Freshwater wetlands for flood control: How manipulating the hydroperiod affects plant and invertebrate communities.

Thoughtfully managed hydroperiods in natural and artificial wetlands could potentially provide a combination of desirable flood control services and high ecological functions. To explore how managed freshwater wetlands typical of the Houston, Texas area would respond to different hydrological regimes that might occur if wetlands were drained in anticipation of a heavy rain that did not materialize, we conducted a mesocosm experiment with six flooding depths and seven drought durations, followed by seven months of recovery. We found that the speed in which mesocosms dried out was a function of initial water depth, with mesocosms initially set with greater water depths (30 cm) taking ~ 38 days to dry out versus zero days for wetlands that were completely drained. Individual plant species (14 species planted; 8 species common at the end of the recovery period) were affected by drought length, flooding depth, or their interaction, although details of these responses varied among the species. The composition of the plant community at the end of the drought period was strongly affected by drought length, and the effect of the drought length treatment persisted through seven months of post-drought recovery, with the 80- and 160-day drought treatments diverging most strongly from shorter drought treatments. Above- and below-ground biomass of plants was not affected by the treatments, but above-ground dead biomass (litter) decreased with increasing drought length. Densities of mosquito larvae, snails and tadpoles were temporally variable, and were affected more during the treatment period and early in recovery than after a disturbance event late in recovery. Our results indicate that managed wetlands in southeast Texas would be quite resilient to dry periods of up to 40 days in duration, especially if water was not completely drained at the beginning of the drought. In addition, many species would persist in managed wetlands even with droughts of up to 160 days. This indicates considerable potential for managing the hydroperiods of artificial detention ponds by retaining water longer to increase ecological function, with little to no loss of flood control services, and for managing the hydroperiods of natural wetlands by draining them in advance of anticipated rains to increase flood control services, with little to no loss of ecological function.

Newborn screening analytes and structural birth defects among 27,000 newborns.

BACKGROUND: Emerging evidence suggests newborn screening analytes may yield insights into the etiologies of birth defects, yet no effort has evaluated associations between a range of newborn screening analytes and birth defects. METHODS: This population-based study pooled statewide data on birth defects, birth certificates, and newborn screening analytes from Texas occurring between January 1, 2007 and December 31, 2009. Associations between a panel of thirty-six newborn screening analytes, collected by the statewide Texas Newborn Screening Program, and the presence of a birth defect, defined as at least one of 39 birth defects diagnoses recorded by the Texas Birth Defects Registry, were assessed using regression analysis. FINDINGS: Of the 27,643 births identified, 20,205 had at least one of the 39 birth defects of interest (cases) as identified by the Texas Birth Defects Registry, while 7,438 did not have a birth defect (controls). Among 1,404 analyte-birth defect associations evaluated, 377 were significant in replication analysis. Analytes most consistently associated with birth defects included the phenylalanine/tyrosine ratio (N = 29 birth defects), tyrosine (N = 28 birth defects), and thyroxine (N = 25 birth defects). Birth defects most frequently associated with a range of analytes included gastroschisis (N = 29 analytes), several cardiovascular defects (N = 26 analytes), and spina bifida (N = 23 analytes). CONCLUSIONS: Several significant and novel associations were observed between newborn screening analytes and birth defects. While some findings could be consequences of the defects themselves or to the care provided to infants with these defects, these findings could help to elucidate mechanisms underlying the etiology of some birth defects.

Morphology and vocalization comparison of the Houston Toad and the Dwarf American Toad: implications for their historic range.

