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.

To assess the knowledge, attitudes, and confidence of caregivers and administrators towards the oral health of nursing home residents in San Antonio, Texas.

OBJECTIVE: The primary objective of this research was to use qualitative methods to assess the knowledge, attitudes, and confidence of caregivers in their ability to provide oral hygiene assistance to residents. The secondary objective was to assess the knowledge and attitude of administrators on the provision of oral hygiene assistance for residents, and their confidence in caregivers' ability to provide oral hygiene assistance to nursing home residents in San Antonio, Texas. METHODS: A semi-structured interview guide was used to conduct face-to-face interviews with seven caregivers and twelve administrative staff from ten nursing homes in San Antonio, Texas. Employees in nursing homes who are caring for residents are referred to as caregivers and those whom they care for are referred to as nursing home residents. One survey instrument was developed for the caregiver's knowledge, attitude, and confidence toward providing oral health care, and another to assess the administrator's knowledge, attitude, and confidence in caregivers providing oral care for nursing home residents. The interviews were recorded, transcribed, and coded for thematic content. RESULTS: The findings revealed that caregivers and administrators had adequate knowledge of the connection between oral and systemic health. The administrators were confident that caregivers were adequately trained to provide oral hygiene care for residents. Caregivers had a positive attitude toward the importance of good oral health. They regularly assessed the residents' oral health, but due to time constraints, staffing shortages, and other competing tasks providing oral health care to the residents was challenging. Most caregivers were confident in their skills in providing oral care for the residents since 85.6% agreed. On the contrary, almost half of the administrators were confident that caregivers have the necessary skills to provide oral care for residents, while 41.7% were unsure. CONCLUSIONS: The study gave a broader insight into the provision of oral care in nursing home residents from the perspectives of caregivers and administrative staff. Administrators must provide caregivers with adequate training and time so they can provide adequate oral health care for the residents.

Comparison of mechanical properties of 3-dimensional printed and thermoformed orthodontic aligners.

INTRODUCTION: Orthodontic treatment using clear aligners has experienced exponential growth since its introduction in the late 1990s. Three-dimensional (3D) printing has also grown in popularity among orthodontists, and companies have begun to produce resins to directly print clear aligners. This study aimed to examine the mechanical properties of commercially available thermoformed aligners and direct 3D-printed aligners under laboratory conditions and a simulated oral environment. METHODS: Samples were prepared (approximately 2.5 × 20 mm) from 2 thermoformed materials, EX30 and LD30 (Align Technology Inc, San Jose, Calif), as well as 2 direct 3D-printing resins, Material X (Envisiontec, Inc; Dearborn, Mich) and OD-Clear TF (3DResyns, Barcelona, Spain). Wet samples were subjected to phosphate-buffered saline at 37°C for 7 days, whereas dry samples were stored at 25°C. Tensile and stress relaxation tests were carried out on an RSA3 Dynamic Mechanical Analyzer (Texas Instruments, Dallas, Tex) and Instron Universal Testing System (Instron, Norwood, Mass) to calculate elastic modulus, ultimate tensile strength, and stress relaxation. RESULTS: The elastic modulus of dry and wet samples was 103.2 ± 17.3 MPa and 114.4 ± 17.9 MPa (EX30), 61.3 ± 9.18 MPa and 103.5 ± 11.4 MPa (LD30), 431.2 ± 16.0 MPa and 139.9 ± 34.6 MPa (Material X), and 38.4 ± 14.7 MPa and 38.3 ± 8.4 MPa (OD-Clear TF), respectively. The ultimate tensile strength of dry and wet samples was 64.41 ± 7.25 MPa and 61.43 ± 7.41MPa (EX30), 40.04 ± 5.00 MPa and 30.09 ± 1.50 MPa (LD30), 28.11 ± 3.75 MPa and 27.57 ± 4.09 MPa (Material X), and 9.34 ± 1.96 MPa and 8.27 ± 0.93 MPa (OD-Clear TF), respectively. Residual stress of wet samples at 2% strain for 2 hours was 59.99 ± 3.02% (EX30), 52.57 ± 12.28% (LD30), 6.98 ± 2.64% (Material X), and 4.39 ± 0.84% (OD-Clear TF). CONCLUSIONS: There was a significant difference in elastic modulus, ultimate tensile strength, and stress relaxation among the samples tested. Moisture, specifically a simulated oral environment, appears to have a greater effect on the mechanical properties of direct 3D-printed aligners when compared with thermoformed aligners. This is likely to impact the ability of 3D-printed aligners to generate and maintain adequate force levels for tooth movement.

