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A condensed disaggregation procedure has been employed to generate synthetic recharge sequences for the Edwards aquifer in the San Antonio region. Two stochastic processes ae used in the procedure: a multivariate annual flow generator, and an annual-to-monthly disaggregation model. The processes are multivariate, first-order autoregressive, implemented in SPIGOT, and fit to a 58-yr historical record based on U.S. Geological Survey (USGS) recharge estimates for the nine river basins of the Edwards aquifer recharge zone. Transformations of basin recharge are employed in order for the autoregressive models to reproduce the marginal distributions of recharge. Validation of the synthetic recharge generation procedure shows some discrepancies between the marginal distributions, correlations, and drought characteristics of the historical and synthetic flows. [ABSTRACT FROM AUTHOR]

Background: This study assessed the psychometric properties of the 10-item Connor Davidson Resilience Scale (CD-RISC-10), a self-report measure of resilience, in youth receiving treatment and/or screening positive for depression/suicidality in psychiatric outpatient settings., Methods: Data from 908 youth (age 12-20 years) were analyzed. A confirmatory factor analysis (CFA) model was fit to the data, and goodness-of-fit was assessed using indices such as the comparative fit index (CFI). Psychometric analyses were performed through the lenses of classical test theory (CTT) and item response theory (IRT). Measurement invariance of the scale was assessed by classifying the sample by depression severity. Finally, intraclass correlation coefficients (ICC) from test-retest were used to assess the reliability of the scale using data collected at baseline and one-month post-baseline., Results: The scale was unidimensional, representing a single latent trait. CFA demonstrated acceptable model fit (CFI = 0.94). CTT analyses showed good internal consistency (Cronbach's alpha 0.85) and good item discrimination (item-total correlations between 0.38 and 0.66). The scale demonstrated good test-retest reliability over a one-month period (ICC = 0.82). IRT analyses exhibited good item performance on all but the three items related to versatility, humor and persistence. These items were also deterrent to the scale having full scalar invariance., Limitations: Limitations include questionable generalizability beyond the sample and biases inherent in self-report scales., Conclusions: CD-RISC-10 has acceptable reliability and validity. However, depressive symptom severity affected selected item performance. If these findings are confirmed in other independent samples, a seven-item version of the scale may be investigated for depressed samples., Competing Interests: Declaration of competing interest Dr. Madhukar H. Trivedi has provided consulting services to Alkermes Inc., Axsome Therapeutics, Biogen MA Inc., Cerebral Inc., Circular Genomics Inc., Compass Pathfinder Limited, GH Research Limited, Heading Health Inc., Janssen, Legion Health Inc., Merck Sharp & Dohme Corp., Mind Medicine (MindMed) Inc., Merck Sharp & Dhome LLC, Naki Health, Ltd., Neurocrine Biosciences Inc., Noema Pharma AG, Orexo US Inc., Otsuka American Pharmaceutical Inc., Otsuka Canada Pharmaceutical Inc., Otsuka Pharmaceutical Development & Commercialization Inc., Praxis Precision Medicines Inc., SAGE Therapeutics, Sparian Biosciences Inc., Takeda Pharmaceutical Company Ltd., WebMD. He sits on the Scientific Advisory Board of Alto Neuroscience Inc., Cerebral Inc., Compass Pathfinder Limited, Heading Health, GreenLight VitalSign6 Inc., Legion Health Inc., Merck Sharp & Dohme Corp, Orexo US Inc., Signant Health. He holds stock in Alto Neuroscience Inc., Cerebral Inc., Circular Genomics Inc., GreenLight VitalSign6 Inc., Legion Health Inc. Additionally, he has received editorial compensation from American Psychiatric Association, and Oxford University Press. Dr. A. John Rush has received consulting fees from Compass Inc., Curbstone Consultant LLC, Emmes Corp., Evecxia Therapeutics, Inc., Holmusk Technologies, Inc., ICON, PLC, Johnson and Johnson (Janssen), Liva-Nova, MindStreet, Inc., Neurocrine Biosciences Inc., Otsuka-US; speaking fees from Liva-Nova, Johnson and Johnson (Janssen); and royalties from Wolters Kluwer Health, Guilford Press and the University of Texas Southwestern Medical Center, Dallas, TX (for the Inventory of Depressive Symptoms and its derivatives). He is also named co-inventor on two patents: U.S. Patent No. 7,795,033: Methods to Predict the Outcome of Treatment with Antidepressant Medication, Inventors: McMahon FJ, Laje G, Manji H, Rush AJ, Paddock S, Wilson AS; and U.S. Patent No. 7,906,283: Methods to Identify Patients at Risk of Developing Adverse Events During Treatment with Antidepressant Medication, Inventors: McMahon FJ, Laje G, Manji H, Rush AJ, Paddock S. Dr. Cynthia Claassen currently serves as a consultant to LivaNova, LLC and has previously consulted with the National Institute for Mental Health. She has received speaking fees from a variety of nonprofit organizations. Dr. David Farmer serves as an Executive Committee Member of the Texas Child Mental Health Care Consortium. Dr. Sarah M. Wakefield serves as an Executive Committee Member of the Texas Child Mental Health Care Consortium. Dr. Cesar A. Soutullo has worked, in the last 3 years, as a Consultant/Advisory Board member of: NeuroTech Solutions Ltd. (Israel), Limbix Health/BigHealth (US), and Inno-sphere (Germany). He has served on the Speaker bureau of Bial (Portugal), Cuquerella Medical Consulting (Spain), Medice (Germany), Rubio (Spain), and Tecnofarma (Peru). He has received Departmental (non-personal) research funds from the John S. Dunn Foundation Endowment, Texas Child Mental Health Care Consortium (Youth Depression & Suicide Research Network), The Favrot Fund, and Vivian L. Smith Foundation. He had received book royalties from Editorial Medica Panamericana. He is a full-time employee of the University of Texas (UTHealth) Houston. Mr. John R. Jeevarajan, Mr. Arrian Theodorou, Dr. Karabi Nandy, Ms. Madelyn Guerra, Dr. Nancy D. Madia, Dr. Lynnel Goodman, Dr. Abu Minhajuddin, Dr. Holli Slater, Mrs. Taryn Mayes, Ms. Amanda Rosenberg, Ms. Summer Ladd, Ms. Nic Ahumada and Ms. Sierra Jackson do not have any conflicts to declare., (Copyright © 2025 Elsevier B.V. All rights reserved.)