Documenting changes in the distribution and abundance of a given taxon requires historical data. In the absence of long-term monitoring data collected throughout the range of a taxon, conservation biologists often rely on preserved museum specimens to determine the past or present, putative geographic distribution. Distributional data for the Houston Toad (Anaxyrus houstonensis) has consistently been confounded by similarities with a sympatric congener, the Dwarf American Toad (A. americanus charlesmithi), both in monitoring data derived from chorusing surveys, and in historical data via museum specimens. In this case, misidentification can have unintended impacts on conservation efforts, where the Houston Toad is federally endangered, and the Dwarf American Toad is of least concern. Previously published reports have compared these two taxon on the basis of their male advertisement call and morphological appearance, often with the goal of using these characters to substantiate their taxonomic status prior to the advent of DNA sequencing technology. However, numerous studies report findings that contradict one another, and no consensus on the true differences or similarities can be drawn. Here, we use contemporary recordings of wild populations of each taxon to test for quantifiable differences in male advertisement call. Additionally, we quantitatively examine a subset of vouchered museum specimens representing each taxon to test previously reported differentiating morphometric characters used to distinguish among other Bufonids of East-Central Texas, USA. Finally, we assemble and qualitatively evaluate a database of photographs representing catalogued museum vouchers for each taxon to determine if their previously documented historic ranges may be larger than are currently accepted. Our findings reveal quantifiable differences between two allopatric congeners with respect to their male advertisement call, whereas we found similarities among their detailed morphology. Additionally, we report on the existence of additional, historically overlooked, museum records for the Houston Toad in the context of its putative historic range, and discuss errors associated with the curation of these specimens whose identity and nomenclature have not been consistent through time. These results bookend decades of disagreement regarding the morphology, voice, and historic distribution of these taxa, and alert practitioners of conservation efforts for the Houston Toad to previously unreported locations of occurrence.

Exploring the relationship between grit scores and academic potential in baccalaureate nursing students.

BACKGROUND: An ongoing nursing shortage poses significant challenges to the healthcare industry, prompting nursing education programs to find ways to increase nurse graduates. Unfortunately, the problem of attrition in nursing education is significant. Despite many years of attrition research, educators still seek to find answers to determine what factors cause some students to succeed and others to fail in nursing programs. Noncognitive variables, like grit, have been largely overlooked as potential solutions to the problem of attrition. PURPOSE: The purpose of this study was to explore the extent to which grit predicts academic potential in baccalaureate nursing students. METHODS: This cross-sectional study included a total of 63 baccalaureate nursing students in their first semester of a four-semester nursing program at a mid-sized public university in East Texas. Participants took an electronic survey reporting demographic information, completing the Short Grit Scale (Grit-S), and consenting to release of their pre-admission science grade point average (sGPA), ATI Test of Essential Academic Skills (TEAS) exam scores, and first-semester nursing GPA (nGPA). RESULTS: When added to sGPA and TEAS scores, grit scores were not a statistically significant predictor of nGPA. Students with high grit scores were just as likely to experience attrition as those with low scores, and grit did not statistically significantly predict first-semester attrition. CONCLUSIONS: Nurse educators are encouraged to pursue strategies to address attrition in nursing education. Traditional selection criteria of sGPA and TEAS exam scores were shown to be predictors of nGPA. Additional research is warranted to explore the relationship between noncognitive variables, especially grit, and nursing student academic potential.

Spatiotemporal analysis of HPV vaccination and associated neighborhood-level disparities in Texas-an ecological study.

Background: HPV is responsible for most cervical, oropharyngeal, anal, vaginal, and vulvar cancers. The HPV vaccine has decreased cervical cancer incidence, but only 49% of Texas adolescents have initiated the vaccine. Texas shows great variation in HPV vaccination rates. We used geospatial analysis to identify areas with high and low vaccination rates and explored differences in neighborhood characteristics. Methods: Using Anselin's Local Moran's I statistic, we conducted an ecological analysis of hot and cold spots of adolescent HPV vaccination coverage in Texas from 2017 to 2021. Next, we utilized a Mann-Whitney U test to compare neighborhood characteristics of vaccination coverage in hot spots versus cold spots, leveraging data from the Child Opportunity Index (COI) and American Community Survey. Results: In Texas, there are 64 persistent vaccination coverage hotspots and 55 persistent vaccination coverage cold spots. The persistent vaccination coverage hot spots are characterized by ZIP codes with lower COI scores, higher percentages of Hispanic residents, higher poverty rates, and smaller populations per square mile compared to vaccine coverage cold spots. We found a more pronounced spatial clustering pattern for male adolescent vaccine coverage than we did for female adolescent vaccine coverage. Conclusion: In Texas, HPV vaccination coverage rates differ depending on the community's income level, with lower-income areas achieving higher success rates. Notably, there are also gender-based discrepancies in vaccination coverage rates, particularly among male adolescents. This knowledge can aid advocates in customizing their outreach initiatives to address these disparities.

