• Questions? E-mail library@dshs.state.tx.us

Medical and Research Library News - December 2016

To receive periodic library news via e-mail, HHS employees may join the e-mail list. For more information about items featured in the library news, contact the Medical and Research Library at library@dshs.state.tx.us.

External links to other sites are intended to be informational and do not have the endorsement of the Texas Department of State Health Services. These sites may also not be accessible to people with disabilities. The links were working at the time they were created.

News and training opportunities
Cool websites and reports on hot topics*
Interesting journal articles
New Books*

December 2016     Happy Holidays Everyone!

mrl-diamondNews and training opportunities

The Evolution of Public Health Learning: Introducing the New TRAIN Learning Network Platform webinar on January 26, 2017 at 1 pm CST. This webinar will introduce the new TRAIN Learning Network platform and will demonstrate new features that will be available to learners on the national TRAIN site at https://www.train.org in early 2017. Register at https://www.train.org/DesktopModules/eLearning/CourseDetails/CourseDetailsForm.aspx?tabid=62&courseid=1067236

National Conference on Tobacco or Health: March 22-24, 2017, Austin, TX. This is a conference for public health professionals to learn about best practices and policies to reduce tobacco use, the leading preventable cause of disease and death in the United States. See http://www.cvent.com/events/2017-national-conference-on-tobacco-or-health/event-summary-50c6c51a45fe4367a45b6449b59f20e5.aspx

mrl-diamondCool websites and reports on hot topics*

Characteristics of Persons with High Health Care Expenditures in the U.S. Civilian Noninstitutionalized Population, 2014. Marc Zodet, AHRQ Statistical Brief #496,: October 2016. Expenditures for hospital inpatient services were extremely rare among persons in the bottom 50% of spending, but were the single largest expenditure component for the high spending tier. See https://meps.ahrq.gov/data_files/publications/st496/stat496.shtml?utm_source=AHRQ&utm_medium=EN-1&utm_term=&utm_content=1&utm_campaign=AHRQ_EN11_1_2016

Facing Addiction in America: The Surgeon General’s Report on Alcohol, Drugs, and Health, released November 2016, is a comprehensive review of the science of substance use, misuse, and disorders. See https://addiction.surgeongeneral.gov/

GIS and Public Health at CDC: Maps & More provides a gallery of maps, infographics, and data visualizations related to public health. See http://www.cdc.gov/gis/mapgallery/index.html

Health of the States: How U.S. States Compare in Health Status and the Factors that Shape Health is a detailed analysis by the Urban Institute of state rankings on 39 health outcomes, and correlations between those health outcomes and 123 determinants of health. See http://www.urban.org/research/publication/health-states

Health Reach from the National Library of Medicine provides health information in many languages for patients as well as guidance about specific immigrant, refugee, and asylee populations for providers. See https://healthreach.nlm.nih.gov/

Hispanic Women's Health Outreach by the Food & Drug Administration provides information targeted for Hispanic women about medication safety, clinical trials, heart health, pregnancy, and general wellness. See http://www.fda.gov/ForConsumers/ByAudience/ForWomen/TakeTimetoCareProgram/ucm520603.htm

National Eye Institute for Kids: This website is about eye health and eye safety and was specifically designed for children. See https://nei.nih.gov/kids

Newborn Screening Education and Training Resources: The Baby's First Test website features fact sheets, videos, promising practices, and educational tools about newborn screening from states and organizations across the United States. See http://babysfirsttest.org/newborn-screening/resources

Nursing Home Antimicrobial Stewardship Guide, from AHRQ, provides toolkits to help nursing homes optimize their use of antibiotics. See http://www.ahrq.gov/nhguide/index.html

