randomly assigned to ingest the caffeinated nitric oxide lozenge or placebo 5min before exercise. Oxygen consumption and blood lactate were assessed at rest and at 50%, 65% and 75% maximal oxygen consumption. Exercise performance was assessed by time to complete a simulated 20.15km cycling time-trial course. No significant treatment effects for oxygen consumption or blood lactate at rest or during steady-state exercise were observed. However, time-trial performance was improved by 2.1% (p<0.01) when participants consumed the nitric oxide lozenge (2424±69s) compared to placebo (2476±78s) and without a significant difference in rating of perceived exertion. These results suggest that acute supplementation with a caffeinated nitric oxide releasing lozenge may be a practical and effective means of improving aerobic exercise performance. [ABSTRACT FROM AUTHOR]

The article focuses on the role of Laura Van Zandt Allen as the chair of the Middle Level Teacher Education Program for grades 4-8 in the Trinity University in San Antonio, Texas. In the fall of 2002, the university prepared for accreditation of its teacher education programs by the National Council for the Accreditation of Teacher Education (NCATE) and the Texas State Board for Educator Certification. Allen had begun writing the Specialized Program Association (SPA) report to submit for National Middle School Association (NMSA)/NCATE review. Other achievements of Allen are elaborated.

Background: This study evaluated the psychometric properties of the 9-item Concise Health Risk Tracking Self-Report (CHRT-SR 9 ), a measure of suicidality, in adolescent psychiatric outpatients., Methods: Altogether, 933 depressed or suicidal adolescents (12-20 years of age), receiving treatment at psychiatric outpatient clinics in Texas, completed the 16-item CHRT-SR at baseline and one month later. CHRT-SR 9 was extracted from CHRT-SR 16 using multigroup confirmatory factor analysis. Sex and age measurement invariance, classical test theory, item response theory (IRT), and concurrent validity analyses (against the suicidal ideation Item 9 of Patient Health Questionnaire-Adolescent (PHQ-A)) were conducted., Results: The CHRT-SR 9 demonstrated excellent model fit with four factors (pessimism, helplessness, despair, and suicidal thoughts). Measurement invariance was upheld. Acceptable item-total correlations (0.56-0.80) and internal consistency (Spearman-Brown 0.78-0.89) were revealed. IRT analyses showed a unidimensional instrument with excellent item performance. Using the CHRT-SR 9 total score as a measure of overall suicidality and comparing it against levels of PHQ-A Item 9, the mean (standard deviation) of CHRT-SR 9 total score was 8.64 (SD = 5.97) for no-risk (0 on Item 9), 17.05 (SD = 5.00) for mild, 23.16 (SD = 5.05) for moderate, and 26.96 (SD = 5.24) for severe-risk (3 on Item 9). Significant differences (p-value<0.0001) indicated that CHRT-SR 9 total score distinguished between levels of suicidal risk. Furthermore, CHRT-SR 9 was sensitive to change over a one-month period., Limitations: Whether CHRT-SR 9 predicts actual suicidal attempts in adolescents is not well defined., Conclusion: The CHRT-SR 9 is an easy-to-administer, user-friendly self-report with good psychometric qualities which makes it an excellent screening measure of suicidal risk in adolescent psychiatric outpatients., Competing Interests: Conflict of interest Dr. Trivedi has provided consulting services to Alkermes Inc, Axsome Therapeutics, Biogen MA Inc., Cerebral Inc., Circular Genomics Inc, Compass Pathfinder Limited, GH Research Limited, Heading Health Inc, Janssen, Legion Health Inc, Merck Sharp & Dohme Corp., Mind Medicine (MindMed) Inc, Merck Sharp & Dhome LLC, Naki Health, Ltd., Neurocrine Biosciences Inc, Noema Pharma AG, Orexo US Inc, Otsuka American Pharmaceutical Inc, Otsuka Canada Pharmaceutical Inc, Otsuka Pharmaceutical Development & Commercialization Inc, Praxis Precision Medicines Inc, SAGE Therapeutics, Sparian Biosciences Inc, Takeda Pharmaceutical Company Ltd, WebMD. He sits on the Scientific Advisory Board of Alto Neuroscience Inc, Cerebral Inc., Compass Pathfinder Limited, Heading Health, GreenLight VitalSign6 Inc, Legion Health Inc, Merck Sharp & Dohme Corp, Orexo US Inc, Signant Health. He holds stock in Alto Neuroscience Inc, Cerebral Inc, Circular Genomics Inc, GreenLight VitalSign6 Inc, Legion Health Inc. Additionally, he has received editorial compensation from American Psychiatric Association, and Oxford University Press. Dr. A. John Rush has received consulting fees from Compass Inc., Curbstone Consultant LLC, Emmes Corp., Evecxia Therapeutics, Inc., Holmusk Technologies, Inc., ICON, PLC, Johnson and Johnson (Janssen), Liva-Nova, MindStreet, Inc., Neurocrine Biosciences Inc., Otsuka-US; speaking fees from Liva-Nova, Johnson and Johnson (Janssen); and royalties from Wolters Kluwer Health, Guilford Press and the University of Texas Southwestern Medical Center, Dallas, TX (for the Inventory of Depressive Symptoms and its derivatives). He is also named co-inventor on two patents: U.S. Patent No. 7,795,033: Methods to Predict the Outcome of Treatment with Antidepressant Medication, Inventors: McMahon FJ, Laje G, Manji H, Rush AJ, Paddock S, Wilson AS; and U.S. Patent No. 7,906,283: Methods to Identify Patients at Risk of Developing Adverse Events During Treatment with Antidepressant Medication, Inventors: McMahon FJ, Laje G, Manji H, Rush AJ, Paddock S. Dr. Emslie is a consultant for Lundbeck, Neuronetics and Otsuka. He receives research support from the American Foundation for Suicide Prevention, Janssen Research & Development and Pharmaceuticals, the National Institutes of Health, the Patient-Centered Outcomes Research Institute, and the State of Texas. Dr. Jha has received contract research grants from Acadia Pharmaceuticals, Neurocrine Bioscience, Navitor/Supernus and Janssen Research & Development, educational grant to serve as Section Editor of the Psychiatry & Behavioral Health Learning Network, consultant fees from Eleusis Therapeutics US, Inc., Janssen Global Services, Janssen Scientific Affairs, Worldwide Clinical Trials/Eliem, and Guidepoint Global, and honoraria from North American Center for Continuing Medical Education, Medscape/WebMD, Clinical Care Options, and Global Medical Education. Dr. Brown has received consulting fees from Sage and Biogen Pharmaceuticals. Dr. Kennard receives royalties from Guilford, Press, Inc.; and serves on the board of trustees for the Jerry M. Lewis, III, MD Research Foundation. Dr. Storch reports receiving research funding to his institution from the Ream Foundation, International OCD Foundation, and NIH. He is a consultant for Brainsway and Biohaven Pharmaceuticals. He owns stock less than $5000 in NView. He receives book royalties from Elsevier, Wiley, Oxford, American Psychological Association, Guildford, Springer, and Jessica Kingsley. Dr. Blader reports having received consultant and speaker's honoraria from Supernus Pharmaceuticals. Ms. Fuselier and Drs. Nandy, Garza, Gushanas, Minhajuddin, Wakefield and Slater do not have any conflicts to declare., (Copyright © 2023. Published by Elsevier B.V.)