Barriers to and facilitators of implementing colorectal cancer screening evidence-based interventions in federally qualified health centers: a qualitative study.

BACKGROUND: There is an urgent need to increase colorectal cancer screening (CRCS) uptake in Texas federally qualified health centers (FQHCs), which serve a predominantly vulnerable population with high demands. Empirical support exists for evidence-based interventions (EBIs) that are proven to increase CRCS; however, as with screening, their use remains low in FQHCs. This study aimed to identify barriers to and facilitators of implementing colorectal cancer screening (CRCS) evidence-based interventions (EBIs) in federally qualified health centers (FQHCs), guided by the Consolidated Framework for Implementation Research (CFIR). METHODS: We recruited employees involved in implementing CRCS EBIs (e.g., physicians) using data from a CDC-funded program to increase the CRCS in Texas FQHCs. Through 23 group interviews, we explored experiences with practice change, CRCS promotion and quality improvement initiatives, organizational readiness, the impact of COVID-19, and the use of CRCS EBIs (e.g., provider reminders). We used directed content analysis with CFIR constructs to identify the critical facilitators and barriers. RESULTS: The analysis revealed six primary CFIR constructs that influence implementation: information technology infrastructure, innovation design, work infrastructure, performance measurement pressure, assessing needs, and available resources. Based on experiences with four recommended EBIs, participants described barriers, including data limitations of electronic health records and the design of reminder alerts targeted at deliverers and recipients of patient or provider reminders. Implementation facilitators include incentivized processes to increase provider assessment and feedback, existing clinic processes (e.g., screening referrals), and available resources to address patient needs (e.g., transportation). Staff buy-in emerged as an implementation facilitator, fostering a conducive environment for change within clinics. CONCLUSIONS: Using CFIR, we identified barriers, such as the burden of technology infrastructure, and facilitators, such as staff buy-in. The results, which enhance our understanding of CRCS EBI implementation in FQHCs, provide insights into designing nuanced, practical implementation strategies to improve cancer control in a critical setting.

"It's different here" Afghan refugee maternal health experiences in the United States.

BACKGROUND: The number of Afghan families in the US has grown over the past two decades, yet there is a paucity of research focused on their maternal healthcare experiences. Afghan families have one of the highest fertility rates in the world and typically have large families. As the US faces rising maternal mortality rates, it is crucial to understand factors that affect health outcomes for culturally distinct groups. We aimed to better understand Afghan women's maternal health experiences in South Texas as a step toward designing culturally sensitive care. METHODS: Using a qualitative descriptive design, twenty Afghan women who gave birth in the US within the past 2 years participated in audio-recorded interviews. The first and second authors conducted each interview using a semi-structured interview guide. The authors used an in vivo coding method and qualitative content analysis of the transcribed narrative data. RESULTS: We identified three broad categories with corresponding sub-categories: 1) Maternal Healthcare Experiences: pregnancy, birthing, and postpartum, 2) Communication: language barrier, relationship with husband, and health information seeking, 3) Access to Care: transportation and financing healthcare. The participants expressed perspectives of gratefulness and positive experiences, yet some described stories of poor birth outcomes that led to attitudes of mistrust and disappointment. Distinct cultural preferences were shared, providing invaluable insights for healthcare providers. CONCLUSIONS: The fact that the Afghan culture is strikingly different than the US mainstream culture can lead to stereotypical assumptions, poor communication, and poor health outcomes. The voices of Afghan women should guide healthcare providers in delivering patient-centered, culturally sensitive maternity care that promotes healthy families and communities.

Psychological capital variables as protective factors in indigenous youth experiencing homelessness.