Environmental Persistence of Monkeypox Virus on Surfaces in Household of Person with Travel-Associated Infection, Dallas, Texas, USA, 2021.

In July 2021, we conducted environmental sampling at the residence of a person in Dallas, Texas, USA, who had travel-associated human West African monkeypox virus (MPXV-WA). Targeted environmental swab sampling was conducted 15 days after the person who had monkeypox left the household. Results indicate extensive MPXV-WA DNA contamination, and viable virus from 7 samples was successfully isolated in cell culture. There was no statistical difference (p = 0.94) between MPXV-WA PCR positivity of porous (9/10, 90%) vs. nonporous (19/21, 90.5%) surfaces, but there was a significant difference (p<0.01) between viable virus detected in cultures of porous (6/10, 60%) vs. nonporous (1/21, 5%) surfaces. These findings indicate that porous surfaces (e.g., bedding, clothing) may pose more of a MPXV exposure risk than nonporous surfaces (e.g., metal, plastic). Viable MPXV was detected on household surfaces after at least 15 days. However, low titers (<102 PFU) indicate a limited potential for indirect transmission.

The Effect of Postpartum Depressive Symptoms (PDS) on Maternal Health Practices After Childbirth, Texas Pregnancy Risk Assessment Monitoring System, 2012-2015.

OBJECTIVES: This study examined the contribution of postpartum depressive symptoms (PDS) on select maternal health practices among Texas women, using 2012-2015 survey data from the Pregnancy Risk Assessment Monitoring System. METHODS: Multiple logistic regression was used to assess the effect of PDS on postpartum checkups, postpartum dental visits, and use of postpartum birth control. Covariates included maternal age, race/ethnicity, marital status, education, and depression before birth. RESULTS: Data from 4679 respondents were used in analyses, and the prevalence of women reporting PDS was 13.8 percent. Women without PDS were more likely to attend a postpartum checkup (adjusted OR = 1.5; 95% CI 1.1-2.1) or have a postpartum dental visit (adjusted OR = 1.4, 95% CI 1.0-1.8) than women with PDS. There was insufficient evidence to conclude any association between PDS and use of postpartum birth control. CONCLUSIONS: These findings highlight adverse effects of PDS on maternal health practices not previously studied. Results stress the importance of healthcare professionals monitoring the moods and actions of women of childbearing age to provide early interventions for women experiencing PDS, and of emphasizing positive maternal health practices after childbirth.

Mucocutaneous nasal histoplasmosis in an immunocompetent dog.

BACKGROUND: Histoplasma (H.) capsulatum is a dimorphic fungus, and infection is typically via inhalation of microconidia. After conversion to the yeast phase within the lung, the organism is subsequently disseminated to other tissues by macrophages. Nasal histoplasmosis appears to be a rare condition in dogs. CASE PRESENTATION: We report the clinical case of a 4.5-year-old male neutered Cocker spaniel/Poodle mix, 7.7 kg, body condition score 6/9, that presented with a 3-month history of sneezing and left-sided mucoid nasal discharge. The history also included a mild swelling (transient) of the right carpus with a lameness (grade II-III/IV), coinciding with the onset of sneezing and nasal discharge. The dog lived primarily indoors in the Texas Gulf Coast area. On physical examination, the dog was febrile, and the left nostril was swollen, ulcerative, deformed, and hypopigmented. Mandibular lymph nodes were firm and mildly enlarged bilaterally. Mild lymphopenia, thrombocytopenia, and hyperglobulinemia were noted. Thoracic radiographs were unremarkable. Computed tomography and rhinoscopy revealed swelling of the rostral portion of the left and right nasal passages. Cytology and histology of biopsies of the affected nasal tissue showed pyogranulomatous inflammation and yeast organisms consistent with H. capsulatum. Weak antigenuria was detected on the MVista H. capsulatum antigen test. Treatment with oral itraconazole led to a resolution of the nasal signs and normalization of the appearance of the nostril over 13 weeks, and neither antigenuria nor antigenemia was detected on several recheck examinations. The dog remained in good general and physical condition and showed no signs of disease recurrence more than 6 years after the last examination. CONCLUSION: We report a rare case of nasal mucocutaneous histoplasmosis in an immunocompetent dog, with an excellent clinical response to oral itraconazole. This case documents that histoplasmosis in dogs can affect primarily the nasal cavity, which responds rapidly to triazole antifungal therapy and has a good prognosis. A similar case has only been reported in human medicine in a young adult.