Out-of-Pocket Health Care Expenses in the U.S. Civilian Noninstitutionalized Population by Age and Insurance Coverage, 2014, P. Gwet, J. Anderson and S.R. Machlin, AHRQ Statistical Brief #495, October 2016. Average out-of-pocket expenses for health care services in 2014 ranged from $288 for children younger than 18 to $1,253 for people age 65 and older. See https://meps.ahrq.gov/data_files/publications/st495/stat495.shtml?utm_source=AHRQ&utm_medium=EN-1&utm_term=&utm_content=1&utm_campaign=AHRQ_EN11_8_2016

Pain Management and Prescription Opioid-Related Harms: Exploring the State of the Evidence: Proceedings of a Workshop in Brief. This workshop gathered information about potential best practices in pain management, including the evolving role of opioids; understanding the epidemiology of the prescription opioid epidemic and discussing possible strategies to address it; as well as identifying potential areas for future research in the field. See https://www.nap.edu/catalog/23694/pain-management-and-prescription-opioid-related-harms-exploring-the-state

Postpartum Depression among Women Utilizing Texas Medicaid, Texas Health and Human Services Commission and Texas Department of State Health Services, October 2016. This report includes recommendations to increase utilization of screening and treatment within the Medicaid program, increase the treatment of postpartum depression provided by the local mental health authorities, and increase continuity of care. See https://hhs.texas.gov/sites/hhs/files/Postpartum-Depression-Among-Women-Utilizing-Texas-Medicaid.pdf

Public Health Informatics: A Call to Action: The Journal of Public Health Management & Practice's Nov/Dec 2016 Supplement is on Public Health Informatics and is available free of charge courtesy of NACCHO. See http://journals.lww.com/jphmp/toc/2016/11001

Resources for Policy Surveillance: A report prepared for the Centers for Disease Control and Prevention Public Health Law Program, February 2015. This report begins with a brief discussion of the concept of legal epidemiology, including policy surveillance, and its relationship to traditional public health law. It then summarizes and discusses results of research projects. See http://publichealthlawresearch.org/sites/default/files/uploaded_images/CombinedYear1Report_Feb2015.pdf

Texas Family Violence Program Statewide Report as required by Human Resources Code, Chapter 51, Health and Human Services Commission, November 2016. This report highlights HHSC-funded contractors' success in providing family violence services. See https://hhs.texas.gov/sites/hhs/files/texas-family-violence-program-statewide-report.pdf

U.S. Public’s Perception of Zika Risk: Awareness, Knowledge, and Receptivity to Public Health Interventions, David Abramson and Rachael Piltch-Loeb. New York University, Briefing Report, October 2016. Although most U.S. residents are generally aware of the virus, their specific knowledge regarding the virus’s symptoms and transmission routes is incomplete. See http://www.nyu.edu/content/dam/nyu/publicAffairs/documents/PDF/research/PiR2_Zika_Report_rf.pdf

mrl-diamondInteresting journal articles

Addictions Neuroclinical Assessment: A Neuroscience-Based Framework for Addictive Disorders. Kwako LE, Momenan R, Litten RZ, Koob GF, Goldman D. Biol Psychiatry. 2016 Aug 1;80(3):179-89
This article proposes a heuristic framework for the Addictions Neuroclinical Assessment that incorporates key functional domains derived from the neurocircuitry of addiction. We review how addictive disorders (ADs) are presently diagnosed and the need for new neuroclinical measures to differentiate patients who meet clinical criteria for addiction to the same agent while differing in etiology, prognosis, and treatment response. The need for a better understanding of the mechanisms provoking and maintaining addiction, as evidenced by the limitations of current treatments and within-diagnosis clinical heterogeneity, is articulated. In addition, recent changes in the nosology of ADs, challenges to current classification systems, and prior attempts to subtype individuals with ADs are described. Complementary initiatives, including the Research Domain Criteria project, that have established frameworks for the neuroscience of psychiatric disorders are discussed. Three domains-executive function, incentive salience, and negative emotionality-tied to different phases in the cycle of addiction form the core functional elements of ADs. Measurement of these domains in epidemiologic, genetic, clinical, and treatment studies will provide the underpinnings for an understanding of cross-population and temporal variation in addictions, shared mechanisms in addictive disorders, impact of changing environmental influences, and gene identification. Finally, we show that it is practical to implement such a deep neuroclinical assessment using a combination of neuroimaging and performance measures. Neuroclinical assessment is key to reconceptualizing the nosology of ADs on the basis of process and etiology, an advance that can lead to improved prevention and treatment.

