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PubMedDate not supplied

A comparative cost analysis of newborn screening for classic congenital adrenal hyperplasia in Texas.

OBJECTIVE: Texas mandates a two-test newborn screening program for congenital adrenal hyperplasia (CAH): one test at birth and a second test at approximately one to two weeks after birth. The authors compared the dollar cost of detecting infants with CAH clinically and through the screening program. METHODS: The authors estimated the costs of screening newborns in 1994 for CAH, including resources used by the Texas Department of Health and the broader cost to society. RESULTS: Fifteen infants with classic CAH were diagnosed in Texas in 1994 among 325,521 infants born (1:21,701 cumulative incidence). Seven infants were detected clinically and the others were detected through screening, six on the first screen and two on the second screen. The first screen identified all previously undetected infants with severe salt-wasting CAH. The cumulative cost to diagnose the seven infants detected clinically was $79,187. The incremental costs for the screening program were $115,169 per additional infant diagnosed through the first screen and $242,865 per additional infant diagnosed through the second screen. CONCLUSIONS: If the goal is early diagnosis of infants with the severe salt-wasting form of CAH, a single screen is effective. If the goal is to detect infants with the simple virilizing form of the disorder who may benefit from early treatment, the second screen is necessary, but it is not as cost-effective as the first screen.

Adrenal Hyperplasia, Congenital↗
PubMed1998

Ciguatera fish poisoning--Texas, 1997.

On October 21, 1997, the Southeast Texas Poison Center was contacted by a local physician requesting information about treatment for crew members of a cargo ship docked in Freeport, Texas, who were ill with nausea, vomiting, diarrhea, and muscle weakness. This report summarizes an investigation of this outbreak by the Texas Department of Health (TDH), which indicated that 17 crew members experienced ciguatera fish poisoning resulting from eating a contaminated barracuda.

Ciguatera Poisoning↗
PubMed1998

Clinical data for use in assessing quality: lessons learned from the Texas Nurses' Association Report Card Project.

The purpose of this report is to describe the Texas Nurses' Association Report Card Project. As part of ANA's Safety and Quality Initiative, the project was designed as a feasibility study to determine whether clinically based quality indicator data could be collected in standard ways across acute care agencies in Texas. Clinicians from 12 agencies, under leadership of the professional association (Texas Nurses' Association), participated in this initial effort to reach consensus on clinical indicator definitions and on how to collect clinical data for each indicator. Data were collected for falls and injuries, bacteremias, pressure ulcers, skill mix, nursing hours per patient day, patient satisfaction (with nursing, hospital stay, education, and pain management), and nurse satisfaction. The process used is described, as well as the findings and the lessons learned. The importance of standard definitions and precise and standard primary sources for the data are emphasized for the phase II report card efforts to follow.

Data Interpretation, Statistical↗
PubMed1998

Endocotyle bushi (Trematoda: Microphallidae) from willets, Catoptrophorus semipalmatus from Galveston, Texas.

During a study of Digenea of shorebirds from Galveston, Texas, 30% (30 of 99) of willets, Catoptrophorus semipalmatus (Charadriiformes), were found to be infected with 55-405 Endocotyle bushi per infected host. Although the specimens from Texas generally agree with E. bushi from Florida, specimens from Texas are less elongated, have a more triangular to heart-shaped ovary, have slightly larger eggs, and have a smaller seminal vesicle.

Animals↗
PubMed1998

Impact of HIV on the practice of dentistry in Houston, Texas.

Texas ranks fourth in the nation in the number of documented HIV-infected and AIDS cases. The city of Houston has the highest prevalence of HIV-infected and AIDS cases in Texas. Dental health personnel have an ethical and legal obligation to provide dental services for HIV-infected persons. The purpose of this study was to assess the impact of HIV on the practice of dentistry in Houston. The study population was all dentists with a current Houston practice address registered with the Texas State Dental Board. A 41-item questionnaire was mailed to a stratified random sample of 500 dentists in Houston. The questionnaire covered four main areas: demographics, knowledge, attitudes, and behavior. About three-quarters of the dentists said they had treated an AIDS or HIV+ patient. Sixty percent of the dentists were not aware that breastmilk is a mode of transmission of HIV. There was a significant correlation between "ever treated" an HIV+ patients and "willingness to treat" an AIDS or HIV+ patient (p < 0.01). The experience of treating HIV-infected patients has a greater impact than knowledge alone in influencing dentists' behavior towards AIDS/HIV+ patients.