Objective: Minimal guidance is available in the literature to develop protocols for training non-clinician raters to administer semi-structured psychiatric interviews in large, multi-site studies. Previous work has not produced standardized methods for maintaining rater quality control or estimating interrater reliability (IRR) in such studies. Our objective is to describe the multi-site Texas Childhood Trauma Research Network (TX-CTRN) rater training protocol and activities used to maintain rater calibration and evaluate protocol effectiveness., Methods: Rater training utilized synchronous and asynchronous didactic learning modules, and certification involved critique of videotaped mock scale administration. Certified raters attended monthly review meetings and completed ongoing scoring exercises for quality assurance purposes. Training protocol effectiveness was evaluated using individual measure and pooled estimated IRRs for three key study measures (TESI-C, CAPS-CA-5, MINI-KID [Major Depressive Episodes - MDE & Posttraumatic Stress Disorder - PTSD modules]). A random selection of video-recorded administrations of these measures was evaluated by three certified raters to estimate agreement statistics, with jackknife (on the videos) used for confidence interval estimation. Kappa, weighted kappa and intraclass correlations were calculated for study measure ratings., Results: IRR agreement across all measures was strong (TESI-C median kappa 0.79, lower 95% CB 0.66; CAPS-CA-5 median weighted kappa 0.71 (0.62), MINI-MDE median kappa 0.71 (0.62), MINI-PTSD median kappa 0.91 (0.9). The combined estimated ICC was ≥0.86 (lower CBs ≥0.69)., Conclusions: The protocol developed by TX-CTRN may serve as a model for other multi-site studies that require comprehensive non-clinician rater training, quality assurance guidelines, and a system for assessing and estimating IRR., Competing Interests: Declaration of competing Interest Disclosures: Drs. Shahidullah, Custer, Widales-Benitez, Aksan, Hatchell, Wagner, Garrett, Ugalde, Weber, have reported no biomedical financial interests or potential conflicts of interest. Dr. Newport has received research support from Eli Lilly, Glaxo SmithKline (GSK), Janssen, the National Alliance for Research on Schizophrenia and Depression (NARSAD), the National Institutes of Health (NIH), Navitor, Sage Therapeutics, Takeda Pharmaceuticals, the Texas Health & Human Services Commission, and Wyeth. He has served on speakers’ bureaus and/or received honoraria from Astra-Zeneca, Eli Lilly, GSK, Pfizer and Wyeth. He has served on advisory boards for GSK, Janssen, Merck, and Sage Therapeutics. He has served as a consultant to Sage Therapeutics. Neither he nor family members have ever held equity positions in biomedical or pharmaceutical corporations. Dr. Eric Storch receives grant support from NIH, the Ream Foundation, Greater Houston Community Foundation, International OCD Foundation, and Texas Higher Education Coordinating Board. He receives book royalties from Elsevier, Springer, American Psychological Association, Jessica Kingsley, Oxford, and Lawrence Erlbaum. He holds stock in NView, where he serves on the clinical advisory board. He was a consultant for Levo Therapeutics, and is currently a consultant for Biohaven Pharmaceuticals and Brainsway. He co-founded and receives payment from Rethinking Behavioral Health, which is a consulting firm that provides support for implementing evidence-based psychological treatment strategies. Dr. Nemeroff has received research support from National Institutes of Health (NIH). He has served as a consultant to AbbVie, ANeuroTech (division of Anima BV), Signant Health, Magstim, Inc., Intra-Cellular Therapies, Inc., EMA Wellness, Sage, Silo Pharma, Engrail Therapeutics, Pasithea Therapeutic Corp., EcoR1, GoodCap Pharmaceuticals, Inc., Senseye, Clexio, Ninnion Therapeutics, AncoraBio, SynapseBio, BioXcel Therapeutics. He is a stockholder with Seattle Genetics, Antares, Inc., Corcept Therapeutics Pharmaceuticals Company, EMA Wellness, Naki Health, Relmada Therapeutics. He has served on advisory boards for ANeuroTech (division of Anima BV), Brain and Behavior Research Foundation (BBRF), Anxiety and Depression Association of America (ADAA), Skyland Trail, Signant Health, Laureate Institute for Brain Research (LIBR), Inc., Heading Health, Pasithea Therapeutic Corp., Sage. He has served on the Board of Directors for Gratitude America, ADAA, Lucy Scientific Discovery, Inc. He holds the following patents: Method and devices for transdermal delivery of lithium (US 6375,990B1); Method of assessing antidepressant drug therapy via transport inhibition of monoamine neurotransmitters by ex vivo assay (US 7148,027B2). Dr. Claassen has received support from the National Institutes of Health (NIH), the Borderline Research Foundation, Timberlawn Foundation and the Jordan Elizabeth Harris Foundation. She currently serves as a consultant to LivaNova PLC. Dr. Rathouz receives research Suppor from the NIH; he serves on a data safety monitoring board for Sunovion Pharmaceuticals., (Copyright © 2023 Elsevier B.V. All rights reserved.)