Unknown in the U.S., areca nut (AN) is the fourth most used psychoactive substance in the world and is associated with oral cancers. We investigated the availability of AN in San Antonio ethnic grocery stores and assessed AN practices in immigrant communities. Grocery stores were contacted to assess AN availability. A survey on AN knowledge and utilization were administered at four community sites with large immigrant populations. 13 of the 19 identified grocery stores carried AN. Most survey participants (n = 66) recognized AN. Most Southeast Asians and South Asians knew what AN is, knew someone who uses it, and knew where to buy it. Most South Asian participants knew its harmful effects. AN usage is associated with older age, male sex, and recent immigration. AN is widely available and utilized among immigrant populations in San Antonio. Further work is needed to raise AN awareness among healthcare workers., (© 2021. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Background: Pharmacists can play an important role in providing medication therapy management (MTM) services, which focus on appropriate medication use. This pilot study aimed to describe pharmacists' MTM service provision, results/outcomes of pharmacists' recommendations and resolution/acceptance rate among patients with high-risk asthma and/or chronic obstructive pulmonary disease (COPD)., Methods: This was a prospective descriptive study of MTM services provided by community pharmacists to Texas Medicaid patients (5-63 years) with "high risk" asthma or COPD. Patients received in-person and telephone consultations that included medication review, asthma control test assessment, and education on adherence and proper medication/device use. Data extracted from MTM software was used to describe: reasons for MTM services, type of pharmacists' interventions, outcomes of pharmacists' recommendations and acceptance rate., Results: Twenty-eight pharmacists provided 139 MTM interventions with 63 patients (2.2 interventions per patient). The most frequent intervention reason was complex drug therapy (53.2%), underuse of medication (8.6%), need for drug therapy (8.6%), new or changed prescription therapy (6.5%), and administration technique (5.0%). The resolution rate was 77.7%. Patient and prescriber, respectively, refused recommendation in 12% and 6% of the interventions. Outcomes included comprehensive medication review (46.7%), improved adherence (6.5%), therapeutic success (6.5%), improved administration technique (5.0%), and initiation of new therapy (5.0%)., Conclusion: Through the provision of MTM, pharmacists were able to identify and intervene with medication-related problems. These interventions are instrumental in helping patients better manage their asthma/COPD. The high resolution rate was encouraging. Larger scale studies are needed to assess clinical and economic outcomes.

BACKGROUND: Socioeconomic factors can have a significant impact on a patient's health status and could be responsible for as much as 70%-80% of a patient's overall health. These factors, called the social determinants of health (SDoH), define a patient's day-to-day experiences. While the influence of such factors is well recognized, who ultimately is responsible for addressing SDoH in health care remains unclear. Physicians and other clinicians are suitably placed to assess SDoH factors that can impact clinical decision making. Understanding Medicare Advantage (MA)-contracted primary care provider (PCP) SDoH perceptions has yet to be fully explored. OBJECTIVES: To (a) understand MA-contracted PCP perceptions of SDoH and (b) investigate correlations between PCP perceptions and their CMS Part D star performances, as well as their hospital admissions and emergency room admissions. METHODS: Survey data were collected from MA-contracted PCPs serving a South Texas market during 2019. An 8-item survey consisting of short answer, ranking, and multiple-choice questions was deployed at attendance-mandatory provider meetings from August to October. Analyses were conducted to understand the providers' SDoH perceptions. PCP responses were first summarized as frequencies and percentages. Baseline descriptive characteristics of the providers were compared by Medicare star ratings using chi-square tests (for categorical variables) and t-tests (for continuous variables). Group differences in physician beliefs on how SDoH affects patients' overall health (question 1), as well as provider beliefs regarding how SDoH affects patients' medication adherence practices (question 2), were assessed using chi-square and t-tests. Associations of provider SDoH perceptions with hospital admissions and emergency room admissions were also assessed. A Fischer's chi-square test was used to examine associations between how PCPs answered the question regarding lack of consistent transportation (question 3) and emergency room admissions. The relationships between PCP perceptions of whose job it is to address SDoH (question 7) and hospital admissions were also evaluated. RESULTS: The response rate for returned surveys was 89%. Analysis revealed that the top 3 barriers were financial insecurity (24.87%), low health literacy (18.65%), and social isolation (15.03%). However, about 36% of PCPs felt they should be the primary addressor of SDoH. There was a significant association between years of practice and CMS Part D star ratings ( P = 0.005). A significant association between responses in belief towards patients' overall health and CMS Part D star ratings was examined ( P = 0.047). There was a statistically significant difference in mean hospital admissions with PCP perception of who should address SDOH ( P = 0.03). Emergency room admissions was significantly associated with perceptions regarding lack of consistent transportation ( P = 0.04). No differences with star ratings were observed. CONCLUSIONS: Previous literature recognize safety and food insecurity as key SDoH barriers. However, they were not among the top SDoH barriers in our survey. Future research should examine patient perceptions of SDoH in this population to identify ways providers can better serve their patients. DISCLOSURES: Funding for this study was provided by CareAllies, a Cigna business. Statistical analysis was completed in partnership with the University of Houston. Payne, Esse, Qian, Serna, Villarreal, and Becho-Dominguez are employees of CareAllies. Mohan and Abughosh are employed by the University of Houston College of Pharmacy. Abughosh reports grants from Valeant and Regeneron/Sanofi, unrelated to this work. Vadhariya has nothing to disclose. This research was presented virtually at the AMCP Pharmacist Virtual Learning Days event, April 2020, as well as the American College of Clinical Pharmacy Virtual Poster Symposium, May 26-27, 2020.

Tailored texting interventions for smoking cessation are increasingly popular given the ubiquitousness of smart phones. Because high development costs and limited expertise may pose substantial barriers to designing and implementing these programs at the local level, utilization of existing programs at the national level is a promising strategy. In 2011, Austin Public Health focused on promoting smoking cessation among Austin/Travis County residents. Their strategy involved marketing and linking their citizens to a federally-funded, evidence-based smoking cessation program via texting. The target audience was low income, 18-24 year olds. Their marketing strategies included radio ads, digital ads, social media ads, and direct outreach at events in Austin, Texas. During the period between April 2016 and July 2017, 1,022 people signed up for the program. The quit rate was comparable to other texting programs which were tailored at the local level, and the program was cost-effective, costing $12,704.56 per life-year added, averting $99.38 per person in medical costs, discounted at 3%., (Copyright © 2020 Brown, Patel, Seidel, LeMaistre and Wilson.)