Acquired Immunodeficiency Syndrome↗
PubMed1999

Measuring costs of guideline-driven mental health care: the Texas Medication Algorithm Project.

BACKGROUND: Algorithms describe clinical choices to treat a specific disorder. To many, algorithms serve as important tools helping practitioners make informed choices about how best to treat patients, achieving better outcomes more quickly and at a lower cost. Appearing as flow charts and decision trees, algorithms are developed during consensus conferences by leading experts who explore the latest scientific evidence to describe optimal treatment for each disorder. Despite a focus on "optimal" care, there has been little discussion in the literature concerning how costs should be defined and measured in the context of algorithm-based practices. AIMS OF THE STUDY: This paper describes the strategy to measure costs for the Texas Medication Algorithm project, or TMAP. Launched by the Texas Department of Mental Health and Mental Retardation and the University of Texas Southwestern Medical Center at Dallas, this multi-site study investigates outcomes and costs of medication algorithms for bipolar disorder, schizophrenia and depression. METHODS: To balance costs with outcomes, we turned to cost-effectiveness analyses as a framework to define and measure costs. Alternative strategies (cost-benefit, cost-utility, cost-of-illness) were inappropriate since algorithms are not intended to guide resource allocation across different diseases or between health- and non-health-related commodities. "Costs" are operationalized consistent with the framework presented by the United States Public Health Service Panel on Cost Effectiveness in Medicine. Patient specific costs are calculated by multiplying patient units of use by a unit cost, and summing over all service categories. Outpatient services are counted by procedures. Inpatient services are counted by days classified into diagnosis groups. Utilization information is derived from patient self-reports, medical charts and administrative file sources. Unit costs are computed by payer source. Finally, hierarchical modeling is used to describe how costs and effectiveness differ between algorithm-based and treatment-as-usual practices. DISCUSSION: Cost estimates of algorithm-based practices should (i) measure opportunity costs, (ii) employ structured data collection methods, (iii) profile patient use of both mental health and general medical providers and (iv) reflect costs by payer status in different economic environments. IMPLICATION FOR HEALTH CARE PROVISION AND USE: Algorithms may help guide clinicians, their patients and third party payers to rely on the latest scientific evidence to make treatment choices that balance costs with outcomes. IMPLICATION FOR HEALTH POLICIES: Planners should consider consumer wants and economic costs when developing and testing new clinical algorithms. IMPLICATIONS FOR FURTHER RESEARCH: Future studies may wish to consider similar methods to estimate costs in evaluating algorithm-based practices.

Journal Article↗
PubMed2003

The uptake of Texas Red-BSA in the excretory system of schistosomes and its colocalisation with ER60 promoter-induced GFP in transiently transformed adult males.

The excretory system of schistosomes has focused some attention during the last years since accumulating evidence suggests that it plays an important role in the host-parasite interaction. Signalling molecules such as phosphatases, but also proteases have been localised in the excretory system. To some extent, however, localisation studies are limited by the fact that sections of fixed specimens are used. In this study, we tested the fluorescent molecules FITC-dextran and Texas Red-BSA for their ability to enter the excretory system of living Schistosoma mansoni males. It is demonstrated that the dyes selectively stain the excretory tubules which are widely distributed along the worm body. This finding was used to investigate whether the staining of worms with Texas Red-BSA can help to localise transgene activity in worms which were transiently transformed by particle bombardment. A vector was used for transformation which contained the green fluorescent protein gene, under the control of the regulatory elements of the cysteine protease ER60 gene. After transformation and staining, confocal laser scanning microscopy revealed that ER60-induced green fluorescent protein activity colocalises with Texas Red-BSA in the excretory tubules. The results suggest a role for ER60 during the host-parasite interaction. Furthermore, the colocalisation approach introduced here opens further perspectives to characterise gene-expression profiles in this parasite.