Background and Objectives: Current physician burnout levels are at historically high levels, especially in family medicine, with many factors playing a role. The goal of this study was to understand demographic, psychological, environmental, behavioral, and workplace characteristics that impact physician wellness and burnout, focusing on family medicine physicians and residents., Methods: Survey respondents were 295 family medicine residents and faculty members across 11 residency programs within the Residency Research Network of Texas (RRNeT). Subjects completed multiple measures to assess resilience, burnout, psychological flexibility, and workplace stress. Respondents also reported personal wellness practices and demographic information. The primary outcome variables were burnout (depersonalization, emotional exhaustion, and personal achievement) and resilience., Results: The predictor variables contributed significant variance (depersonalization=27.1%, emotional exhaustion=39%, accomplishment=37.7%, resilience=37%) and resulted in large effect sizes (depersonalization f²=.371, emotional exhaustion f²=.639, accomplishment f²=.605, resilience f²=.587) among the three burnout models and the resilience model for the sample. Similar variance and effect sizes were present for independent resident and program faculty samples, with resilience being the only outcome variable with significant differences in variance between the samples., Conclusions: This study demonstrates the roles of both individual and organization change needed to impact provider wellness, with special attention to resilience across faculty and residents. The results of this study may inform workplace policies (ie, organizational practice change) and wellness programming and curricula (ie, individual level) for family medicine residents and program faculty.

