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Financial exploitation (FE) is one of the most common reports to Adult Protective Services (APS) and the cases are often complex. Consequently, APS caseworkers report FE investigations to be among the most difficult while simultaneously reporting low confidence in productive outcomes for these investigations. This necessitates finding ways to support APS FE investigations. This paper describes the structure, process, and formative findings of a collaboration between forensic accounting examiners and APS workers to investigate complex cases of FE. Among the 77 FE cases completed, forensic examiners reviewed multiple years of financial records which included over 101,000 transactions, totaling over $213,000,000.00 in finances, and identified over $8,000,000 in questionable activity. Scores on the 8-item Client Satisfaction Questionnaire were high indicating high program satisfaction by APS workers, subject matter experts, and forensic examiners. These findings support the feasibility and acceptability of forensic accounting and APS collaborations to investigate complex cases of FE. [ABSTRACT FROM AUTHOR]

This study examines semantic development in 60 Spanish-English bilingual children, ages 7 years 3 months to 9 years 11 months, who differed orthogonally in age (younger, older) and language experience (higher English experience [HEE], higher Spanish experience [HSE]). Children produced 3 associations to 12 pairs of translation equivalents. Older children produced more semantic responses and code switched more often from Spanish to English than younger children. Within each group, children demonstrated better performance in the more frequently used than the less used language. The HEE children outperformed the HSE children in English and the HSE children outperformed the HEE children in Spanish. These effects of age and language experience are consistent with predictions of the revised hierarchical model of bilingual lexical organization. (Contains 4 tables and 3 figures.)

Purpose: This study documents the risk for language impairment in Latino children who had different levels of exposure to English and Spanish. Method: A total of 1,029 preschool- and kindergarten-age children were screened in the domains of semantics and morphosyntax in both Spanish and English. Parent report was used to document current exposure to and use of Spanish and English, as well as year of first exposure to English. Risk for language impairment was compared for language group, year of first English exposure, age, and mother's education. Results: While bilingual children's scores on each subtest were significantly lower compared to their functional monolingual peers, they were no more likely to fall in the at-risk range based on a combination of all 4 subtests. Maternal education and year of first English exposure were weakly associated with risk for language impairment but not with language group (via 5 levels of first and second language exposure). Conclusions: Prevalence of risk for language impairment when both languages are tested is not related to language group. (Contains 5 tables and 1 figure.)

Background: Nonword repetition (NWR) involves the ability to perceive, store, recall and reproduce phonological sequences. These same abilities play a role in word and morpheme learning. Cross-linguistic studies of performance on NWR tasks, word learning, and morpheme learning yield patterns of increased performance on all three tasks as a function of age and language experience. These results are consistent with the idea that there may be universal information-processing mechanisms supporting language learning. Because bilingual children's language experience is divided across two languages, studying performance in two languages on NWR could inform one's understanding of the relationship between information processing and language learning. Aims: The primary aims of this study were to compare bilingual language learners' recall of Spanish-like and English-like items on NWR tasks and to assess the relationships between performance on NWR, semantics, and morphology tasks. Methods & Procedures: Sixty-two Hispanic children exposed to English and Spanish were recruited from schools in central Texas, USA. Their parents reported on the children's input and output in both languages. The children completed NWR tasks and short tests of semantics and morphosyntax in both languages. Mixed-model analysis of variance was used to explore direct effects and interactions between the variables of nonword length, language experience, language outcome measures, and cumulative exposure on NWR performance. Outcomes & Results: Children produced the Spanish-like nonwords more accurately than the English-like nonwords. NWR performance was significantly correlated to cumulative language experience in both English and Spanish. There were also significant correlations between NWR and morphosyntax but not semantics. Conclusions & Implications: Language knowledge appears to play a role in the task of NWR. The relationship between performance on morphosyntax and NWR tasks indicates children rely on similar language-learning mechanisms to mediate these tasks. More exposure to Spanish may increase abilities to repeat longer nonwords. This knowledge may shift across levels of bilingualism. Further research is needed to understand this relationship, as it is likely to have implications for language teaching or intervention for children with language impairments. (Contains 3 figures and 5 tables.)

A study to predict teachers' self-efficacy in using technology for pedagogical purposes was conducted in a predominantly Hispanic school district in south Texas; 438 elementary teachers completed a 32-item survey aligned to the National Educational Technology Standards for Teachers. Findings suggested that the instrument is highly reliable in measuring Hispanic school teachers' self-efficacy when they are asked to rate their confidence in their ability to perform technology tasks for educational purposes. An exploratory factor analysis (orthogonal and nonorthogonal) allowed the derivation of composite measures. Three subscales regarding issues of pedagogy composed the dependent variable. Regression analyses (OLS and 2SLS) revealed that two derived composite measures and two contrast variables listed in the general information of the survey strongly predicted the response variable. (Contains 3 tables.)