Flavanols have beneficial effects on vascular health and we have recently demonstrated that cerebral vasodilatory capacity in healthy young African Americans (AA) is improved with acute flavanol intake relative to aged-matched Caucasian Americans (CA). However, whether the positive benefits of acute flavanol consumption would also be present in the cutaneous microvascular circulation of AA remains unknown. Thus, we hypothesized that acute consumption of flavanol-rich cocoa (FC) would improve the previously reported reduced cutaneous microvascular responses to local heating in young AA. Seven AA and seven CA participated in this double-blind crossover study. Data were collected on two different days, separated by a minimum of one week. Two intradermal microdialysis membranes were inserted in the forearm and each site was randomly assigned to receive lactated Ringer's solution or NO synthase (NOS) inhibitor. Participants were randomly assigned to consume either a non-flavanol containing (NF) beverage or FC beverage. Cutaneous vascular conductance (CVC) was calculated as cutaneous blood flux/mean arterial pressure and normalized as % maximal CVC (%CVCmax). The difference in %CVCmax between the Ringer's site and NOS inhibited site was calculated to assess NO contribution (Δ %CVCmax). In the Ringer's site, acute consumption of FC beverage improved %CVCmax during 39 °C heating when compared to NF beverage in AA (NF: 36 ± 6 vs. FC: 47 ± 5%CVCmax; P < .01) while there was similar %CVCmax during 39 °C heating between beverages in CA (NF: 55 ± 4 vs. FC: 59 ± 5%CVCmax; P = .40). During 39 °C heating, NO contribution was significantly higher with FC beverage than NF beverage in AA (NF: 27 ± 5 vs. FC: 35 ± 4 Δ %CVCmax; P = .03) while there was similar NO contribution between beverages in CA (NF: 42 ± 4 vs. FC: 45 ± 4 Δ %CVCmax; P = .36). This data suggests that acute consumption of FC could be a therapeutic solution to improve an attenuated microvascular function in young AA., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Background: Sepsis is a leading cause of hospitalization, and subsequent readmissions are frequent and costly. There is an expanding body of literature describing risk factors for readmissions in patients with sepsis. However, there are little data studying medically underserved patients who typically receive their care at a safety net hospital., Methods: In a retrospective cohort study, we evaluated 1355 sepsis survivors at risk of hospital readmission in fiscal year 2013 at a safety net hospital. We described patient characteristics during their initial and readmission hospitalizations and analyzed risk factors associated with 30-day readmission., Results: The 30-day readmission rate among sepsis survivors was 22.6%. Comorbid conditions associated with readmissions included end-stage renal disease (odds ratio [OR], 1.26; 95% confidence interval [CI], 1.17-1.36), malignancy (OR, 1.14; 95% CI, 1.08-1.21), and cirrhosis (OR, 1.11; 95% CI, 1.02-1.20). Bacteremia during the initial hospitalization (OR, 1.07; 95% CI, 1.01-1.15) and being discharged with a vascular catheter (OR, 1.10; 95% CI, 1.01-1.20) were associated with readmission. Less severe sepsis during the initial hospitalization was associated with a reduced risk of 30-day readmission (OR, 0.91; 95% CI, 0.87-0.94)., Conclusions: At a safety net hospital, patients who survived their initial sepsis hospitalization had a 30-day readmission rate to our institution of 22.6% that is comparable to rates described in prior studies. Readmission was commonly due to infection. Factors associated with readmission included multiple comorbid medical conditions, bacteremia, and being discharged with a vascular catheter. Further studies in this population are needed to determine potential modifiability of these risk factors in an attempt to reduce sepsis readmissions.

Over the past century, the environment of the Gulf of Mexico has been significantly altered and impaired by extensive human activities. A national commitment to restore the Gulf was finally initiated in response to the unprecedented Deepwater Horizon oil spill in 2010. Consequently, there is a critical need for an assessment framework and associated set of indicators that can characterize the health and sustainability of an ecosystem having the scale and complexity of the Gulf. The assessment framework presented here was developed as an integration of previous ecological risk- and environmental management-based frameworks for assessing ecosystem health. It was designed to identify the natural and anthropogenic drivers, pressures, and stressors impinging on ecosystems and ecosystem services, and the ecological conditions that result, manifested as effects on valued ecosystem components. Four types of societal and ecological responses are identified: reduction of pressures and stressors, remediation of existing stressors, active ecosystem restoration, and natural ecological recovery. From this conceptual framework are derived the specific indicators to characterize ecological condition and progress toward achieving defined ecological health and sustainability goals. Additionally, the framework incorporates a hierarchical structure to communicate results to a diversity of audiences, from research scientists to environmental managers and decision makers, with the level of detail or aggregation appropriate for each targeted audience. Two proof-of-concept studies were conducted to test this integrated assessment and decision framework, a prototype Texas Coastal Ecosystems Report Card, and a pilot study on enhancing rookery islands in the Mission-Aransas Reserve, Texas, USA. This Drivers-Pressures-Stressors-Condition-Responses (DPSCR 4 ) conceptual framework is a comprehensive conceptual model of the coupled human-ecological system. Much like its predecessor, the ecological risk assessment framework, the DPSCR 4 conceptual framework can be tailored to different scales of complexity, different ecosystem types with different stress regimes, and different environmental settings. Integr Environ Assess Manag 2019;15:544-564. © 2019 The Authors. Integrated Environmental Assessment and Management published by Wiley Periodicals, Inc. on behalf of Society of Environmental Toxicology & Chemistry (SETAC)., (© 2019 The Authors. Integrated Environmental Assessment and Management published by Wiley Periodicals, Inc. on behalf of Society of Environmental Toxicology & Chemistry (SETAC).)