Indigenous youth in the United States are at high-risk for experiencing homelessness related to adverse childhood experiences such as parental substance use and low educational attainment. Such experiences may lead to adverse physical and mental health issues; these youth also have positive attributes of psychological capita (hope, self-efficacy, resilience, optimism) that are related to health outcomes. The purpose of this secondary analysis was to describe demographic attributes and psychological capital in Indigenous youth experiencing homelessness (IYEH) who participated in a longitudinal intervention study related to safe sex behaviors and life satisfaction. From a total of 602, Indigenous participants (n = 111; mean age 21.25 ± 1.82 years) were recruited from drop-in centers in Austin, Texas and Columbus, Ohio. Data were collected immediately after the intervention and at 3- and 6-month intervals. For this analysis, only data collected at the final time-point were used. Valid scales with Cronbach alphas of 0.75-0.92 (Hope, Resilience, Optimism, Self-efficacy for Substance Refusal, Self-efficacy for Safer Sex, Safe Sex Behaviors, Social Connectedness, and Life Satisfaction) were used. The majority of the IYEH reported smoking, drinking, and using drugs. Psychological capital variables of hope, self-efficacy for negotiating safer sex, resilience, and optimism were significantly related to one another, but not to safe sex behaviors or intention to use condoms. Resilience and optimism were significantly related to social connectedness but not to other psychological capital variables. Life satisfaction was significantly associated with hope, resilience, and optimism. Findings have implications for further theory and research development.

The N400 effect captures nuances in implicit political preferences.

We conducted a study in San Antonio, Texas, in the weeks preceding the 2022 state Governor election to determine if implicit or explicit measures of political preference could predict voter behavior. We adapted an established event-related potential (ERP) paradigm showing political statements to participants one word at the time where the last word made the statement pro-Republican or pro-Democratic. Our sample of college students included decided and undecided voters, and was reflective of the demographic make-up of south-central Texas. Our implicit measures were an established authoritarianism scale and the N400 effect to the sentence-final word. The N400 is an ERP to any stimulus that engages semantic memory and has been shown to measure implicit disagreement with political statements. Explicit measures of political preference and authoritarianism were predictive of vote choice. The expected N400 effect was found for Democratic voters, with larger amplitude to pro-Republican than pro-Democratic statements. Surprisingly, decided Republican voters showed no difference in N400 responses to pro-Republican and pro-Democratic statements and there was no group difference in the N400 effect. In turn, the N400 was not predictive of voter behavior. We argue that the N400 effect reflected individual political preferences, but that ultimately voter behavior aligned with partisan identity.

Neighborhood Resources and Health Outcomes Among Stroke Survivors in a Population-Based Cohort.

BACKGROUND: Stroke survivors believe neighborhood resources such as community centers are beneficial; however, little is known about the influence of these resources on stroke outcomes. We evaluated whether residing in neighborhoods with greater resource density is associated with favorable post-stroke outcomes. METHODS AND RESULTS: We included Mexican American and non-Hispanic White stroke survivors from the Brain Attack Surveillance in Corpus Christi project (2009-2019). The exposure was density of neighborhood resources (eg, community centers, restaurants, stores) within a residential census tract at stroke onset. Outcomes included time to death and recurrence, and at 3 months following stroke: disability (activities of daily living/instrumental activities of daily living), cognition (Modified Mini-Mental State Exam), depression (Patient Health Questionnaire-8), and quality of life (abbreviated Stroke-Specific Quality of Life scale). We fit multivariable Cox regression and mixed linear models. We considered interactions with stroke severity, ethnicity, and sex. Among 1786 stroke survivors, median age was 64 years (interquartile range, 56-73), 55% men, and 62% Mexican American. Resource density was not associated with death, recurrence, or depression. Greater resource density (75th versus 25th percentile) was associated with more favorable cognition (Modified Mini-Mental State Exam mean difference=0.838, 95% CI=0.092, 1.584) and among moderate-severe stroke survivors, with more favorable functioning (activities of daily living/instrumental activities of daily living=-0.156 [95% CI, -0.284 to 0.027]) and quality of life (abbreviated Stroke-Specific Quality of Life scale=0.194 [95% CI, 0.029-0.359]). CONCLUSIONS: We observed associations between greater resource density and cognition overall and with functioning and quality of life among moderate-severe stroke survivors. Further research is needed to confirm these findings and determine if neighborhood resources may be a tool for recovery.