Development of an E-Cigarettes Education and Cessation Program: A South Texas Oral Health Network Study.

Electronic cigarette (e-cigarette) use, or vaping, among youth and young adults has become a major public health concern. The prevalence of vaping has grown an astounding 900% among high school students from 2011 to 2015, and e-cigarette use among high school students has increased by 78% from 2017 to 2018, largely due to the rise in popularity of the high-dose nicotine product, JUUL. To date, there are few evidence-based e-cigarette cessation programs. To address this need, the South Texas Oral Health Network collaborated with dental practitioners and community members to conduct focus groups assessing knowledge and awareness of e-cigarette use. Based on this feedback, we developed a dental practitioner-based e-cigarette cessation program. The next step will be to utilize this program in a practice-based research network, a "real-world" practice setting that has the potential to increase the number of dental practitioners who counsel their patients about ecigarettes.

Povidone-iodine Irrigation for Pediatric Perforated Appendicitis May Be Protective: A Bayesian Pilot Randomized Controlled Trial.

OBJECTIVES: A randomized controlled trial was conducted to test the hypothesis that povidone-iodine (PVI) irrigation versus no irrigation (NI) reduces postoperative intra-abdominal abscess (IAA) in children with perforated appendicitis. METHODS: A 100 patient pilot randomized controlled trial was conducted. Consecutive patients with acute perforated appendicitis were randomized (1:1) to PVI or NI from April 2016 to March 2017 and followed for 1 year. Patients and postoperative providers were blinded to allocation. The primary endpoint was 30-day image-confirmed IAA. Secondary outcomes included initial and total 30-day length of stay (LOS), emergency department (ED) visits, and readmissions. Intention-to-treat analyses were performed to estimate the probability of clinical benefit using Bayesian regression models (an optimistic prior for the primary outcome and neutral priors for secondary outcomes). Frequentist statistics were also used. RESULTS: Baseline characteristics were similar between treatment arms. The PVI arm had 12% postoperative IAA versus 16% in the NI arm (relative risk 0.72, 95% credible interval 0.38-1.23). Bayesian analysis estimates 89% probability that PVI reduces IAA. High probability of benefit was seen in all secondary outcomes for the PVI arm: fewer ED visits and readmissions, and shorter initial and total 30-day LOS. The probability of benefit in reduction of total 30-day LOS in PVI patients was 96% and was significant (P = 0.05) on frequentist analysis. CONCLUSIONS: PVI irrigation for perforated appendicitis in children demonstrated a strong probability of reduction in postoperative IAA with a high probability of decreased LOS. With the favorable probability of benefit in all outcomes, this pilot study serves as evidence to continue a definitive trial.

Development and validation of the Dental Nutrition Knowledge Competency Scale for low-income women.

OBJECTIVE: To develop and validate a Dental Nutrition Knowledge Competency Scale to assess dental health-related nutrition knowledge of low-income women. DESIGN: This is a cross-sectional study. A literature search for foods/dietary practices related to dental caries was conducted and the items were incorporated into an initial questionnaire. A panel of ten nutrition experts evaluated it for its content, readability and relevance, and a focus group of six low-income women determined its readability and comprehension. Then the questionnaire was administered to 150 low-income women. Construct validity was evaluated by item difficulty, item discrimination and factor analysis. Internal consistency reliability was tested via Cronbach's α. In a sub-sample of forty women, test-retest reliability was established. Paired-sample t tests were conducted to examine differences between test scores at the two time points, 2 weeks apart. SETTINGS: Community centres in low-income housing in Central Texas, USA. PARTICIPANTS: A total of 150 low-income women, aged 18-50 years; annual household income <250 % of the federal poverty level. RESULTS: Item difficulty and discrimination analysis resulted in elimination of eight questions. Factor analysis identified twenty-four items that loaded on three factors related to knowledge. These included foods/dietary practices that affect dental caries, added sugars in foods and on food labels, and recommended frequency of oral hygiene practices. The subscales and the completed scale exhibited good internal consistency (mean 0·7 (sd 0·97)) and test-retest reliability (mean 0·8 (sd 0·013)). CONCLUSIONS: The Dental Nutrition Knowledge Competency Scale is a validated and reliable instrument to assess nutrition knowledge related to dental health in low-income women.