Introduction: The purpose of this pilot study was to assess the effectiveness of the revised My Body Knows When (MBKW) program to promote intuitive eating behaviors within a sample of a military population through an online or in-person delivery mode., Materials and Methods: Fifty-six overweight or obese adults (70% female); military service members (20%), retirees (38%) and family (42%) participated in the 10-week MBKW program at two military installations from 2012 to 2014. Body Mass Index, Intuitive Eating Scale-2 (IES-2; 23-item) and Motivation for Eating scale (MFES; 43-item) were collected at baseline and 10-weeks. Data were stratified by sex. Descriptive data were reported as mean ± standard deviation (SD), frequency, or percentage. A paired t-test was conducted with data at baseline and 10 weeks (α = 0.05, 80% power)., Results: Participants were predominantly female (70%); mean age of 51 ± 13 years; and BMI of 34.1 ± 5.5 kg/m2. There were no demographic, MFES, or IES-2 baseline differences between groups (in-person vs. online) or location. All subjects were collapsed into one group for a pre-post MBKW implementation assessment due to small sample size despite the original intent to stratify by online and in-person grouping. At 10 weeks, the remaining 26 participants exhibited a significant improvement (mean ± SD) in BMI (-0.4 ± 0.6 kg/m2; p = 0.012), environmental/social eating score (2.7 ± 0.4 points [pts]; -0.5 pt change; p < 0.001), emotional eating score (2.2 ± 0.5 pts; -0.6 pt change; p = 0.001), unconditional permission to eat score (3.4 ± 0.4 pts; +0.3 pt change; p = 0.017), eating for physical rather than emotional eating score (3.7 ± 0.8 pts; +1.0 pt change; p < 0.001), and reliance on hunger and satiety cues score (3.6 ± 0.5 pts; +0.8 pt change; p = 0.001). High attrition rates at the 10-week follow-up assessment precluded accurate assessment of long-term intervention effects., Conclusions: The MBKW program was associated with improved intuitive eating behaviors and with less external eating influence on behavior; however, a larger sample is required to assess the effectiveness of MBKW delivery mode. Modest weight loss was attained but testing the efficacy of the MBKW program in a large diverse sample with alternate scenarios may be worthwhile (e.g., primary prevention against weight gain, or during weight maintenance to prevent weight regain)., (Published by Oxford University Press on behalf of the Association of Military Surgeons of the United States 2019.)

Type 2 diabetes (T2D) is a prevalent risk factor for tuberculosis (TB), but most studies on TB-T2D have focused on TB patients, been limited to one community, and shown a variable impact of T2D on TB risk or treatment outcomes. We conducted a cross-sectional assessment of sociodemographic and metabolic factors in adult TB contacts with T2D (versus no T2D), from the Texas-Mexico border to study Hispanics, and in Cape Town to study South African Coloured ethnicities. The prevalence of T2D was 30.2% in Texas-Mexico and 17.4% in South Africa, with new diagnosis in 34.4% and 43.9%, respectively. Contacts with T2D differed between ethnicities, with higher smoking, hormonal contraceptive use and cholesterol levels in South Africa, and higher obesity in Texas-Mexico (p < 0.05). PCA analysis revealed striking differences between ethnicities in the relationships between factors defining T2D and dyslipidemias. Our findings suggest that screening for new T2D in adult TB contacts is effective to identify new T2D patients at risk for TB. Furthermore, studies aimed at predicting individual TB risk in T2D patients, should take into account the heterogeneity in dyslipidemias that are likely to modify the estimates of TB risk or adverse treatment outcomes that are generally attributed to T2D alone., (Copyright © 2018 The Authors. Published by Elsevier Ltd.. All rights reserved.)

This paper describes the expanded English/Spanish version of the Management Information and Decision Support Epilepsy Tool (MINDSET) as well as the methods and findings from a feasibility study conducted from July 2016 through February 2017 with 43 Spanish and English-speaking Hispanic people living with epilepsy (PWE) in Arizona (n = 23) and Texas (n = 20) over two consecutive regular clinic visits. The expansion of MINDSET added goal setting and strategy selection to improve self-management (S-M) in PWE. The previous study tested the feasibility of English MINDSET, which was designed to facilitate the identification and discussion of S-M issues between the patient and healthcare provider (HCP) during a regular clinic visit. Results indicate MINDSET feasibility for use in the following: 1) identifying S-M issues across several domains; 2) selecting and assessing confidence in tailored S-M goals/strategies for improvement; 3) discussing S-M issues/goals/strategies/confidence with a HCP; and 4) creating an action plan (AP) and tracking achievement during regular clinic visits. Across two visits, 80-90% of patients agreed that the revised version of MINDSET was helpful, understandable, trustworthy, promoted careful thinking about management, was of appropriate duration, and would be helpful in future management and communication with HCP. Participating HCPs agreed that MINDSET improved the ease, thoroughness, and accuracy in identifying patient S-M issues and establishing a plan for improvement., (Copyright © 2018 Elsevier Inc. All rights reserved.)

It has been established that endothelial function in conduit vessels is reduced in young African Americans (AA) relative to Caucasian Americans (CA). However, less is known regarding endothelial function in microvasculature of young AA. We hypothesized that microvascular function in response to local heating of skin is attenuated in young AA relative to age-matched CA due largely to the lack of NO bioavailability, which is in turn improved by intradermal l-arginine supplementation and/or inhibition of arginase. Nine AA and nine CA adults participated in this study. Participants were instrumented with four microdialysis membranes in the cutaneous vasculature of one forearm and were randomly assigned to receive 1) lactated Ringer's solution as a control site; 2) 20 mM NG-nitro-l-arginine (l-NAME) to inhibit NO synthase activity; 3) 10 mM l-arginine to local supplement l-arginine; or 4) a combination of 5.0 mM (S)-(2‑boronoethyl)-l-cysteine-HCL (BEC) and 5.0 mM Nω-hydroxy-nor-l-arginine (nor-NOHA) at a rate of 2.0 μl/min to locally inhibit arginase activity. Cutaneous vascular conductance (CVC) was calculated as red blood cell flux divided by mean arterial pressure. All CVC data were presented as a percentage of maximal CVC (%CVCmax) that was determined by maximal cutaneous vasodilation induced by 44 °C heating plus sodium nitroprusside administration. The response during the 42 °C local heating plateau was blunted in the AA at the control site (CA: 84 ± 12 vs. AA: 62 ± 6 vs. %CVCmax; P < 0.001). This response was improved in AA at the l-arginine site (Control: 62 ± 6 vs. l-arginine: 70 ± 18%CVCmax; P < 0.05) but not in the arginase inhibited site (Control: 62 ± 6 vs. Arginase inhibited: 62 ± 13%CVCmax; P = 0.91). In addition, the AA group had an attenuated NO contribution to the plateau phase during 42 °C local heating relative to the CA group (CA: 56 ± 14 vs. AA: 44 ± 6 Δ %CVCmax; P < 0.001). These findings suggest that 1) cutaneous microvascular function in response to local heating is blunted in young AA when compared to age-matched young CA; 2) this attenuated response is partly related to decrease in NO bioavailability in young AA; and 3) a local infusion of l-arginine, but not arginase inhibition, improves cutaneous microvascular responses to local heating in young AA relative to CA., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Using a Decision-Making Ecology (DME) approach and proportional hazards models, the study isolated four case factor profiles that interacted strongly with race and resulted in disparate reunification outcomes for African American children compared with Anglos. The four interrelated factors were drug involvement, a solo infant case, single mothers, and relative placements. A cohort of 21,763 children from the Texas Department of Family and Protective Services who were placed for the first time in care, who were under 13 and either Anglo or African American were followed for 20 months or more post entry into care. Starting with an initial model consisting of main effects only and consistent with other studies, African American children had a 12% lower hazard rate of reunification compared to Anglo children. However, when a set of case profiles involving combinations of single parents, single infants, drug involvements and kinship placements were crossed with race, the magnitude of the effect of race on hazard rates fanned out from no difference to as much as 68% that of Anglo children. The results show that racial disparities in outcomes resulting from complex, contextual decision making cannot be modeled well with simple main effects models., (Copyright © 2015 Elsevier Ltd. All rights reserved.)