Animals↗
PubMed2002

Age-related reference ranges for complexed prostate-specific antigen and complexed/total prostate-specific antigen ratio: results from East Texas Medical Center Cancer Institute screening campaign.

The East Texas Medical Center Cancer Institute conducted a regional prostate cancer screening campaign over a 3-year period from 1998 through 2000. Total prostate-specific antigen (tPSA), complexed PSA (cPSA), and cPSA/tPSA ratio (c/tPSA) values were determined. To better define prostate cancer in the population, we chose to determine age-based reference ranges for these PSA isoforms in apparently healthy men. Participants (N = 12,902) between the ages of 20 and 94 were screened and demographic information and serum tPSA and cPSA values were collected across 41 centers throughout East Texas. Men with an abnormal digital rectal examination, a follow-up biopsy indicating prostatic disease, or any clinical signs and symptoms of prostatic disease were excluded. Sera from 7541 evaluable men were tested with the Bayer Immuno 1 PSA and cPSA methods at East Texas Medical Center. The resulting PSA data were then stratified by decade of age to determine age-related reference ranges for each PSA species. The cPSA values increased across all age decades: 40 to 49 years, 1.45 ng/mL; 50 to 59, 1.92 ng/mL; 60 to 69, 2.49 ng/mL; and 70 to 79, 2.77 ng/mL (95th percentile). tPSA levels also increased with age: 1.81 ng/mL, 2.45 ng/mL, 3.17 ng/mL, and 3.57, respectively. Comparatively, the c/tPSA levels remained constant (0.87), regardless of age. The upper limits of tPSA and cPSA values reported here suggest that men should be screened using lower cutoff values than are currently in use. These limits may more accurately identify prostate cancer among otherwise healthy men.

Adult↗
PubMed2001

Effects of land use data on dry deposition in a regional photochemical model for eastern Texas.

Land use data are among the inputs used to determine dry deposition velocities for photochemical grid models such as the Comprehensive Air Quality Model with extensions (CAMx) that is currently used for attainment demonstrations and air quality planning by the state of Texas. The sensitivity of dry deposition and O3 mixing ratios to land use classification was investigated by comparing predictions based on default U.S. Geological Survey (USGS) land use data to predictions based on recently compiled land use data that were collected to improve biogenic emissions estimates. Dry deposition of O3 decreased throughout much of eastern Texas, especially in urban areas, with the new land use data. Predicted 1-hr averaged O3 mixing ratios with the new land use data were as much as 11 ppbv greater and 6 ppbv less than predictions based on USGS land use data during the late afternoon. In addition, the area with peak O3 mixing ratios in excess of 100 ppbv increased significantly in urban areas when deposition velocities were calculated based on the new land use data. Finally, more detailed data on land use within urban areas resulted in peak changes in O3 mixing ratios of approximately 2 ppbv. These results indicate the importance of establishing accurate, internally consistent land use data for photochemical modeling in urban areas in Texas. They also indicate the need for field validation of deposition rates in areas experiencing changing land use patterns, such as during urban reforestation programs or residential and commercial development.

Agriculture↗
PubMed1981

Gametic frequency of second chromosomes of the T-007 type in a natural population of Drosophila melanogaster in Texas.

The T-007 second chromosome, which was isolated from a natural population of Drosophila melanogaster in south Texas in 1970, is known to show, when made heterozygous in males with a standard cn bw second chromosome, a transmission frequency (k) of 0.35-much lower than the theoretically expected 0.5. Natural populations of this species in Texas contain second chromosomes that, against the standard cn bw genetic background, are associated with distorted transmission frequencies comparable to that of the T-007 chromosome. In order to explain how such chromosomes can persist in natural populations in nontrivial frequencies, it has been postulated that, although such chromosomes show reduced k values when tested under the genetic background of a laboratory stock such as cn bw, they may show, on the average, k values larger than 0.5 under natural genetic backgrounds. If this were true, the frequency of chromosomes of the T-007 type (T chromosomes) should be higher in male than in female gametes under natural genetic backgrounds. The present study was conducted to examine this possibility. The results clearly showed that the frequency of such chromosomes was much higher among male than among female gametes, and that the transmission frequency of this type of chromosome was higher than 0.5 under natural genetic backgrounds. These results suggest that T chromosomes behave like Segregation Distorter (SD) chromosomes in natural populations of this species in Texas. A possible relationship between T-007 and SD chromosomes is suggested.