PlanoUp!: A pilot program for the identification and treatment of depression for youth in low-income secondary schools.

Rates of depression in youth are continuing to increase at a steady rate, yet these youth often do not receive mental health services (Bertha & Balázs, 2013; Thomas et al., 2011). Schools are an ideal setting to connect youth to mental health services; however, many barriers exist with respect to schools having adequate resources and access to the appropriate levels of services (Duong et al., 2021; Owens & Peltier, 2002). Schools may collaborate with local community providers with available resources to address these gaps. The current article describes the pilot of a school-based mental health promotion program intended to reduce depression in youth by promoting access to care through referrals to community providers. Data were collected, via self-report measures, every 3 months for 12 months from students from three middle and high schools in North Texas. The students (N = 88) enrolled in this program experienced significant reductions in their depression symptoms at the end of 12 months. This program highlights the importance of school-community partnerships to promote access to care to address mental health concerns. The results from our pilot study demonstrate the feasibility and the potential of school-based programs in improving the mental health of youth in schools through community partnership. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Implementation of a High-Value, Evidence-Based Care Program: Impact and Opportunities for Learning Organizations.

GOAL: Value-based care is not simply a matter of cost, but also one of outcomes and harms per dollar spent. This definition encompasses three key components: healthcare delivery that is organized around patients' medical conditions, costs and outcomes that are actively and consistently measured, and information technology that enables the other two components. Our objective in this project was to implement and measure a systemwide high-value, evidence-based care initiative with five pillars of high-value practices. METHODS: We performed a quasi-experimental study from September 1, 2019, to August 31, 2022, of a new care program at the University of Texas Medical Branch. Drawing from the ABIM Foundation's Choosing Wisely Campaign, the program was based on five pillars-blood management and antimicrobial, laboratory, imaging, and opioid stewardship-with interdisciplinary teams led by institutional subject matter experts (i.e., administrative leaders) accompanied by nursing, information technology, pharmacy, and clinical and nonclinical personnel including faculty and trainees. Each pillar addressed two goals with targeted interventions to assess improvements during the first three fiscal years (FYs) of implementation. The targets were set at 10% improvement by the end of each FY. Monthly measurements were recorded for each FY. PRINCIPAL FINDINGS: We tracked performance toward 30 pillar goals and determined that the teams were successful in 50%, 50%, and 70% of their goals for FY 2020, 2021, and 2022, respectively. For example, in the antimicrobial stewardship FY 2021 pillar, one goal was to decrease meropenem days of therapy (DOT) by 10% (baseline was 45 DOT/1,000 patient days; the target was 40.5 DOT/1,000 patient days). We measured quarterly DOT/1,000 patient day rates of 32.02, 30.57, and 26.9, respectively, for a cumulative rate of 26.9. Critical interventions included engaging and empowering providers and service lines (including outliers whose performance was outside norms), educational conferences, and transparent data analyses. PRACTICAL APPLICATIONS: We showed that a multidisciplinary approach to the implementation of an evidence-based, high-value care program through a partnership of engaged administrative leaders, providers, and trainees can result in sustainable and measurable high-value healthcare delivery. Specifically, structuring the program with pillars to address defined metrics resulted in progressive improvement in meeting value-based goals at the University of Texas Medical Branch. Also, challenges can be embraced as learning opportunities to inform value-based interventions that range from technological to educational tactics. The results at the University of Texas Medical Branch provide a benchmark for the implementation of a program that engages, empowers, and aligns innovative value-based care initiatives.

Improving pediatric atopic dermatitis care in the emergency department and primary care setting: a collaborative quality improvement pilot project.