Purpose: To determine the association between youth sport team participation and dietary behaviors among elementary school-aged children., Design: Cross-sectional survey., Setting: Public schools in Texas during 2009-2010., Subjects: A total of 5035 ethnically diverse fourth graders., Measures: Participation in organized sports teams, consumption of select food items (fruits, vegetables, beverages, sweets/snacks)., Analysis: Multiple logistic regression was used to assess the association between each food item (eaten at least once on the previous day) and number of sports teams as the independent class variable (0, 1 ,2, ≥3), adjusting for body mass index physical activity, socioeconomic status, and ethnicity., Results: Significant dose-response associations were observed between number of sports teams and consumption of fruits and vegetables. For boys, the likelihood of eating fruit and fruit-flavored drinks was significantly higher and the odds of drinking soda were lower with the number of teams. For girls, the likelihood of consuming green vegetables increased as sports teams participation increased, and participation was positively associated with diet soda consumption. A positive association was observed between the number of sports teams and scores on the Healthy Food Index for boys and girls., Conclusion: The findings that sports participation is associated with consumption of fruits and vegetables and lower consumption of soda suggest that efforts should be focused on supporting youth team sports to promote healthier food choices. Since sports are available to all ages, sports may be an important venue for promoting healthier dietary behaviors.

Background: In 2012, the United States experienced one of its worst West Nile virus (WNV) epidemics, reporting 5,387 human cases and final death toll of 243. Texas was at the epicenter of the outbreak, with 1,875 reported cases and 89 deaths that year. The Texas outbreak centered mainly in the Dallas-Fort Worth area where 30 deaths were reported. We report three cases of severe WNV infection complicated by meningoencephalitis in our organ transplant population., Methods: Clinical data were collected from chart review. Therapy and outcomes on three identified patients were reviewed and compared with previously reported cases of WNV infection in kidney/pancreas transplant recipients and the general population., Results: Two recipients of kidney and one recipient of a combined kidney and pancreas transplant were treated at our center for WNV infection. All three patients presented with a rapid decline in mental status within 24 hours of admission consistent with meningoencephalitis. Diagnosis was made based on detection of WNV IgM in the serum. All patients received intravenous immunoglobulin (IVIG) therapy at 400 mg/kg × 3 to 4 doses. As a result, two patients had a full recovery, and one patient died., Conclusion: Transplant recipients have a higher risk of neurologic complications from WNV infection. In areas where WNV is endemic, clinicians must have a high index of suspicion when treating patients presenting with fever, headache, and confusion. Full recovery in two of three patients suggests a potential role of IVIG therapy in controlling active WNV infection, particularly in immunosuppressed patients.

To describe gestational weight gain among Hispanic women and to examine psychological, social, and cultural contexts affecting weight gain. A total of 282 Hispanic women were surveyed post-partum before leaving the hospital. Women were queried about their prepregnancy weight and weight gained during pregnancy. Adequacy of gestational weight gain was based on guidelines set by the Institute of Medicine in 2009. Independent risk factors for excessive or insufficient weight gain were examined by logistic regression. Most women were unmarried (59 %), with a mean age of 28.4 ± 6.6 years and an average weight gain of 27.9 ± 13.3 lbs. Approximately 45 % of women had gained too much, 32 % too little, and only 24 % had an adequate amount of weight gain. The mean birth weight was 7.3, 7.9, and 6.8 lbs among the adequate, excessive, and insufficient weight gain groups. Among women who exercised before pregnancy, two-thirds continued to do so during pregnancy; the mean gestational weight gain of those who continued was lower than those who stopped (26.8 vs. 31.4 lbs, p = 0.04). Independent risk factors for excessive weight gain were being unmarried, U.S. born, higher prepregnancy body mass index, and having indifferent or negative views about weight gain. Independent risk factors for insufficient weight gain were low levels of support and late initiation of prenatal care. Depression, stress, and a woman's or her partner's happiness regarding pregnancy were unrelated to weight gain. The results of this study can be used by prenatal programs to identify Hispanic women at risk for excessive or insufficient gestational weight gain.

Objective: To compare patients' complementary and alternative medicine (CAM) use and physicians' familiarity with certain CAM modalities in the same setting and to assess patient-provider dialogue about patients' CAM use., Methods: An observational survey study with convenience sampling at ambulatory family medicine clinics in two Texas cities. A total of 69 healthcare providers and 468 patients completed the surveys. Patients' surveys assessed use of 27 CAM therapies, perception of CAM use and interaction with providers. Providers' survey assessed perception and attitude toward CAM use., Results: CAM modalities most used by the patients are not those modalities that providers best understood. Of the 330 patients (70%) who responded to the relevant questions about discussing CAM, 44.5% reported never having discussed CAM use with their providers. Binomial logistic regression revealed no link between age, gender or ethnicity for discussing CAM with providers. College-educated patients (adjust OR=2.8, 95%CI=1.3-6.0) and US citizens were both about three times more likely to discuss CAM than their counterparts., Conclusion: Lack of knowledge and unfamiliarity with CAM modalities might prevent important patient-provider discussions., Practice Implications: Providers should use existing resources and encourage a bilateral dialogue that involves transferring of information and assisting patients in decisions making about CAM use and health care., (Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.)

Background: South Dallas experiences significant disparities in breast cancer mortality, with a high proportion of stage III and IV diagnoses. To address these rates, the Dallas Cancer Disparities Community Research Coalition created an educational intervention to promote breast health and early detection efforts., Objectives: The goals of the intervention were to increase (a) knowledge regarding the chief contributing factors for breast cancer, (b) awareness of the importance of screening for early detection, and (c) the proportion of women who have engaged in appropriate breast cancer screening practices., Methods: Eligibility criteria for this nonrandomized, controlled trial included women age 40 and older, English-speaking, and having no personal history of cancer. Control participants received written breast health educational materials. Intervention participants attended 8 weekly sessions that included interactive educational materials, cooking demonstrations, and discussions emphasizing primary and secondary breast cancer prevention. All study participants completed a 1-hour survey at baseline and 4 months later., Results: There were 59 women were enrolled in the intervention and 60 in the control group. At follow-up, after controlling for baseline mammography status, women in the intervention group were 10.4 times more likely (95% confidence interval [CI], 2.9-36.4) to have received a screening mammogram in the last year compared with the control group. Intervention participants demonstrated statistically significantly higher rates of breast self-examination (odds ratio [OR], 3.0; 95% CI, 1.0-8.6) and breast cancer knowledge (p=.003)., Conclusion: Lessons learned from this community-based participatory research (CBPR) study can be used to create sustainable cancer disparity reduction models that can be replicated in similar communities.