Aspiration of superabsorbent polymer beads resulting in focal lung damage: a case report.

BACKGROUND: Concerns have recently been raised about reported incidents of intestinal obstruction following ingestion of Superabsorbent polymer (SAP) beads. Texas Poison Centers reported 110 cases of superabsorbent polymer bead ingestions between 2011 and 2016 (Pediatr Emerg Care 35:426-7, 2019). Furthermore, cases of related auditory complications following the placement of SAP beads into the external auditory canal have also been reported. Here, we report the first case of significant airway damage secondary to the ingestion of a SAP bead (Orbeez), which was aspirated and then overlooked. Further, we hypothesized that the capability of the bead to expand in size once exposed to water from the respiratory mucous may contribute to airway damage. CASE PRESENTATION: A 3-year-old boy presented to our hospital with persistent cough and recurrent hospitalizations to the general ward and intensive care unit. The boy was diagnosed with focal lung bronchiectasis in the left lower lobe, which occurred after the patient aspirated an Orbeez bead before a year. The bead was removed using flexible bronchoscopy and a retrieval basket. CONCLUSION: Orbeez beads are commonly ingested by young children resulting in gastrointestinal obstruction. The beads can easily be aspirated by children and overlooked by their caregivers and physicians for long periods of time due to their small size. The bead can cause significant airway damage after multiplying in size when coming into contact with respiratory mucus which consists of 95% water.

Does Preventive Care Reduce Severe Pediatric Dental Caries?

INTRODUCTION: Tertiary oral health services (caries-related surgery, sedation, and emergency department visits) represent high-cost and ineffective ways to improve a child's oral health. We measured the impact of increased Texas Medicaid reimbursements for preventive dental care on use of tertiary oral health services. METHODS: We used difference-in-differences models to compare the effect of a policy change among children (≤9 y) enrolled in Medicaid in Texas and Florida. Linear regression models estimated 4 outcomes: preventive care dental visit, dental sedation, emergency department use, and surgical event. RESULTS: Increased preventive care visits led to increased sedation visits (1.7 percentage points, P < .001) and decreased emergency department visits (0.3 percentage points, P < .001) for children aged 9 years or younger. We saw no significant change in dental surgical rates associated with increased preventive dental care reimbursements. CONCLUSION: Increased access to preventive dentistry was not associated with improved long-term oral health of Medicaid-enrolled children. Policies that aim to improve the oral health of children may increase the effectiveness of preventive dentistry by also targeting other social determinants of oral health.

Incidence of cervical spine fractures on CT: a study in a large level I trauma center.

INTRODUCTION/PURPOSE: Though spinal fractures constitute a minority of all traumas, the financial burden imposed is immense especially following cervical spine trauma. There have been several papers in the past describing the incidence of cervical spine fractures. In this paper, we report the incidence of cervical spine fractures and correlate with demographic information and cause of injury and review the mechanism of fractures. MATERIALS AND METHODS: We performed retrospective analysis of 934 patients who had undergone CT scan for cervical spine trauma at our institute which includes 16 hospitals and one level I trauma center over a period of 2 years. This list was created from a wider database of 13,512 patients imaged for suspected cervical spine injury. All patients who had at least one positive finding on CT were included in this study irrespective of any demographic difference. Each patient was analyzed by reviewing the medical records, and correlation was sought between demographics and cause of injury. RESULTS: In our study, the peak incidence of cervical spine trauma was in the age group of 21-30 years followed by 31-40 years with a male:female ratio of 2.1. The major cause of injury in the study population was motor vehicle accidents (66.1%), followed by fall from height of less than 8 ft (12.2%). With regard to the ethnic distribution, Caucasians (46.9%) constituted the major population followed by Hispanic population (23.3%). C1 and C2 were observed to be more frequently fractured as compared with the subaxial spine. Incidence of C2 fractures (188 levels) was higher as compared with C1 (102 levels). Incidence of body and lateral mass fractures was marginally higher as compared with odontoid fractures. C7 (50 levels) was the most fractured vertebral body in the subaxial spine followed by C6 (35 levels) and C5. CONCLUSION: Spinal trauma is on the rise and it helps to know the factors which can guide us for better management of these patients. We can utilize these results to prognosticate and streamline clinical management of these patients.