Emergency department visits and healthcare expenditures for pediatric atopic dermatitis have been increasing over the last two decades. There is a paucity of replicable quality improvement initiatives addressed at educating primary care and emergency medicine clinicians on this condition. The goal of this initiative was to improve clinician knowledge and comfort in the diagnosis and management of pediatric atopic dermatitis and superinfection. Clinicians were recruited via email from academic and community settings in Travis County, Texas, in 2020. They were sent a pre-intervention survey, a series of three quizzes, and a post-intervention survey. After each quiz, participants received performance feedback and various forms of multimodal education. Differences between the first and final quiz scores and clinician confidence levels were analyzed for statistical significance. Fifty-six clinicians completed the intervention. The average overall and treatment-specific scores increased significantly by 10% and 37%, respectively. Further, confidence levels improved significantly in the majority of clinicians. Clinician qualitative feedback revealed high satisfaction. Results from this educational quality improvement project have demonstrated that this is an effective and replicable resource for educating clinicians who manage pediatric atopic dermatitis in the emergency department and outpatient setting.

Supporting Local Public Health and Planning Professionals to Implement Built Environment Changes: A Technical Assistance Program to Promote Physical Activity in Texas.

Built environment approaches that improve active transportation infrastructure and environmental design can increase physical activity. Funded by the Centers for Disease Control and Prevention, the Texas Department of State Health Services rejuvenated the Texas Plan4Health program from 2018 to 2023 to expand such approaches in Texas by providing technical assistance to teams of local public health professionals and planners to identify and implement projects connecting people to everyday destinations via active transport in their communities. However, the COVID-19 pandemic prompted Texas Plan4Health to modify the delivery of technical assistance to accommodate restrictions on travel and in-person gatherings. We used qualitative methods to conduct a postintervention process evaluation to describe the modified technical assistance process, understand the experiences of the 4 participating communities, and identify short-term outcomes and lessons learned. Texas Plan4Health helped communities overcome common barriers to built environment change, facilitated collaboration across community public health and planning professionals, and educated professionals about active transportation infrastructure and the relationship between their disciplines, thereby increasing community capacity to implement built environment improvements. This outcome, however, was mediated by the pre-existing resources and previous experiences with active transportation planning among the participating communities. Public health practitioners seeking to improve active transportation infrastructure and environmental design for physical activity should consider community-engaged approaches that advance partnership-building and collaborative experiential education among public health, planning, and other local government representatives, directing particular attention and additional training toward communities with fewer resources.

Climate change anxiety, hurricane exposure, and climate change actions and attitudes: results from a representative, probability-based survey of US Gulf Coast residents.

BACKGROUND: Exposure to climate change-related threats (eg, hurricanes) has been associated with mental health symptoms, including post-traumatic stress symptoms. Yet it is unclear whether climate change anxiety, which is understudied in representative samples, is a specific mental health threat, action motivator, or both, particularly in populations exposed to climate-change related disasters. We sought to examine the associations between exposure to hurricanes, climate change anxiety, and climate change actions and attitudes in a representative sample of US Gulf Coast residents. METHODS: This study used data from a 5-year, representative, prospectively assessed, probability-based, longitudinal cohort sample of residents in Texas and Florida (USA) exposed to exogenous catastrophic hurricanes rated category 3 or greater. Participants were adults aged 18 years and older and were initially recruited from the Ipsos KnowledgePanel in the 60 h before Hurricane Irma (Sept 8-11, 2017). Relationships between climate change anxiety, hurricane exposure, hurricane-related post-traumatic stress symptoms, general functional impairment, and climate change-related individual-level actions (eg, eating a plant-based diet and driving more fuel efficient cars) and collective-level actions (eg, petition signing and donating money) and climate change action attitudes were evaluated using structural equation modelling. FINDINGS: The final survey was completed by 1479 individuals (787 [53·2%] women and 692 [46·8%] men). Two climate change anxiety subscales (cognitive-emotional impairment and perceived experience of climate change) were confirmed using confirmatory factor analysis. Mean values were low for both climate change anxiety subscales: cognitive-emotional impairment (mean 1·31 [SD 0·63], range 1-5) and perceived climate change experience (mean 1·67 [SD 0·89], range 1-5); these subscales differentially predicted outcomes. The cognitive-emotional impairment subscale did not significantly correlate with actions or attitudes; its relationship with general functional impairment was attenuated by co-occurring hurricane-related post-traumatic stress symptoms, which were highly correlated with general functional impairment in all three models (all p<0·0001). The perceived climate change experience subscale correlated with climate change attitudes (b=0·57, 95% CI 0·47-0·66; p<0·0001), individual-level actions (b=0·34, 0·21-0·47; p<0·0001), and collective-level actions (b=0·22, 0·10-0·33; p=0·0002), but was not significantly associated with general functional impairment in any of the final models. Hurricane exposure correlated with climate change-related individual-level (b=0·26, 0·10-0·42; p=0·0011) and collective-level (b=0·41, 0·26-0·56; p<0·0001) actions. INTERPRETATION: Expanded treatment for post-traumatic stress symptoms after disasters could help address climate change-related psychological distress; experiences with climate change and natural hazards could be inflection points to motivate action. FUNDING: National Science Foundation and the National Center for Atmospheric Research.