Premise of the Study: Climate change and shifts in land use are two major threats to biodiversity and are likely to disproportionately impact narrow endemics. Understanding their origins and the extent of their genetic diversity will enable land managers to better conserve these unique, highly localized gene pools. Viola guadalupensis is a narrow endemic of the Guadalupe Mountains (west Texas, USA). Its affinities within Viola section Chamaemelanium have been the subject of some debate. Furthermore, the polyploid and presumably reticulate relationships within this section remain largely unknown., Methods: We counted chromosomes for V. guadalupensis. Phylogenies for the chloroplast trnL-F region and the low-copy nuclear gene GPI for 24 Viola taxa were generated and used to produce a polyploid phylogenetic network. Divergence dates were obtained by fossil calibration., Key Results: Meiotic chromosome counts revealed that V. guadalupensis is tetraploid (n = 12), and the presence of two GPI homoeologs further suggested allotetraploidy. Phylogenetic reconstructions showed that it originated through hybridization between unidentified members of subsection Canadenses (paternal parent) and subsection Nuttallianae (maternal parent). A fossil-calibrated relaxed clock dating analysis of GPI estimated the maximum age of V. guadalupensis to be 8.6 (5.7-11.6) Myr, suggesting the species evolved after the Guadalupe Mountains formed 12-13 Ma., Conclusions: Viola guadalupensis originated by intersubsectional hybridization followed by polyploidization. Within section Chamaemelanium, this phenomenon has occurred repeatedly in the last 9 Myr (at least for V. bakeri, V. douglasii, V. glabella, and V. sempervirens). Consequences for the systematics of the section are discussed.

Objective: To assess the impact of community pharmacists on clinical outcomes in Hispanic patients with type 2 diabetes., Methods: 126 patients were enrolled in this longitudinal pre/post cohort study that took place in nine community and four workplace pharmacies in San Antonio, TX. Pharmacists provided education, point-of-care testing for glycemic and metabolic parameters, clinical assessment, goal setting, and drug therapy management with physicians. Study outcomes were changes in glycosylated hemoglobin (A1C) and accompanying metabolic parameters (blood pressure, lipid parameters, and body mass index) during a 1-year time frame., Results: In the overall cohort, A1C was not reduced significantly from baseline to 12 months (7.8% vs. 7.6%, P = 0.516). However, statistically significant reductions occurred for fasting plasma glucose, triglycerides, and diastolic blood pressure. None of the other parameters was affected significantly. In the subgroup of patients not at target values at baseline, significant reductions occurred for A1C (9.2% vs. 8.6%, P = 0.001), systolic blood pressure (147 vs. 143 mm Hg, P = 0.031), diastolic blood pressure (91 vs. 87 mm Hg, P < 0.001), triglycerides (259 vs. 219 mg/dL, P < 0.001), LDL cholesterol (139 vs. 123 mg/dL, P < 0.001), and total cholesterol (237 vs. 222 mg/dL, P = 0.008)., Conclusion: Interventions performed by community pharmacists are effective in improving clinical outcomes in a Hispanic cohort with diabetes. Pharmacists' efforts were most successful in patients not at target glycemic and metabolic levels.

Because of the nursing shortage and a demand for maximum enrollment, a group of five baccalaureate and seven associate degree nursing programs in West Texas first met in 2007 to form the West Texas Nursing Education Consortium (WTNEC). To emphasize the importance of scale and distance, the West Texas region is larger than all of the northeastern states combined. The founding group agreed that the first mission of WTNEC should be to pool resources in order to increase admission and graduation rates for WTNEC schools. Two years later, this mission is being accomplished by the implementation of a plan designed to increase participating schools' admissions, retention, and graduation rates. A grant proposal was written and funded to develop a central regionalization of the application process for entry into WTNEC generic programs (associates degree in nursing and bachelor of science in nursing), with the goal of decreasing and possibly eliminating student vacancy rates in member schools and perhaps reducing the resources needed by each school for the admission process. The implemented centralized application system allowed prospective students to apply online to the centralized admission portal. Students maintained the freedom to choose the nursing program(s) they wanted to attend, but they were also made aware of possible openings in other participating schools. The admission portal also saved potential students time and money by submitting one centralized application, resulting in consolidation of the nursing school application process. Eleven of the 12 consortium schools participated in the centralized application system., (2011 Elsevier Inc. All rights reserved.)

Examinations of heavy drinking and dating violence have typically focused on either female victimization or male perpetration; yet recent findings indicate that mutual aggression is the most common pattern of dating violence. The current study investigated the relation between heavy drinking and dating violence for both men and women. Participants (N=2247) completed surveys that assessed their heavy drinking and dating violence frequency across the first three years of college. Findings indicated that heavy drinking and dating violence were both relatively stable across time for men and women, but the relation between heavy drinking and dating violence differed by gender. For men, heavy drinking and dating violence were concurrently associated during their freshman year (Year 1), whereas for women heavy drinking during their sophomore year (Year 2) predicted dating violence in their junior year (Year 3). In addition to providing educational material on healthy relationships and conflict resolution techniques, intervention efforts should target both heavy drinking and dating violence for men during or prior to their freshman year of college, whereas women may primarily benefit from efforts to reduce their heavy drinking., (Copyright (c) 2010 Elsevier Ltd. All rights reserved.)

While the promise and enthusiasm for regional health information organizations (RHIOs) are immense, a significant issue regarding this type of health information exchange, (HIE) remains unclear: financial sustainability. As of today, there is a clear lack of concrete business models implemented in RHIOs' projects. The purpose of this study is to conduct a literature review of the current state of RHIOs adaptation and implementation of business models for successful financial sustainability, as well as evaluate existing RHIOs financial situation to determine and recommend best models for economic uphold. This literature review will be the starting point for thorough analysis and understanding of the economic factors required for RHIOs to generate a return on investment (ROI) and become self-sustainable.

A national approach to medical care for the uninsured is for the provision of primary and preventive care through Community Health Centers. Access to specialty care for both Medicaid and uninsured patients is in decline even though specialty care has been shown to be cost-effective and improve outcomes. The consequences could result in further deterioration of the health of the uninsured and underinsured populations and increasing costs born by the insured and safety net providers. Telemedicine can provide specialty services efficiently if planned with a business model to sustain the program. This paper outlines a pilot framework to plan and cost-justify telemedicine specialty care for the uninsured and marginally insured. This potential framework is supported by data from an urban community with the highest concentration of uninsured in the country: Houston, Texas. Further study and evaluation will be needed once the framework and tools are implemented to empirically prove the sustainability of telemedicine specialty care for the urban uninsured.