Combined aerobic and resistance training effects on glucose homeostasis, fitness, and other major health indices: a review of current guidelines. Johannsen NM, Swift DL, Lavie CJ, et al. Sports Med. 2016 Dec;46(12):1809-1818.
The combination of aerobic and resistance training (AER + RES) is recommended by almost every major organization to improve health-related risk factors associated with sedentary behavior. Since the release of the Physical Activity Guidelines for Americans in 2008, several large well-controlled trials and ancillary reports have been published that provide further insight into the effects of AER + RES on health-related outcomes. The current manuscript examines the literature on the effects of AER + RES on major clinical outcomes, including glucose homeostasis, cardiorespiratory fitness (CRF), and muscular strength, as well as other important clinical outcomes, including metabolic syndrome, hypertension, dyslipidemia, and quality of life. Collectively, research suggests that AER + RES and AER or RES alone improves glycemic control and insulin sensitivity compared with continued sedentary behavior. Significant changes in CRF are also observed, suggesting a reduction in cardiovascular disease-related mortality risk. Reduced adiposity, especially abdominal adiposity, and increased strength may also interact with CRF to promote additional health benefits associated with AER + RES. While findings from our review support current physical activity guidelines, a paucity of research limits the generalizability of the results.

Getting reorgs right. Heidari-Robinson S, Heywood S, Harvard Business Review. 2016 Nov;94(11):84-89. 
Chances are you have experienced at least one company reorganization. Reorgs can be a great way to unlock value: Two-thirds of them deliver at least some performance improvement, and with change accelerating in the business environment, they are becoming more and more common, the authors say. But most reorgs aren’t entirely successful: According to a survey conducted at McKinsey, more than 80% fail to deliver the value they are supposed to in the time planned, while 10% cause real damage to the company involved. More important, they can be miserable experiences for employees. Research suggests that reorgs—and the accompanying uncertainty about what the future holds—may cause greater stress and anxiety than layoffs, leading to noticeably reduced productivity in about 60% of cases. That is because the leaders of reorgs do not specify their objectives clearly enough, miss some of the key actions (for example, focusing on reporting lines and forgetting processes and people), or do things in the wrong order (such as deciding on the way forward before assessing the strengths and weaknesses of what they have already). To help maximize the value and minimize the misery of reorgs, the authors have developed a simple five-step process for running them.

Media content about vaccines in the United States and Canada, 2012-2014: An analysis using data from the Vaccine Sentimeter. Powell GA, Zinszer K, Verma A, et al. Vaccine. 2016 Nov 3. pii: S0264-410X(16)31015-5. doi: 10.1016/j.vaccine.2016.10.067. [Epub ahead of print]
Background: A system for monitoring vaccine-related media content was previously developed and studied from an international perspective. This monitoring approach could also have value at a regional level, but it has yet to be evaluated at this scale. We examined regional patterns of vaccine-related media topics and sentiment in the US and Canada. Methods: We extracted vaccine-relevant US and Canadian online media reports between June 2012 and October 2014 from the Vaccine Sentimeter, a HealthMap-based automated media monitoring system for news aggregators and blogs. We analyzed regional distributions of reports about vaccines, categories (i.e., topics), sentiment, and measles outbreaks. Findings: The Vaccine Sentimeter captured 10,715 reports during the study period. Negative sentiment was highest in reports about vaccine safety (47%), Hepatitis B (19%), and Vermont (18%). Analyses of measles outbreaks revealed geographical variation in media content. For example, religious beliefs were mentioned in 27% of measles reports in Texas and 22% of British Columbia reports, but there were no references to religion in media on measles from California. Interpretations: A regional analysis of online sentiment towards vaccine can provide insights that may give US and Canadian public health practitioners a deeper understanding of media influences on vaccine choices in their regions and consequently lead to more effective public health action. 