Childcare needs as a barrier to healthcare among women in a safety-net health system.

BACKGROUND: Childcare needs are an understudied social determinant of health. The effect of childcare needs on access to healthcare must be understood to inform health system interventions and policy reform. This study sought to characterize childcare needs, access to childcare, and prior experience with navigating childcare needs in healthcare settings among women in a safety-net population. METHODS: We conducted a cross-sectional study of patient-reported survey data collected in-person between April and October 2019. Surveys were administered in waiting rooms of ambulatory services in a large, urban safety-net health system in Dallas, Texas. Survey respondents were derived from a random convenience sample of women waiting for outpatient appointments. Participants were screened for having children under the age of 13 and/or childcare responsibilities for inclusion in the sample. Outcomes of interest included self-reported delayed or missed care, reasons for delayed or missed care, perceived difficulty in accessing childcare, prior methods for managing childcare during healthcare appointments, and prior experience with childcare centers. RESULTS: Among the 336 respondents (96.7% response rate), 121 (36.0%) reported delaying or missing a mean 3.7 appointments/year. Among women with delayed or missed care, 54.5% reported childcare barriers as the primary reason for deferral of care, greater than transportation (33%) or insurance (25%) barriers. Respondents rated childcare access as more difficult than healthcare access. Delayed or missed care due to childcare was more common among White (68.8%) and Black (55.0%) women compared to Hispanic women (34.3%). Common methods of navigating childcare needs during scheduled appointments included bringing children to appointments (69.1%) and re-scheduling or missing the scheduled appointment (43.0%). 40.6% of patients reported leaving an appointment before completion due to childcare needs. CONCLUSIONS: Childcare needs are a leading barrier to healthcare among women accessing care in safety-net settings. Unmet childcare needs result in deferral of care, which may impact health outcomes. Childcare access is perceived as more challenging than healthcare access itself. Health system and policy interventions are needed to address childcare as a social determinant of health.

"The Hotel of 10,000 Stars": The Impact of Social-Structural Determinants of Health Among Im/migrant Shrimpers in the Gulf of Mexico.

Objectives. To identify appropriate interventions to prevent injury, we conducted a qualitative study among commercial shrimp fishermen in the Gulf of Mexico. Methods. Using qualitative and participatory research methods, including interviews, photovoice, and workplace observations in southeast Texas and the Rio Grande Valley in Texas, we examined the social‒structural dimensions that contribute to physical and psychological injury. Results. We found that multiple layers of vulnerability and danger exist among shrimpers with interacting themes: (1) recognizing risk, (2) precarious employment, and (3) psychological distress. Conclusions. Our results add to the growing body of knowledge that emphasizes the negative health impacts of underregulated, high-risk, and physically demanding work performed primarily by im/migrants. Public Health Implications. Our findings highlight the larger social‒structural conditions and context of hardships endemic to migrant labor and suggest implications for practice and policy interventions. (Am J Public Health. 2024;114(8):824-832. https://doi.org/10.2105/AJPH.2024.307696).