Migrant children are considered one of the most at-risk populations in the United States. They face multiple obstacles of poverty, poor health, mobility, and limited English proficiency, which contributes to the difficulties that migrant children may encounter in the educational system. Limited research has been conducted regarding migrant students with disabilities. The purpose of this study was to examine the extent to which the migrant student population was identified as having disabilities in Texas. Analyses were conducted on a state level, district level, and disability category level. Data were obtained from the Texas Education Agency. The sample consisted of 223 districts that had a total of 9,078 migrant special education students. The state-level analysis found that migrant students, collectively, were not disproportionately represented in special education when compared to the overall state percentage of migrant student representation in general education. The district-level analysis, however, indicated that there was a disproportionate representation of migrant students that received special education services in many school districts in Texas. Moreover, the disability category-level analysis indicated that there was a higher percentage of migrant students that received services under the learning disability category than would be expected. (Contains 3 tables and 1 figure.)

Explores issues concerning representation, training, guidelines, and parent representative roles to determine how Mexican-American parents serving on an elementary school advisory council were involved in school decision-making. Parents' role may be minor, due to factors (like staff assumptions) resulting in unequal knowledge, respect, and resources. (Contains 42 references.) (MLH)

A project is reported in which selected bilingual Mexican-American teachers from Texas traveled to Mexico for a four-week study to collect materials appropriate for U.S. classroom use. The effects of the project on language fluency and ethnic self-concept are discussed. (22 references) (LB)

This study examines the national landscape of hybridized fossil energy (FE) power plants with energy storage (ES) technologies ("ES-FE") and presents the compilation of an ES-FE dataset, which includes over 65 ES-FE projects and concepts in the United States, comprising approximately 500 MWh of co-located ES capacity with FE power plants. This study also estimates the economic feasibility of adding ES to existing FE power plants by characterizing the potential revenues that can be generated by the ES component through flexibility and capacity value. The analysis focuses on ES technologies with 2- to 10-h. durations located in four U.S. independent system operators (ISOs): Midcontinent ISO (MISO), Electric Reliability Council of Texas (ERCOT), PJM Interconnection (PJM), and California ISO (CAISO), which have +70,000 MW of combined FE power capacity that could add ES. Annual revenues are estimated for the ES component using a what-if-analysis approach, for capacity value, price arbitrage, or ancillary services provision. The results show that annual revenues depend on the end-use storage service, wholesale electricity and capacity market prices, and ES technology operation parameters such as discharging duration and cycling frequency. When performing a sensitivity analysis, ES accrues $7–178/kW-yr. via price arbitrage and ancillary services provision in the four ISOs, and $13–92/kW-yr. when providing capacity value only in MISO and PJM. A cash flow analysis is performed to estimate the net present value (NPV) of the ES addition using a range of ES costs. The study finds that for most ES technologies considered, these revenues alone are insufficient to achieve economic feasibility. Of the 1645 total runs analyzed, 115 had positive NPVs (7%). Therefore, other revenue streams or monetizable benefits are necessary to achieve the break-even point. • There are at least 65 ES-FE projects and concepts in the U.S., as of end of 2022. • MISO, ERCOT, PJM, and CAISO have +70,000 MW of FE power units, which could add ES. • ES capacity provision yields $13–92/kW-yr. in PJM and MISO (2019$). • ES stacking services yields $7–178/kW-yr. in MISO, ERCOT, PJM, CAISO (2019$). • Only 115 out of 1645 cases analyzed have positive NPVs. [ABSTRACT FROM AUTHOR]

Nine-banded armadillos (Dasypus novemcinctus) are naturally infected with Mycobacterium leprae and have been implicated in zoonotic transmission of leprosy. Early studies found this disease mainly in Texas and Louisiana, but armadillos in the southeastern United States appeared to be free of infection. We screened 645 armadillos from 8 locations in the southeastern United States not known to harbor enzootic leprosy for M. leprae DNA and antibodies. We found M. leprae-infected armadillos at each location, and 106 (16.4%) animals had serologic/PCR evidence of infection. Using single-nucleotide polymorphism variable number tandem repeat genotyping/genome sequencing, we detected M. leprae genotype 3I-2-v1 among 35 armadillos. Seven armadillos harbored a newly identified genotype (3I-2-v15). In comparison, 52 human patients from the same region were infected with 31 M. leprae types. However, 42.3% (22/52) of patients were infected with 1 of the 2 M. leprae genotype strains associated with armadillos. The geographic range and complexity of zoonotic leprosy is expanding. [ABSTRACT FROM AUTHOR]