The transition from high school to college is an important developmental milestone that holds the potential for personal growth and behavioral change. A cohort of 2,245 students was recruited during the summer before they matriculated into college and completed Internet-based surveys about their participation in a variety of behavioral risks during the last 3 months of high school and throughout the 1st year of college. Alcohol use, marijuana use, and sex with multiple partners increased during the transition from high school to college, whereas driving after drinking, aggression, and property crimes decreased. Those from rural high schools and those who elected to live in private dormitories in college were at highest risk for heavy drinking and driving after drinking.

Unintended pregnancy among military women influences their lives and has implications for troop readiness and deployment. The purpose of this study was to identify the prevalence of unintended pregnancy in the US Army and assess the variables associated with unintended pregnancy. Using a cross-sectional design, 212 female soldiers who delivered viable infants at Darnall Army Community Hospital, Fort Hood, Texas from 1 June 1998 to 6 October 1998 completed a self-administered survey on pregnancy intention and sociodemographic factors. Approximately 35% of the infants were intended, 51% were unintended and 14% were ambivalent, resulting in 65% not intended, a rate consistent with the upper level of civilian communities. Factors associated univariably with unintended pregnancy included being unmarried, being in the lower enlisted rank, having less than a college degree, and living in the barracks. This study shows the importance of developing programmes and policies that address pregnancy among military personnel.

Objectives: To determine pharmacist awareness of medication therapy management (MTM), confidence in and intentions to provide MTM, related training needs, and barriers to MTM provision; and to assess pharmacist and practice site characteristics that are related to confidence in providing MTM., Design: Nonexperimental cross-sectional study., Setting: May 2006 in Texas., Participants: 1,833 Texas community pharmacists who were affiliated with the Texas Pharmacy Association., Intervention: an anonymous, self-administered online survey was e-mailed to participants., Main Outcome Measures: Awareness of MTM legislation, confidence in providing MTM, intentions to provide MTM, and barriers to MTM provision. Pharmacist and practice site characteristics were also collected., Results: The response rate was 11.8% (n = 157). Overall, pharmacists (>75%) were aware of the three criteria for targeted beneficiaries. They were confident in providing medication therapy review (MTR), creating a personal medication record (PMR), and performing intervention and referral but were only somewhat confident in creating a medication action plan. Pharmacists disagreed or were neutral about having adequate documentation systems for MTM. The majority of respondents intend to become MTM providers (74%) and were interested in additional training (78%). Independent pharmacists, those with adequate documentation systems, and those who had previously provided patient care services were more confident regarding MTM provision., Conclusion: Pharmacist intentions to provide MTM indicate that they are eager to expand their roles as patient care providers. Pharmacist confidence in providing MTR, creating a PMR, and performing the intervention and referral suggest that pharmacists already have many of the skills necessary to provide MTM; however, more education about creating action plans and using documentation systems may help pharmacists become successful MTM providers.

Studies have found that certain racial groups, particularly the children of African American families, are placed in foster care at a higher rate than children of other races. These families are also sometimes found to be afforded fewer services that might prevent these removals, relative to families of other races. It is unclear why this is so. Poverty has been suspected, and sometimes found, to be the primary cause of the disparity. Lacking in some of these analyses, however, was how risk of future abuse/neglect to the child entered into the decisions and particularly, how assumptions about race, poverty, and risk are factored into the decision-making process. It is important to understand this process if we are to find a way to correct it. The current study addresses this process.

Heavy alcohol consumption has been associated with collegiate sporting events, but little is known about specific levels of consumption over the course of an entire sports season. Ongoing web-based daily monitoring at the University of Texas at Austin allowed assessment of drinking levels of students (n=541) over two full football seasons. High-profile football game days were among the heaviest days for alcohol consumption, comparable to consumption on other well-known drinking days such as New Years Eve and Halloween weekend. Men increased their drinking for all games, and women with greater social involvement were more likely to drink heavily during away games. Among lighter drinkers, away games were associated with a greater likelihood of behavioral risks as intoxication increased.

Perceived awareness and caring, or beliefs about how much parents and peers know and care about students' behavior, was assessed in relation to students' drinking patterns. Prior to and at the end of the first semester at college, participants completed Web-based surveys assessing alcohol use, family and social motives, and perceived awareness and caring from parents and peers. Family motives moderated the effect of perceived parental awareness and caring on the quantity of high school alcohol use, whereas social motives moderated the effect of perceived peer awareness and caring on frequency and quantity of college drinking. Longitudinally, college alcohol use was predicted by perceived awareness and caring from parents. Perceived awareness and caring may affect alcohol use whereby parents exert influence during high school but peers are more influential in college.

A survey of 152 methicillin-resistant Staphylococcus aureus (MRSA) strains from medical centers in Las Cruces, NM, and El Paso, TX, revealed the presence of spa types 2 and 24 (clone USA100) and spa type 1 (clone USA300-0114). Las Cruces MRSA displayed relatively high vancomycin MICs, and one hetero-vancomycin-intermediate S. aureus strain was identified.

The purpose of this article is to share authors' experiences associated with the Transforming Care at the Bedside initiative, a national program funded by the Robert Woods Johnson Foundation with direction and technical assistance provided by the Institute for Healthcare Improvement. The article discusses the innovation process and the change cycles, impact of various innovations, and lessons learned.

As society becomes increasingly globalized, it is imperative to include international educational perspectives in the nursing profession. This article shares experiences of a university and hospital in facilitating education of students of nursing from India. It includes implementing partnerships, student selection process, and transcultural considerations. These considerations include faculty preparation for receiving students from India. In addition, ways to prepare Indian and U.S. students are examined.

The Texas Department of Health and University of Texas Southwestern staff, using formative assessment data, developed a set of innovative methods and tools to increase the use of behavioral and epidemiologic data in decision-making about HIV prevention interventions by HIV prevention community planning groups (CPGs) and HIV prevention providers. Semistructured interviews, mail surveys, meeting observations, and content analysis of funding proposals were used to measure the results of the multifaceted intervention. Compared to baseline measures, CPG members reported that data played a more central and desired role in their decision-making. HIV prevention providers exposed to the project's materials were more likely to choose evidence-based interventions to conduct. The tools and structural intervention methods of this project were diffused and had an impact on the use of behavioral data by community planning groups and HIV prevention providers. The structural interventions were not sufficient without the additional effect of the trained peers acting as advocates and intervention innovators.

A formative assessment was conducted with Texas HIV prevention community planning group (CPG) members, prevention provider staff, and supervisors of those staff to better understand how to enhance their use of epidemiologic and behavioral data in the selection and prioritization of prevention interventions. Semi-structured interviews, mail surveys, and content analysis of funding proposals were used to determine the current use of these data, their perceived value, and the most trusted sources for data. CPG members, prevention provider staff, and supervisors valued information from their peers and networking most, and made more use of socially available information than they did research or systematically collected assessment data. CPG members wanted more local data and data on specific sub-populations of interest. Prevention providers viewed the utility of behavioral data as limited, and were primarily concerned with the pragmatic aspects of fielding interventions; however, this group also expressed an interest in rapid community assessment methods and learning more about new and effective prevention interventions. These results led to the development of training and technical assistance materials.