Objective: Trauma Quality Improvement Program participation among all trauma centers has shown to improve patient outcomes. We aim to identify trauma quality events occurring during the Emergency Department (ED) phase of care., Methods: This is a single-center observational study using consecutively registered data in local trauma registry (Jan 1, 2016-Jun 30, 2017). Four ED crowding scores as determined by four different crowding estimation tools were assigned to each enrolled patient upon arrival to the ED. Patient related (age, gender, race, severity of illness, ED disposition), system related (crowding, night shift, ED LOS), and provider related risk factors were analyzed in a multivariate logistic regression model to determine associations relative to ED quality events., Results: Total 5160 cases were enrolled among which, 605 cases were deemed ED quality improvement (QI) cases and 457 cases were ED provider related. Similar percentages of ED QI cases (10-12%) occurred across the ED crowding status range. No significant difference was appreciated in terms of predictability of ED QI cases relative to different crowding status after adjustment for potential confounders. However, an adjusted odds ratio of 1.64 (95% CI, 1.17-2.30, p < 0.01) regarding ED LOS ≥2 h predictive of ED related quality issues was noted when analyzed using multivariate logistic regression., Conclusion: Provider related issues are a common contributor to undesirable outcomes in trauma care. ED crowding lacks significant association with poor trauma quality care. Prolonged ED LOS (≥2 h) appears to be linked with unfavorable outcomes in ED trauma care., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Background and Purpose: This study assessed pharmacy students' self-rated ability to provide cessation counseling for e-cigarette use and traditional cigarette smoking., Educational Activity and Setting: A cross-sectional study was conducted in spring 2014 at The University of Texas at Austin. Participants included first through fourth year (P1-P4) doctor of pharmacy (PharmD) students. Perceived confidence and knowledge to counsel on cigarette smoking cessation and e-cigarette cessation were self-rated and based on the Ask-Advise-Assess-Assist-and Arrange (5 A's) follow-up model as well as general counseling skills for recreational nicotine product use cessation. Comparisons were made between students' confidence to counsel patients on traditional cigarette smoking cessation and e-cigarette cessation and by class level., Findings: Compared to cigarette smoking cessation counseling, students were less confident in their ability to counsel on e-cigarette cessation using the 5 A's model and general counseling skills. Students perceived themselves to be less knowledgeable about the harmful effects of e-cigarettes, pharmacists' role in counseling on e-cigarette cessation, and how patients can benefit from e-cigarette cessation counseling. A higher proportion of students reported having no training on e-cigarette cessation compared to cigarette smoking cessation (59% vs 9%)., Summary: Targeted training on how to counsel patients on e-cigarette cessation should be included in pharmacy curricula. Such training is expected to increase the confidence of pharmacists-in-training to address the needs of patients who use e-cigarettes., (Published by Elsevier Inc.)

Purpose: The objective of this study was to complete a comprehensive retrospective review of the epidemiology and patterns of injury in mandibular trauma based on the Parkland Memorial Hospital trauma database over a 17-year period. The authors identified 4,143 fractures in 2,828 patients from the databank. In mandibular trauma, the mechanism of injury and several other variables can be an important point of differentiation with regard to fracture pattern. By showing the statistical relation between these and fracture pattern, the authors hope to provide surgeons with a better understanding of such a relation., Materials and Methods: Mandibular fracture data were collected from the Parkland Memorial Hospital trauma registry using International Classification of Diseases, Ninth Revision codes (802.21 to 802.39). Information included fracture type, age, gender, mechanism of injury, and associated injuries. The Parkland Memorial Hospital trauma registry yielded 4,143 mandibular fractures in 2,828 patients managed at Parkland Memorial Hospital from 1993 through 2010., Results: Based on retrospective analysis, results were obtained for age, gender, monthly distribution, anatomic distribution, and mechanism of injury. The average age was approximately 38 years, with most patients (33%) in the third decade. An overwhelming majority of patients were men (83.27%), with only 16.27% consisting of women. Most injuries occurred in the summer months, with July being the most common month of occurrence. The mechanism of injury predominantly involved low-velocity blunt injuries (62%) compared with high-velocity blunt injuries (31%). The anatomic distribution of fractures evaluated was the angle (27%), symphysis (21.3%), condyle and subcondyle (18.4%), and body (16.8%)., Conclusion: This study helps provide and support the relation between several variables associated with many common traumatic injuries seen in the mandible. This analysis can be used to help surgeons identify and anticipate injuries based on age, gender, and mechanism of injury., (Copyright © 2015 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.)

Background and Objectives: The aim of our study was to deepen our understanding of the factors that may explain the observational literature that more primary care physicians in an area contribute to better population health outcomes and lower health care costs., Methods: This study used in-depth, qualitative interviewing of family physicians in both urban and rural, academic, and private practices. Interviews were initiated with a series of grand tour questions asking subjects to give examples and personal narratives demonstrating cost-effectiveness and cost inefficiencies in their own practices. An iterative open-coding approach was used to analyze transcripts to search for unifying themes and sub-themes until consensus among investigators was achieved., Results: Thirty-eight respondents gave examples of how their decision-making approaches resulted in improved patient outcomes and lower costs. Family physicians' cost-effective care was founded on two themes-characteristic attitudes and skills of the physicians themselves and a thorough knowledge of the whole patient. Family physicians also felt their approaches to gathering information and then making diagnostic and treatment decisions resulted in fewer tests and fewer treatments ordered overall. Family physicians also delivered care in less expensive facilities and generated lower overall charges for physician fees., Conclusions: Family physicians perceived that their approaches to patient care result in medical decision making priorities and care delivery processes that contribute to more cost-effective health care. These outcomes were achieved less by providing preventive services and strictly adhering to guidelines but rather by how they individualized the management of new symptoms and chronic conditions.