A spatial model for the beneficial use of dredge spoil deposition: Creation and management of breeding habitat for reddish egrets in Texas.

Many species of coastal waterbirds have faced population declines in recent years as a result of loss and degradation of habitat. The creation of new habitat through strategic placement of dredge spoil can be an effective tool to mitigate habitat loss. The use of dredge spoil islands for nesting, wintering, and migratory stopover habitat by waterbirds has been documented extensively over the past several decades. Most of the reddish egret (Egretta rufescens) breeding population in the United States occurs in Texas, where it has declined by more than 30% since the 1970s. Reddish egrets breed on dredge spoil islands along the Texas coast, and the stability of breeding colonies has been variable since the 1970s. If nesting habitat is degraded or limiting in Texas, the creation of new nesting islands through strategic dredge spoil placement could benefit reddish egrets. We developed a spatially explicit prioritization model for targeted conservation of reddish egrets in the Laguna Madre, Texas, through colonial island establishment using dredge spoil. Prioritization is based on availability of foraging areas, potential competition at foraging areas, and distance of potential sites to the mainland. 'Priority areas' are potential nesting island locations that would maximize the foraging benefits for breeding reddish egrets. Model outputs show that highest priority areas in the Laguna Madre are located in the southernmost portion of the lagoon. Other priority areas are located in the lower Laguna Madre, and at the mouth of Baffin Bay. In addition, we provide a repeatable and transparent framework for the development of spatial support tools that help guide targeted placement of dredge spoil in an effort to conserve colonial waterbirds. We illustrate the model development for reddish egrets, a threatened species in Texas, however our framework can be applied to other similar species.

Pediatric Orbeez Ingestions Reported to Texas Poison Centers.

OBJECTIVES: There is concern that ingestion of superabsorbent polymer toys, which can absorb large amounts of fluid and increase greatly in volume, may pose a risk if swallowed by children.The intent of this study was to characterize pediatric Orbeez ingestions reported to a statewide poison center system. METHODS: Cases were Orbeez ingestions among patients 19 years or younger reported to Texas poison centers during January 2011 to June 2016. The distribution by various demographic and clinical factors was determined. RESULTS: Of 110 total cases, 56% were female and 55% were 5 years or younger. Eighty-six percent of the ingestions were unintentional. Sixty-nine percent occurred at the patient's home and 28% at school. Seventy-eight percent of the patients were managed on site. The reported adverse effects were vomiting (4%), abdominal pain (3%), constipation (1%), diarrhea (1%), and fever (1%). The reported treatments were dilution (42%), food or snack (16%), other emetics (1%), whole bowel irrigation (1%), antihistamines (1%), and intravenous fluids (1%). CONCLUSIONS: Pediatric Orbeez ingestions tended to involve younger children, were unintentional, and occurred at the child's home or school. Most ingestions were managed outside of a healthcare facility. This study provides further evidence that ingestion of Orbeez by children is not likely to result in serious problems, such as intestinal obstruction. The information in this investigation may assist in prevention and education activities.

Liposomal Bupivacaine May Benefit Select Reduction Mammaplasty Patients.