Intraspecific variation in Gyrodactylus mediotorus and G. crysoleucas (Gyrodactylidae) from Nearctic shiners (Leuciscidae): evidence for ongoing speciation, host-switching, and parasite translocation.

A parasitological investigation of Cyprinella venusta and Notropis cf. stramineus sampled in Texas, USA, in the Guadalupe River, revealed the presence of Gyrodactylus crysoleucas Mizelle and Kritsky, 1967 on C. venusta, and Gyrodactylus mediotorus King, Marcogliese, Forest, McLaughlin & Bentzen, 2013 on both fish species. This represents new leuscicid fish hosts and locality records for these two gyrodactylids. Gyrodactylus crysoleucas previously identified from both non-native Californian Notemigonus crysoleucas and from farmed stocks in Minnesota demonstrated intraspecific variability in terms of morphology and genetics as a local adaptation associated with isolation by distance. Results further confirmed G. crysoleucas as alien in the western USA and suggested host-switching involving C. venusta and N. crysoleucas. Conservative morphology and genetics on the part of G. mediotorus from C. venusta and N. cf. stramineus (Guadalupe River) was observed, while higher genetic divergence in the ITS sequences associated with morphological discrepancy was found between the studied G. mediotorus specimens and those of Notropis hudsonius than when considering the parasites of Notropis texanus. The separation of G. mediotorus into geographical subgroups may indicate ongoing speciation linked to the Pleistocene glaciations in North America, and to hydrographic barriers that facilitated separate evolutionary paths leading to speciation. We suggest that deep investigations of Gyrodactylus populations will help to understand the speciation of these parasites and their adaptation to Nearctic fish hosts.

Title: Variation intraspécifique chez Gyrodactylus mediotorus et G. crysoleucas (Gyrodactylidae), parasites de ménés néarctiques (Leuciscidae) : preuves d'une spéciation en cours, d'un changement d'hôte et d'une translocation de parasites. Abstract: Une enquête parasitologique sur Cyprinella venusta et Notropis cf. stramineus échantillonnés au Texas, États-Unis, dans la rivière Guadalupe, a révélé la présence de Gyrodactylus crysoleucas Mizelle et Kritsky, 1967 sur C. venusta, et de Gyrodactylus mediotorus King, Marcogliese, Forest, McLaughlin & Bentzen, 2013 sur les deux espèces de poissons. Ceci représente de nouveaux poissons Leuciscidae hôtes et des nouvelles localités pour ces deux Gyrodactylidae. Gyrodactylus crysoleucas, identifié précédemment à partir de Notemigonus crysoleucas californiens non indigènes et de stocks d'élevage du Minnesota a démontré une variabilité intraspécifique en termes de morphologie et de génétique en tant qu'adaptation locale associée à l'isolement par la distance. Les résultats ont en outre confirmé que G. crysoleucas était exotique dans l'ouest des États-Unis et ont suggéré un changement d'hôte impliquant C. venusta et N. crysoleucas. Une morphologie et une génétique conservatrices pour G. mediotorus de C. venusta et N. cf. stramineus (rivière Guadalupe) ont été observées, tandis qu'une divergence génétique plus élevée dans les séquences ITS, associée à une divergence morphologique, a été trouvée chez les spécimens étudiés de G. mediotorus et de Notropis hudsonius lorsque l'on considère les parasites de Notropis texanus. La séparation de G. mediotorus en sous-groupes géographiques peut indiquer une spéciation continue liée aux glaciations du Pléistocène en Amérique du Nord et à des barrières hydrographiques qui ont facilité des chemins évolutifs séparés menant à la spéciation. Nous suggérons que des études approfondies sur les populations de Gyrodactylus aideront à comprendre la spéciation de ces parasites et leur adaptation aux poissons hôtes néarctiques.