Introduction: Chronic low back pain (CLBP) is a disabling and expensive condition commonly seen in family physicians' offices. A complete understanding of factors contributing to patients' return to work remains elusive., Objective: To describe patients with CLBP seen in family physicians' offices and to explore factors interfering with return to work., Subjects: Three hundred sixty outpatients with CLBP for more than 3 months., Setting: Ten participating family physicians' offices of the Residency Research Network of Texas., Primary Outcome: The effect of pain on work effect as measured by a Likert scale., Results: Patients were typically female (72%), overweight or obese (mean body mass index, 33.4), had pain for many years (mean, 13.6 years), and screened positive for recent depressive symptoms (83%). The majority of patients took at least some opioid medication for their pain (59%). Multivariate linear regression analysis found that the largest single contributor to effect on work was the subjects' score on the SF-36 physical function scale (β = -0.382). Other contributors included average daily pain (β = 0.189), the frequency of flare-ups of pain (β = 0.108), the effect of the painful flare-ups (β = 0.170), and current depressive symptoms (β = 0.131) (adjusted R(2) for model = 0.535). Age, sex, race/ethnicity, total time the patient has had CLBP, other comorbidities (including a diagnosis of depression), disability status, use of opioids, history of intimate partner violence, social support, and procedures attempted were not predictive., Discussion: Future studies attempting to demonstrate the effectiveness of interventions in CLBP should measure depressive symptoms and the magnitude and effect of painful flare-ups, not just the overall pain score. The majority of CLBP patients seen in these practices take opioids for their pain. Screening and treating for depression may be reasonable for some patients, though evidence of its effectiveness is lacking.

This study investigated how many citizens of Tarrant County do not have health insurance, what sources fund their health care, and how this level of funding compares with the privately insured population. Data for 1995 were obtained from various government agencies, local hospitals, local charitable organizations, and a survey of local private physicians. Medicare and Medicaid were considered to be forms of health insurance. Approximately 20% of the citizens of Tarrant County did not have health insurance. Third-party funding for health care for this population was approximately 56% of the funding for the privately insured population ($967 vs $1726 per person per year). The Tarrant County Hospital District contributed 52% of the uninsured funding; private hospitals and physicians, 26%; other state and local agencies, 21%; and charitable donations, 1%. I conclude that health care for the uninsured of Tarrant County is rationed compared with that of the privately insured population.

The family practice residency program of John Peter Smith Hospital (JPSH) emphasizes "full-service" training to enable its graduates to provide a wide range of services to underserved areas, particularly rural communities. The purpose of this study was to investigate the practice patterns of rural JPSH family practice graduates. Of 180 identified JPSH family practice residency graduates who currently practice in rural Texas, 102 (57%) responded to a postcard survey. Data were analyzed by decade of graduation. Recent graduates were more likely to provide obstetrical care than were older graduates. The proportion of graduates providing obstetrical care at some time during their careers was similar. Recent graduates were more likely to perform office-based procedures such as colonoscopy and esophagogastroduodenoscopy. Rural JPSH family practice graduates provided more obstetrical care, critical care, and office-based procedures than did other rural members of the American Academy of Family Physicians. Practice patterns of JPSH family practice graduates have changed little over the past 30 years, except that recent graduates do more obstetrics and perform more endoscopies. These data show that the skills and knowledge of full-service family physicians are still needed in rural Texas.

To establish the seroprevalence of the human immunodeficiency virus (HIV) in our county hospital obstetric patients, and to assess the predictive value of screening questionnaires for high-risk behaviors attributing to HIV infection, we conducted written surveys and blinded HIV testing over a 4-month period ending February 1993. Blinded HIV antibody testing was performed on 1348 patients upon admission to labor and delivery. The coded blood samples were matched to similarly coded surveys of patient demographics and behaviors implicated in HIV transmission. The overall HIV prevalence in our regional population remains virtually unchanged at a rate of 0.22% (2.2 per 1000 patients). Questionnaires regarding health history were not predictive for HIV infection in our patients. Universal screening questionnaires cannot predict HIV infection. Similarly, routine mandatory testing for HIV performed on obstetric patients on the day of delivery are not cost-effective and do not provide clinically meaningful information needed to alter management protocols.