Animals↗
PubMed2004

Influence of the type of anesthesia provider on costs of labor analgesia to the Texas Medicaid program.

BACKGROUND: The Texas Medicaid Program (Medicaid) defines billable time for labor analgesia as face-to-face time; therefore, anesthesia providers determine billed time. The authors' goal was to determine the influence of anesthesia providers on labor analgesia costs billed to Medicaid. METHODS: Under the Freedom of Information Act, Medicaid provided data on claims paid for 6 months in 2001 for labor analgesia administered during the course of a vaginal delivery. Claims were either time based (codes 00946 or 00955) or a flat fee (codes 26311 or 26319). Using modifiers, the authors grouped time-based claims as either anesthesiologist group or certified registered nurse anesthetist (CRNA) group. The cost to Medicaid was based on the 2001 fee schedule. The conversion factor was 18.21 USD per American Society of Anesthesiologists unit. The flat-fee reimbursement was 152.50 USD. CRNA services were paid at 85% of the fee schedule. Average time per time claim, percent of providers with more than 4 h of billed time, and cost per claim were determined for each group. Providers with more than 120 claims (> 20 claims/month) were considered high-volume. RESULTS: The database included 21,378 claims (anesthesiologist group: 12,698 claims from 219 providers; CRNA group: 8,680 claims from 117 providers). For time-based claims, the average time per case was significantly higher in the CRNA group (146 min) than in the anesthesiologist group (105 min). The CRNA group cost to Medicaid (225.11 USD) was 19% more per claim than the anesthesiologist group (189.26 USD). The difference in cost per claim was greater among high-volume providers--213.10 USD for the CRNA group versus 168.76 USD for the anesthesiologist group. If a flat-fee program were instituted using the average cost per claim for all groups (203.81 USD), the Texas Medicaid program would save more than 500,000 USD annually. CONCLUSIONS: The costs of labor analgesia billed to Texas Medicaid were 19% to 26% less per patient when provided by anesthesiologists than by CRNAs, despite lower per-unit reimbursement of CRNAs.

Analgesia, Obstetrical↗
PubMed2025

Wastewater Sequencing Reveals Persistent Circulation and Rising Prevalence of Several Oncogenic Viruses Across Texas.

BACKGROUND: Oncogenic viruses cause high-risk cancers in humans and are responsible for nearly 20% of all cancer cases worldwide. Currently, very limited data exists in the realm of wastewater-based viral epidemiology (WBE) of cancer-causing viruses, with existing studies using targeted approaches (i.e PCR-based approaches) which lack scalability. Our study aims to carry out WBE with hybrid-capture probes to detect and track multiple oncogenic viruses simultaneously in wastewater across Texas, USA, overcoming the drawbacks associated with targeted approaches. METHODS: Here, we used a hybrid-capture approach to detect, filter and sequence oncogenic virus signals from wastewater samples collected over a duration of three years, from May 2022 to May 2025. Once viral reads were sequenced, we utilized established computational tools to characterize reads into their respective virus of origin. Next, viral abundances of each characterized oncogenic virus were tracked over time and read coverage across their genomes was measured using read mapping techniques. FINDINGS: We detected six known oncogenic viruses, along with three suspected oncogenic viruses across all sampling locations within Texas. Over three years, viral abundance gradually increased, with distinct peaks and dips over the summer and winter months. The prevalence of high-risk viruses such as HPV and EBV rose sharply, with increases in abundance observed post-2024. We also obtained nearly 100% genome coverage with viral reads captured using a hybrid-capture technique for almost all oncogenic viruses and their types. INTERPRETATIONS: Our study shows that a hybrid-capture method can efficiently overcome the challenges faced with using targeted approaches for WBE. Using this method, we get broader read coverage, coupled with concurrent and consistent real-time tracking dynamics of multiple oncogenic viruses. Our findings also emphasize the persistent circulation and rising prevalence of high-risk cancer-causing viruses, underscoring the need for sustained public health interventions to protect communities and assess viral prevalence in high-risk populations. FUNDING: This work was supported by S.B. 1780, 87th Legislature, 2021 Reg. Sess. (Texas 2021), the Baylor College of Medicine and the Alkek Foundation Seed Funds.