BACKGROUND: Postoperative pain control can be challenging in reduction mammaplasty patients. This study compares perioperative liposomal bupivacaine (Exparel; Pacira Pharmaceuticals, Inc, San Diego, Calif) with standard local anesthetics to determine if liposomal bupivacaine decreases opioid and antiemetic use, impacting length of stay and complication rates, thus improving patient outcomes. METHODS: A retrospective review of 170 reduction mammaplasty patients was performed. Patients were divided into groups based on local anesthetic used (bupivacaine only and liposomal bupivacaine) and into subgroups based on obesity classification. Length of hospital stay; pain scores immediately postoperatively, at discharge, and at follow-up; and postoperative analgesics and antiemetics were compared. Further analysis was performed after weight stratification within pre- and postmenopausal categories. RESULTS: Liposomal bupivacaine resulted in less pain than bupivacaine immediately postoperatively and at discharge in obesity class I (P = 0.021 and P = 0.018). In obesity class II, antiemetic use was lower in the liposomal bupivacaine group (P = 0.012). Length of stay was persistently lower with liposomal bupivacaine for premenopausal women, and this difference was significant in obesity class I (P = 0.038). In premenopausal women, discharge pain scores were lower in the overweight liposomal bupivacaine group (P = 0.034) and analgesic use was lower in obesity class III (P = 0.004). CONCLUSIONS: Liposomal bupivacaine decreases postoperative pain, opioid, and antiemetic use in select patients. Liposomal bupivacaine might not be equally efficacious in pain reduction in obese or postmenopausal women given the theoretical increased absorption by adipose tissue. In addition, liposomal bupivacaine may have a dose-dependent effect, and weight-based dosing should be investigated.

Acute salivary cortisol response among Mexican American adolescents in immigrant families.

OBJECTIVES: Though previous research has indicated that language brokering can be stressful, the findings are mixed, pointing to potential moderators of the association. Guided by an ecological perspective, we examined the role of individual, family, and environmental factors in Mexican American adolescents' acute cortisol responses to language brokering. METHOD: The study consisted of 46 Mexican American adolescents recruited around a metropolitan city in Central Texas. Participants translated a difficult medical document from English to Spanish for their parents, followed by an arithmetic task (modeled after the Trier Social Stress Test [TSST]). Participants' perceptions (perceived efficacy and parental dependence), parental hostility, and discrimination experiences were assessed via self-report and were examined as moderators of adolescents' responses to the task. RESULTS: Results revealed differential responses to the task based on individual, family, and environmental factors. High efficacy and low dependence-parental hostility-discrimination related to stress responses characterized by low baselines, steeper reactivity, and faster recovery. Low efficacy and high dependence related to greater baseline stress and a slower recovery. High levels of parental hostility related to a slower recovery. High levels of discrimination related to greater baseline stress. CONCLUSIONS: The study demonstrates that the modified TSST task can elicit an acute hypothalamic-pituitary-adrenal axis response, but the nature of this response is dependent upon participants' perceptions of language brokering (parental dependence and efficacy), parental hostility, and discrimination experiences. Adolescents' individual characteristics and contextual demands remain important considerations in understanding their acute stress responses. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Fluoride exposure in public drinking water and childhood and adolescent osteosarcoma in Texas.

PURPOSE: The purpose of this study was to examine the association between fluoride levels in public drinking water and childhood and adolescent osteosarcoma in Texas; to date, studies examining this relationship have been equivocal. Using areas with high and low naturally occurring fluoride, as well as areas with optimal fluoridation, we examined a wide range of fluoride levels in public drinking water. METHODS: This was a population-based case-control study, with both cases and controls obtained from the Texas Cancer Registry. Eligible cases were Texas children and adolescents <20 years old diagnosed with osteosarcoma between 1996 and 2006. Controls were sampled from children and adolescents diagnosed with either central nervous system (CNS) tumors or leukemia during the same time frame. Using geocoded patient addresses at the time of diagnosis, we estimated patients' drinking water fluoride exposure levels based on the fluoride levels of their residence's public water system (PWS). Unconditional logistic regression models were used to assess the association between osteosarcoma and public drinking water fluoride level, adjusting for several demographic risk factors. RESULTS: Three hundred and eight osteosarcoma cases, 598 leukemia controls, and 604 CNS tumor controls met selection criteria and were assigned a corresponding PWS fluoride level. PWS fluoride level was not associated with osteosarcoma, either in a univariable analysis or after adjusting for age, sex, race, and poverty index. Stratified analyses by sex were conducted; no association between PWS fluoride level and osteosarcoma was observed among either males or females. CONCLUSIONS: No relationship was found between fluoride levels in public drinking water and childhood/adolescent osteosarcoma in Texas.

Notes from the Field: Outbreak of Hand, Foot, and Mouth Disease Caused by Coxsackievirus A6 Among Basic Military Trainees - Texas, 2015.