HIV prevention community planning was developed to promote identification of local prevention priorities through a process that was evidence-based and provided community input. There are a variety of barriers to effective use of data in community planning which include characteristics of data (availability, timeliness, relevance to planning tasks), characteristics of planning group members and providers of data (e.g., skills in understanding and applying data), and social-organizational aspects of community-planning groups (CPGs). Lessons learned from this project illustrate how to create locally relevant sources of data, build data use skills of CPG members and data providers, and address social-organizational aspects of planning, while also better integrating community planning with implementation of prevention plans. Adaptation of tools and methods is discussed along with future considerations for research and planning practice.

Assessments of community planning in Massachusetts and Texas were used to develop tools for increasing the use of data by HIV prevention community planning groups (CPGs) and prevention providers while also increasing participation of CPG members. Barriers to data use included organizational problems in CPGs (e.g., lack of clear procedures, distrust of peers and leadership) and technical assistance needs for CPG members and researchers who provide data. The absence of data relevant to local epidemics was another barrier. Specific linkages are provided between the assessments of these needs and the development of a technical assistance tools (e.g., websites, templates for data presentation, experiential involvement in data use) and strategies for organizational change in CPGs, as well as efforts to better use available data and create or identify new sources of local data.

This article provides an overview of clinical data warehousing and its historical perspective from the early 1990s to present. It uses a survey of five Houston-area healthcare leaders to answer questions such as why commercially available solutions may be more suitable as their enterprise information systems vs. developing them in-house. Which products and vendors are servicing these organizations? What are these organizations looking for when making such strategic purchases? In general, this work is intended as a guideline for healthcare entities to further investigate the commercial clinical data warehousing market and get a feel for industry trends.

Objective: The purpose of this retrospective cohort study is to update mortality experience at refinery/petrochemical plant facilities in Baton Rouge, Louisiana, and Baytown, Texas., Methods: Standardized mortality ratios (SMRs) were calculated for 1970-1997 based on death rates in the respective states., Results: SMRs are near or below unity for most causes of death. Among elevations, Baton Rouge has an SMR of 2.42 (95% CI = 1.16-4.45) for chronic lymphocytic leukemia, 1.58 (95% CI = 1.17-2.08) for hypertension with heart disease, and 1.47 (95% CI = 0.98-2.11) for non-Hodgkin's lymphoma. Baytown has an SMR of 2.13 (95% CI = 1.10-3.73) for acute nonlymphocytic leukemia (ANLL) and 3.11 (95% CI = 1.01-7.26) for unspecified brain/spinal cord neoplasms. The above findings pertain to pre-1950 hires and exhibit no apparent job-related patterns. Both cohorts have approximately twofold increases in mesothelioma deaths, similar to the last update, with most decedents having held maintenance jobs., Conclusions: Periodic examination of mortality patterns has an important role in assessing overall employee health status and identifying potential areas of increased risk. Mortality surveillance will continue to monitor these outcomes among more recent workers.

Objective: The purpose of this study was to test the effects of varying the amount of physical practice and mental imagery rehearsal on learning basic surgical procedures., Study Design: Using a sample of 65 second-year medical students, 3 randomized groups received either: (1) 3 sessions of physical practice on suturing a pig's foot; (2) 2 sessions of physical practice and 1 session of mental imagery rehearsal; or (3) 1 session of physical practice and 2 sessions of imagery rehearsal. All participants then performed a surgery on a live rabbit in the operating theater of a veterinary college under approved conditions. Analysis of variance was applied to pre- and post-treatment ratings of surgical performance., Results: Physical practice followed by mental imagery rehearsal was statistically equal to additional physical practice., Conclusion: Initial physical practice followed by mental imagery rehearsal may be a cost-effective method of training medical students in learning basic surgical skills.

Object: Preoperative embolization is viewed by the authors as a useful adjunct in the surgical management of cerebral arteriovenous malformations (AVMs). This study was performed to determine the rate of significant complication in patients undergoing this procedure., Methods: Demographic, anatomical, and procedure data were collected prospectively. The treating physician reported complications. In addition, a review of medical records including procedure reports, operative reports, and discharge summaries was performed. Univariate statistical analysis was performed to determine if any of the variables was predictive of a poor outcome of embolization (death or permanent neurological deficit). Endovascular procedures for embolization were performed 339 times in 201 patients during an 11-year period. Female patients comprised 53.7% of the study group and 85.6% of the AVMs were supratentorial. Embolization was performed using polyvinyl alcohol particles, N-butyl cyanoacrylate, detachable coils, and/or the liquid polymer Onyx. Analyzed by procedure, a poor result of embolization occurred in 7.7%. Analyzed by patient, 11% died or had a permanent neurological deficit as a result of the embolization. None of the demographic, anatomical, or procedure variables identified were predictive of a poor outcome., Conclusions: Preoperative embolization may gradually reduce flow to an AVM, reduce intraoperative blood loss, and reduce operative time. The risks of this procedure, however, are not insignificant and must be considered in planning treatment for patients with AVMs.

Objective: A cost-effectiveness analysis was conducted to investigate the clinical and economic impact of teleophthalmology in evaluating diabetic retinopathy in prison inmates with type 2 diabetes., Research Design and Methods: Based on a hypothetical teleophthalmology system to evaluate diabetic retinopathy patients with type 2 diabetes in a prison care setting, a Markov decision model was developed with probability and cost data derived primarily from published epidemiological and outcome studies. A 40-year-old African-American man with type 2 diabetes was used as a reference case subject. The number of quality-adjusted life-years (QALYs) gained was used as the clinical outcome, and the cost in U.S. dollars from the year 2003 was used as the economic outcome. Teleophthalmology and nonteleophthalmology strategies were compared using an expected QALYs calculation and two types of sensitivity analyses: probabilistic and traditional n-way sensitivity analyses., Results: The teleophthalmology strategy dominates in the cost-effectiveness analysis for the reference case subject: 16,514/18.73 dollars QALYs for teleophthalmology and 17,590/18.58 dollars QALYs for nonteleophthalmology. Ninety percent of the Monte Carlo simulations showed cost effectiveness (annual cost/QALYs < or = 50,000 dollars) in the teleophthalmology strategy based on an assumed inmate population. Teleophthalmology is the better strategy if the number of diabetic inmates in the prison community is >500., Conclusions: Our cost-effectiveness analysis demonstrates that teleophthalmology holds great promise to reduce the cost of inmate care and reduce blindness caused by diabetic retinopathy in type 2 diabetic patients.