Journal Article↗
PubMed1981

Trends in cardiovascular mortality in Spanish-surnamed, other white, and black persons in Texas, 1970--1975.

Certain categories of cardiovascular disease have significantly declined recently as causes of death. In the present investigation we describe the variation in cardiovascular mortality in Texas by ethnicity, age and sex during 1970--1975 using age-standardized proportional mortality ratios. Specifically, the question of whether the three major ethnic groups in Texas have shared equally in any changes in cardiovascular mortality is examined. Several subcategories of cardiovascular mortality are considered. Among the sex-ethnic groups both ischemic heart disease and acute myocardial infarction mortality declined less among Spanish-surnamed males and females than in their other white and black counterparts. Chronic ischemic heart disease increased in relative importance for all groups except Spanish-surnamed females, in whom it decreased. There was no significant decrease in cerebrovascular disease mortality among Spanish-surnamed males or females as there was in the other groups. These results suggest that important differences in cause-structure of mortality are occurring in the ethnic subpopulations of Texas.

Acute Disease↗
PubMed2001

Prevalence of virulent Rhodococcus equi in soil from five R. equi-endemic horse-breeding farms and restriction fragment length polymorphisms of virulence plasmids in isolates from soil and infected foals in Texas.

Rhodococcus equi isolates (462) obtained from 64 soil samples collected on 5 R. equi-endemic horse-breeding farms and isolates from 100 infected foals in Texas were examined to determine the prevalence and genotypic diversity of virulence-associated plasmids. Isolates were tested for the presence of 15-17-kDa virulence-associated protein antigens (VapA) by immunoblotting and virulence-associated plasmids by PCR. Plasmid DNAs were isolated and analyzed by digestion with restriction endonucleases for estimation of size and comparison of polymorphisims. Rhodococcus equi were isolated from soil of all 5 farms; however, virulent R. equi were only isolated from 3 of the 5 farms and represented 18.8% (87 of 462) of total isolates. Of the 87 virulent soil isolates, 56 (64.5%) contained an 85-kb type I plasmid, 23 (26.4%) an 87-kb type I plasmid, 7 (8%) a newly defined 85-kb type III plasmid (Tx 43), and 1 (1.1%) a newly defined 85-kb type IV plasmid (Tx 47). Of the 100 isolates from infected foals, 96 were virulent. Of the 96 virulent isolates, 51 (53.1%) contained an 85-kb type I plasmid, 39 (40.6%) an 87-kb type I plasmid, 4 (4.2%) an 85-kb type III plasmid (Tx 43), and 2 (2.1%) an 85-kb type IV plasmid (Tx 47). There are at least 4 different R. equi virulence-associated plasmids in Texas, 2 of which have not previously been described. Based upon virulence plasmid typing, there is geographic diversity among isolates of R. equi from clinical and environmental samples on horse-breeding farms in Texas. There is not a strong correlation between the presence of virulent R. equi in farm soils and the R. equi disease status of those farms.

Actinomycetales Infections↗
PubMed2001

Sitaxsentan (ICOS-Texas Biotechnology).

ICOS-Texas Biotechnology is developing the endothelin A (ETA) receptor antagonist, sitaxsentan, for the potential treatment of pulmonary hypertension, congestive heart failure (CHF), chronic obstructive pulmonary disease and subarachnoid hemorrhage [205713], [302200]. The compound is in phase IIa trials as an iv formulation for CHF and has completed phase I safety trials as an oral formulation [272071]. Phase II/III trials for pulmonary hypertension are planned for the first quarter of 2001 [3945711]. In June 2000, ICOS and Texas Biotechnology established a joint venture to develop and commercialize endothelin antagonists [370007]. US-05591761 was issued to Texas in January 1997, covering TBC-11251 and several related isomers [2309301.