On July 7, 2015, a man aged 22 years reported to sick call during basic military training at Lackland Air Force Base (AFB), Texas. He had erythematous, crusted papulovesicular lesions on the extensor surfaces of the upper and lower extremities. The patient was afebrile and otherwise well, and was evaluated later that day by the dermatology service. A viral infection was considered most likely because of the patient's age, absence of fever or constitutional symptoms, and the distribution and morphology of the lesions. The initial differential diagnosis included Henoch-Schönlein purpura, parvovirus B19, and Rocky Mountain spotted fever. However, the clinical signs, including the unique morphology and distribution of grouped vesicles and papules was suggestive of hand, foot, and mouth disease (HFMD), although the patient did not have oral lesions and reported no contact with another person with HFMD. A viral culture and punch biopsy of one of the lesions were obtained.

A cross-sectional study of parental awareness of and reasons for lack of health insurance among minority children, and the impact on health, access to care, and unmet needs.

BACKGROUND: Minority children have the highest US uninsurance rates; Latino and African-American children account for 53 % of uninsured American children, despite comprising only 48 % of the total US child population. The study aim was to examine parental awareness of and the reasons for lacking health insurance in Medicaid/CHIP-eligible minority children, and the impact of the children's uninsurance on health, access to care, unmet needs, and family financial burden. METHODS: For this cross-sectional study, a consecutive series of uninsured, Medicaid/CHIP-eligible Latino and African-American children was recruited at 97 urban Texas community sites, including supermarkets, health fairs, and schools. Measures/outcomes were assessed using validated instruments, and included sociodemographic characteristics, uninsurance duration, reasons for the child being uninsured, health status, special healthcare needs, access to medical and dental care, unmet needs, use of health services, quality of care, satisfaction with care, out-of-pocket costs of care, and financial burden. RESULTS: The mean time uninsured for the 267 participants was 14 months; 5 % had never been insured. The most common reason for insurance loss was expired and never reapplied (30 %), and for never being insured, high insurance costs. Only 49 % of parents were aware that their uninsured child was Medicaid/CHIP eligible. Thirty-eight percent of children had suboptimal health, and 2/3 had special healthcare needs, but 64 % have no primary-care provider; 83 % of parents worry about their child's health more than others. Unmet healthcare needs include: healthcare, 73 %; mental healthcare, 70 %; mobility aids/devices, 67 %; dental, 61 %; specialty care, 57 %; and vision, 46 %. Due to the child's health, 35 % of parents had financial problems, 23 % cut work hours, and 10 % ceased work. Higher proportions of Latinos lack primary-care providers, and higher proportions of African-Americans experience family financial burden. CONCLUSIONS: Half of parents of uninsured minority children are unaware that their children are Medicaid/CHIP-eligible. These uninsured children have suboptimal health, impaired access to care, and major unmet needs. The child's health causes considerable family financial burden, and one in 10 parents ceased work. The study findings indicate urgent needs for better parental education about Medicaid/CHIP, and for improved Medicaid/CHIP outreach and enrollment.

Treatment of pediatric hyperkalemia with sodium polystyrene sulfonate.

OBJECTIVE: To describe the safety and efficacy of sodium polystyrene sulfonate (SPS) in pediatric patients with acute hyperkalemia. METHODS: A retrospective chart review of all patients less than 18 years of age administered SPS for acute hyperkalemia at Texas Children's Hospital between 2011 and 2014. RESULTS: Our cohort consisted of 156 patients (mean age 6.8 ± 6.1 years). The peak mean potassium concentration observed was 6.5 ± 0.77 mmol/l prior to administration of SPS. The mean SPS dose was 0.64 ± 0.32 g/kg. The majority (91 %) of the SPS doses were given orally. The nadir mean potassium concentration in the 48 h post-SPS was 4.7 ± 1.2 mEq/l, which occurred at 16.7 ± 14.7 h post-dose. In the 48 h following SPS administration, 68 (43 %) patients required at least one additional intervention after SPS dose. Patients who required an additional intervention after initial SPS dose differed significantly in weight, baseline serum potassium, and were more likely to have received SPS treatment via the rectal route. A gastrointestinal adverse event was documented in 24 (15 %) patients. CONCLUSIONS: SPS was used effectively and safely in the majority of patients in this report. However, it may not be appropriate as a first single-line agent in patients with severe acute hyperkalemia who require a greater than 25 % reduction in serum potassium levels or those at a high risk for cardiac arrhythmias.