Newborn screening: a review of history, recent advancements, and future perspectives in the era of next generation sequencing. Almannai M, Marom R, Sutton VR. Curr Opin Pediatr. 2016 Dec;28(6):694-699.
Purpose of Review: The purpose of this review is to summarize the development and recent advancements of newborn screening. Recent Findings: Early initiation of medical care has modified the outcome for many disorders that were previously associated with high morbidity (such as cystic fibrosis, primary immune deficiencies, and inborn errors of metabolism) or with significant neurodevelopmental disabilities (such as phenylketonuria and congenital hypothyroidism). The new era of mass spectrometry and next generation sequencing enables the expansion of the newborn screen panel, and will help to address technical issues such as turnaround time, and decreasing false-positive and false-negative rates for the testing. Summary: The newborn screening program is a successful public health initiative that facilitates early diagnosis of treatable disorders to reduce long-term morbidity and mortality.

One health interactions of Chagas disease vectors, canid hosts, and human residents along the Texas-Mexico border. Garcia MN, O'Day S, Fisher-Hoch S, et al.. PLoS Negl Trop Dis. 2016 Nov 10;10(11):e0005074. doi: 10.1371/journal.pntd.0005074. eCollection 2016.
Background: Chagas disease (Trypanosoma cruzi infection) is the leading cause of non-ischemic dilated cardiomyopathy in Latin America. Texas, particularly the southern region, has compounding factors that could contribute to T. cruzi transmission; however, epidemiologic studies are lacking. The aim of this study was to ascertain the prevalence of T. cruzi in three different mammalian species (coyotes, stray domestic dogs, and humans) and vectors (Triatoma species) to understand the burden of Chagas disease among sylvatic, peridomestic, and domestic cycles. Methodology/Principal Findings: To determine prevalence of infection, we tested sera from coyotes, stray domestic dogs housed in public shelters, and residents participating in related research studies and found 8%, 3.8%, and 0.36% positive for T. cruzi, respectively. PCR was used to determine the prevalence of T. cruzi DNA in vectors collected in peridomestic locations in the region, with 56.5% testing positive for the parasite, further confirming risk of transmission in the region. Conclusions/Significance: Our findings contribute to the growing body of evidence for autochthonous Chagas disease transmission in south Texas. Considering this region has a population of 1.3 million, and up to 30% of T. cruzi infected individuals developing severe cardiac disease, it is imperative that we identify high risk groups for surveillance and treatment purposes.

Population-based precision cancer screening: a symposium on evidence, epidemiology, and next steps. Marcus PM1, Pashayan N2, Church TR3, et al. Cancer Epidemiol Biomarkers Prev. 2016 Nov;25(11):1449-1455.
Precision medicine, an emerging approach for disease treatment that takes into account individual variability in genes, environment, and lifestyle, is under consideration for preventive interventions, including cancer screening. On September 29, 2015, the National Cancer Institute sponsored a symposium entitled "Precision Cancer Screening in the General Population: Evidence, Epidemiology, and Next Steps". The goal was two-fold: to share current information on the evidence, practices, and challenges surrounding precision screening for breast, cervical, colorectal, lung, and prostate cancers, and to allow for in-depth discussion among experts in relevant fields regarding how epidemiology and other population sciences can be used to generate evidence to inform precision screening strategies. Attendees concluded that the strength of evidence for efficacy and effectiveness of precision strategies varies by cancer site, that no one research strategy or methodology would be able or appropriate to address the many knowledge gaps in precision screening, and that issues surrounding implementation must be researched as well. Additional discussion needs to occur to identify the high priority research areas in precision cancer screening for pertinent organs and to gather the necessary evidence to determine whether further implementation of precision cancer screening strategies in the general population would be feasible and beneficial.