In Texas there are limited data on the epidemiology of coccidioidomycosis. Our goal is to determine the prevalence of coccidioidomycosis in a county hospital in El Paso, Texas. The charts of all patients with coccidioidomycosis admitted to the hospital in the past 9 years was retrospectively reviewed statistical analysis performed. Forty-one cases were identified, giving a prevalence of 3.2 cases per 10,000 discharges. Pneumonic consolidation occurred in 14 (44%), miliary pattern in 6 (19%) and cavitation in 6 (19%) cases. Pulmonary involvement occurred in 32 patients (78%) and meningeal involvement in 3 patients. Six patients had disseminated disease. The mortality rate was higher with disseminated disease (50% compared to 3.6%, P= 0.04). Four had concomitant pulmonary tuberculosis. Diabetes mellitus was found in 17 patients (41.4%), followed by HIV infection in 15 (36.5%). Patients with HIV had a higher incidence of disseminated disease (36.4% vs. 0%, P= 0.01). Four patients died, and the risk of death was increased in disseminated disease ( P < 0.05). Coccidioiomycosis is not as frequent in El Paso, and for that matter in Texas, as in other states, but still has to be taken into consideration both in HIV and in diabetic patients. [ABSTRACT FROM AUTHOR]

The involvement of Mexican American parents in their children's education was explored in a year-long case study of an elementary school in Texas. Interviews, document analysis, and observations of parent activities revealed that parent involvement was influenced by several factors, including language, parent cliques, parents' education, attitudes of the school staff, cultural influences, and family issues. Although the school staff addressed some of the issues, in general, teachers did not recognize the influence that these concerns had on parent involvement. The findings have implications for teachers that affect both the level and areas of Mexican American parent involvement. An understanding of these factors will provide ways to increase and improve parent involvement. [ABSTRACT FROM AUTHOR]

Purpose: This project evaluated an integrated strategy to actively promote sleep in patients in a cardiothoracic intensive care unit (ICU). A multidisciplinary sleep guideline was developed to create a patientcentered environment that maximizes opportunities to promote sleep and rest. Practices addressed by the guideline are keeping the patient care environment quiet at night, clustering nursing care to minimize disruption, and scheduling patient care activities during awake times as a priority instead of at nurses' convenience. Background: Hospitalized patients commonly experience poor sleep and report poor sleep quality. Sleep is an essential biological function that is crucial to supporting immune function and promoting recovery and restoration of health. In the presence of illness, sleep deprivation may complicate illness and impair recovery. Our unit research team identified poor sleep and its consequences as a source of patient dissatisfaction and a modifiable patient outcome. Method: The team collected baseline data on unit noise, patients' sleep satisfaction, and modifiable tasks that disrupt patients' sleep. Before the new sleep guideline was implemented, staff was educated on the importance of sleep for hospitalized patients, what patients in our unit report, and how to use the guideline to provide a multifaceted approach to promote quiet and sleep. This training included strategies to improve environmental light and noise, attention to assessing and providing sleep hygiene for patients, and rescheduling nonessential tasks. After the implementation of the guideline, 6-month and 1-year data were collected at 2-week intervals. Results: Improvements in practice were achieved in areas of quietness, decreased number of nighttime baths, and discussing sleep with patients. The barriers to sleep cited by patients show the inherent problems in providing sleep for postoperative patients in the ICU and areas for improvement. Changing embedded practice patterns is a recursive, long-term process that requires ongoing feedback for staff and persistence of the intervention to achieve the stated goal. [ABSTRACT FROM AUTHOR]

Objective: Hypertension can cause significant morbidity and reduced life expectancy. Most patients with hypertension have primary hypertension; however, 10% to 15% have secondary hypertension. Endocrine disorders as a secondary cause occur in approximately 10% of patients with secondary hypertension, and thyroid disorders account for approximately 1% of all patients with hypertension. The identification of patients with hyperthyroidism has important benefits for these particular patients. The objective of this study was to examine the occurrence of high blood pressure in patients with hyperthyroidism.Methods: We reviewed the clinical information available from 414 new patients referred to an endocrinology clinic in west Texas for evaluation of hyperthyroidism. The final cohort included 96 patients who had both thyroid laboratory tests and blood pressure measurements at the time of their clinic visit. We also examined this relationship in a nationally representative sample of US adults (National Health and Nutrition Examination Survey 2007-2012), which included thyroid test results and at least one blood pressure measurement (N = 8837).Results: Sixty-five of these clinic patients had elevated blood pressure based on criteria suggested by the American College of Cardiology/American Heart Association. These patients had similar thyroid hormone levels as patients who did not have hypertension but tended to be older. Ordinary least squares regression analysis of the National Health and Nutrition Examination Survey 2007-2012 data demonstrated a significant positive association between free T3 levels and systolic blood pressure, adjusting for age, sex, and the use of levothyroxine.Conclusions: These findings from a specialty clinic and a national sample suggest that clinicians should consider the possibility of hyperthyroidism in patients with hypertension, even in older patients. [ABSTRACT FROM AUTHOR]