Animals↗
PubMed2002

Screening for hydroxychloroquine toxicity by Texas ophthalmologists.

OBJECTIVE: To determine current practice patterns for screening for hydroxychloroquine (HCQ) toxicity by Texas ophthalmologists. METHODS: A survey was sent to all comprehensive ophthalmologists and retina specialists in the state of Texas. Questions included need for baseline examinations, frequency of followup, tests used to monitor for toxicity, and influences on monitoring regimen. RESULTS: Two hundred ninety of 577 surveys were returned correctly completed (response rate = 50.3%). Two hundred fifty-seven respondents (88.6%) felt a baseline examination was necessary prior to beginning HCQ therapy, and 223 (76.9%) followed patients every 6 months during HCQ therapy. Visual acuity, slit lamp examination, and dilated fundus examination were performed on almost all patients, and about three-quarters of respondents also checked visual fields and color vision. While 183 ophthalmologists (63.1%) used the Ishihara pseudoisochromatic plates to check color vision, there was no consensus on the preferred visual field test. One hundred twenty-two respondents (42.1%) stated they had diagnosed a patient with HCQ ocular toxicity. CONCLUSION: Most ophthalmologists in Texas continue to perform baseline examinations and follow HCQ patients semiannually for the development of ocular toxicity despite recent recommendations questioning the need for such close followup. The majority check visual acuity, perform slit lamp and dilated fundus examinations, and test color vision and visual fields, although there is no consensus on the preferred method to test visual fields.

Antirheumatic Agents↗
PubMed1994

Physician, manage thyself. Texas doctors form IPAs to gain control of health-care delivery.

Mention managed care to most physicians, and the first thing they think of is loss of independence. Specifically, they associate managed care with having to answer to someone they may not agree with over how to treat their patients and run their practices. As managed care plans penetrate ever deeper into Texas, more and more physicians are looking for ways to minimize that loss of autonomy. And in many cases, they are finding it in the form of physician-driven independent practice associations (IPAs). Such associations are growing rapidly in virtually every corner of the state. Texas physicians, fearful of what health-system reform may bring to them and their patients and determined to control their fates, are becoming allies in IPAs. Texas, in fact, is quickly catching up with many urban states in the formation of IPAs. However, to meet specific local needs, several groups are introducing some unique forms of practice associations to the mix.

Delivery of Health Care↗
PubMed2006

The Texas Children's Medication Algorithm Project: revision of the algorithm for pharmacotherapy of attention-deficit/hyperactivity disorder.

OBJECTIVE: In 1998, the Texas Department of Mental Health and Mental Retardation developed algorithms for medication treatment of attention-deficit/hyperactivity disorder (ADHD). Advances in the psychopharmacology of ADHD and results of a feasibility study of algorithm use in community mental health centers caused the algorithm to be modified and updated. METHOD: We convened a consensus conference of academic clinicians and researchers, practicing clinicians, administrators, consumers, and families to revise the algorithms for the pharmacotherapy of ADHD itself as well as ADHD with specific comorbid disorders. New research was reviewed by national experts, and rationales were provided for proposed changes and additions to the algorithms. The changes to the algorithms were discussed and approved both by the national experts and experienced clinicians from the Texas public mental health system. RESULTS: The panel developed consensually agreed-upon algorithms for ADHD with and without comorbid disorders. The major changes included elimination of pemoline as a treatment option, adding atomoxetine to the algorithm, and refining guidelines for treating ADHD with comorbid depression, aggressive behaviors, and tic disorders. CONCLUSIONS: Medication algorithms for ADHD can be modified to keep abreast of developments in the field. Although these evidence- and consensus-based treatment recommendations may be a useful approach to guide the treatment of ADHD in children, additional research is needed to determine how these algorithms can be used to maximally benefit child outcomes.

Adrenergic Uptake Inhibitors↗