Preventable death rates fell where communities expanded population health activities through multisector networks. Mays GP, Mamaril CB, Timsina LR. Health Aff (Millwood). 2016 Nov 1;35(11):2005-2013.
The US health system faces mounting pressure to improve population health. Research suggests a need for greater coordination and alignment across the sectors that deliver medical, public health, and social services. This study uses sixteen years of data from a large cohort of US communities to measure the extent and nature of multisector contributions to population health activities and how these contributions affect community mortality rates. The results show that deaths due to cardiovascular disease, diabetes, and influenza decline significantly over time among communities that expand multisector networks supporting population health activities. The findings imply that incentives and infrastructure supporting multisector population health activities may help close geographic and socioeconomic disparities in population health.

Salmonella surveillance among great-tailed grackles (Quiscalus mexicanus) and other urban bird species in eastern Texas. Grigar MK, Cummings KJ, Rodriguez-Rivera LD, et al. Vector Borne Zoonotic Dis. 2016 Nov 9. [Epub ahead of print]
Wild birds may play an important role in maintaining and transmitting Salmonella. Their ability to travel large distances and their proximity to human habitations could make them a vehicle for bridging Salmonella from wild and domestic animals to humans. To determine the potential public health risk presented by urban birds, we investigated the prevalence of Salmonella among great-tailed grackles (Quiscalus mexicanus) and other cohabiting urban bird species. Fecal samples were collected from 114 birds communally roosting in parking lots of retail locations in Brazos County, Texas, from February through July of 2015. Great-tailed grackles and European starlings (Sturnus vulgaris) were the predominant species sampled. Standard bacteriologic culture methods were used to isolate Salmonella from samples, and isolates were characterized by serotyping and antimicrobial susceptibility testing. Overall, 1.8% (2/114) of samples were confirmed positive for Salmonella. Both positive birds were great-tailed grackles sampled in June, yielding a 2.6% (2/76) apparent prevalence among this species. Isolates were serotyped as Salmonella Typhimurium and found to be pan-susceptible based on the National Antimicrobial Resistance Monitoring System (NARMS) panel of antimicrobial agents. The occurrence of Salmonella in great-tailed grackles represents a potential threat to public health, particularly considering their population size and tendency to congregate near human establishments such as grocery stores.

Social media self-efficacy of health education specialists: training and organizational development implications. Alber JM, Paige S, Stellefson M, Bernhardt JM. Health Promot Pract. 2016 Nov;17(6):915-921.
A growing number of public health organizations are applying the power of social media (SM) for health promotion and behavior change. This cross-sectional study of health education specialists (n = 353) examined which demographic and occupational factors were associated with SM self-efficacy, and evaluated SM self-efficacy related to each of the Seven Areas of Responsibility. A series of one-way analyses of variance were conducted to determine whether differences in SM self-efficacy existed by sex, age, years of work experience, and SM access at work. A multiple linear regression examined the relationship between SM self-efficacy and SM experience when controlling for demographic and occupational factors. Statistically significant differences in SM self-efficacy existed by age, F(2, 289) = 6.54, p = .002. SM experience (β = 1.43, t = 11.35, p < .001) was a statistically significant predictor of SM self-efficacy, even after controlling for age, sex, years of work experience, and level of SM access, F(5, 290) = 30.88, p < .001, R2 = .35. Results revealed statistically significant differences in mean SM self-efficacy scores by the Areas of Responsibility, F(4.69, 1425.46) = 22.46, p < .001. Professional health organizations should have policies in place and trainings that are conducive to learning and applying SM for health education research and practice.