Setting Five health care systems in Texas. Objective To describe the epidemiology of inadequate isolation for pulmonary tuberculosis leading to tuberculosis (TB) exposures from confirmed TB patients and the patient factors that led to the exposures. Design A retrospective cohort and case-control study of adult patients with TB resulting in exposures (cases) vs those TB patients who did not result in exposures (controls) during January 2005 to December 2012. Results There were 335 patients with pulmonary TB disease, 199 cases and 136 controls. There was no difference between groups in age (46 ± 14.6 vs 45 ± 17 years; P >.05), race, or substance abuse. Cases were more likely to be transplant recipients (adjusted odds ratio [AOR], 18.90; 95% CI, 1.9–187.76), have typical TB chest radiograph (AOR, 2.23; 95% CI, 1.1–4.51), and have positive acid-fast bacilli stains (AOR, 2.36; 95% CI, 1.31–4.27). Cases were less likely to have extrapulmonary disease (AOR, 0.47; 95% CI, 0.24–0.95). Conclusions TB exposure resulting from inadequate isolation is frequent in health care settings. Extrapulmonary involvement resulted in earlier airborne isolation. Being a transplant recipient, having chest radiograph findings typical for TB, and sputum positivity acid-fast bacilli upon staining were associated with increased risk of inadequate isolation. [ABSTRACT FROM AUTHOR]

Replacing legacy high carbon technologies (LHCTs) with new low carbon technologies (NLCTs), particularly NLCTs featuring variable renewable resources, can disproportionally influence the costs associated with maintaining a reliable and competent grid system. Traditional cost metrics and publicly available tools that make use of these metrics fail to capture the total systems cost (TSC) implications of such changes, highlighting the need for a tool that will capture these implications. This paper presents the results of a tool developed to estimate the System Cost of Replacement Energy (SCoRE) when NLCTs replace LHCTs in an operating region. The SCoRE estimates potential changes in the TSC resulting from the replacement. The SCoRE tool is applied to the Electric Reliability Council of Texas (ERCOT) operating region. LHCTs, namely coal- and natural gas-fired power plants are replaced by NLCTs including solar photovoltaics and wind, with and without energy storage, and coal and natural gas power plants equipped with carbon capture and storage (CCS). The results showcase the TSC implications of different replacement scenarios, which for ERCOT include larger increases in the TSC if LHCTs are replaced with wind and solar, in lieu of natural gas power plants equipped with CCS, for all decarbonization targets considered. • Technology transformations to achieve decarbonization will impact system costs. • SCoRE tool estimates system costs implications of LHCT being replaced with NLCT. • Wind and NGCC + CCS is the least cost pathway for 90% decarbonization in ERCOT. • Renewable energy curtailment appears cheaper than co-locating it with energy storage. • Solar PV + Battery storage become impractical at >70% decarbonization. [ABSTRACT FROM AUTHOR]

Reports on the findings of a study to determine whether undiagnosed or unreported dengue cases had occurred in Laredo, Texas during January-July 1999. Indication that there were cases of undiagnosed dengue infection, an arboviral illness transmitted by Aedes aegypti mosquitoes; Review of suspected dengue case-patients.

Objectives: To determine how often pharmacists inquire about patients' complementary and alternative medicine (CAM) use, actions taken in response to patients' CAM use, and demographic or professional characteristics that predict differences in pharmacists' actions., Methods: A survey was mailed to 400 randomly selected community pharmacists who resided in Texas-Mexico border cities., Results: Most (63.8%) pharmacists had encountered patients who were using CAM. They documented CAM use in 9.8% of cases and monitored for drug-related problems in 39.4%. Among users, pharmacists sometimes to usually (3.4 ± 1.4 [mean ± SD]) took actions such as referring patients to their physicians. Pharmacists were not particularly comfortable (3.2 ± 1.0) with responding to CAM inquiries but believed patients needed adequate CAM knowledge. Pharmacists rarely to sometimes (2.6 ± 1.2) asked patients about their CAM use. Inquiry about CAM use was greater when information could be documented in profiles (F = 4.29, P = 0.02) and when pharmacists had additional training in CAM (t = -2.59, P = 0.01). Also, in pharmacies that stocked herbal or homeopathic products, pharmacists were more likely to recommend other CAM therapies appropriate for patients' conditions (t = -3.27, P < 0.01)., Conclusion: Pharmacists were not very proactive in inquiring about CAM use, and their actions (e.g., referral to physician) were somewhat passive. More routine inquiry and documentation are needed. Pharmacists should routinely ask about and document CAM use by patients in order to optimize drug therapy outcomes.