Suicide-related knowledge and confidence among behavioral health care staff in seven states. Silva C, Smith AR, Dodd DR, et al. Psychiatr Serv. 2016 Nov 1;67(11):1240-1245.
Objective: Death by suicide is a serious and growing public health concern in the United States. This noncontrolled, naturalistic study examined professionals' knowledge about suicide and confidence in working with suicidal individuals, comparing those who had received either of two gatekeeper trainings-Question, Persuade, and Refer (QPR) or Applied Suicide Intervention Skills Training (ASIST)-or other suicide-relevant training or no training. Methods: Participants (N=16,693) were individuals in various professional roles in the field of behavioral health care in Indiana, Kentucky, New York, Pennsylvania, Tennessee, Texas, and Utah. Participants completed a survey assessing suicide knowledge and skills confidence. Results: Most participants (52.9%) reported no previous suicide prevention or assessment training. Individuals with suicide-relevant training demonstrated greater suicide knowledge and confidence than those with no such training. Among those who had received any training, no differences were found in suicide knowledge; however, individuals who had received ASIST reported greater confidence in working with suicidal individuals, compared with those who had received other training. Professional role and prior experience with a client who had died by suicide had significant positive relationships with suicide knowledge and confidence. Regional differences emerged between states and are examined within the context of statewide suicide prevention initiatives. CONCLUSIONS: Increasing access to and incentives for participating in suicide-relevant training among behavioral health care staff may foster a more knowledgeable and confident group of gatekeepers. Future research should examine whether increases in knowledge and confidence among staff translate into actual changes in practice that help protect and serve at-risk individuals.

Treatment of adult depression in the United States. Olfson M, Blanco C, Marcus SC. JAMA Intern Med. 2016 Oct 1;176(10):1482-1491.
Importance: Despite recent increased use of antidepressants in the United States, concerns persist that many adults with depression do not receive treatment, whereas others receive treatments that do not match their level of illness severity. Objective: To characterize the treatment of adult depression in the United States. Design, Setting, And Participants: Analysis of screen-positive depression, psychological distress, and depression treatment data from 46 417 responses to the Medical Expenditure Panel Surveys taken in US households by participants aged 18 years or older in 2012 and 2013. Main Outcome And Measures: Percentages of adults with screen-positive depression (Patient Health Questionnaire-2 score of ≥ 3) and adjusted odds ratios (AORs) of the effects of sociodemographic characteristics on odds of screen-positive depression; percentages with treatment for screen-positive depression and AORs; percentages with any treatment of depression and AORs stratified by presence of serious psychological distress (Kessler 6 scale score of ≥13); and percentages with depression treatment by health care professional group (psychiatrists, other health care professionals, and general medical providers); and type of depression treatment (antidepressants, psychotherapy, and both) all stratified by distress level. Results: Approximately 8.4% (95% CI, 7.9-8.8) of adults screened positive for depression, of which 28.7% received any depression treatment. Conversely, among all adults treated for depression, 29.9% had screen-positive depression and 21.8% had serious psychological distress. Adults with serious compared with less serious psychological distress who were treated for depression were more likely to receive care from psychiatrists (33.4% vs 17.3%, P < .001) or other mental health specialists (16.2% vs 9.6%, P < .001), and less likely to receive depression care exclusively from general medical professionals (59.0% vs 74.4%, P < .001). They were also more likely to receive psychotherapy (32.5% vs 20.6%, P < .001), though not antidepressant medications (81.1% vs 88.6%, P < .001). Conclusions and Relevance: Most US adults who screen positive for depression did not receive treatment for depression, whereas most who were treated did not screen positive. In light of these findings, it is important to strengthen efforts to align depression care with each patient's clinical needs.

mrl-diamondNew Books*

1. As We Speak: How to Make Your Point and Have It Stick by Peter Meyers and Shann Nix.
2. The Certified Six Sigma Yellow Belt Handbook by Govind Ramu.
3. Leadership and the One Minute Manager: Increasing Effectiveness through Situational Leadership, 2nd ed., by Ken Blanchard, Patricia Zigarmi and Drea Zigarmi.
4. Managing the Unexpected: Sustained Performance in a Complex World, 3rd ed. by Karl E. Weick and Kathleen M. Sutcliffe.
5. The New One Minute Manager by Ken Blanchard and Spencer Johnson.
6. The Sage Dictionary of Statistics & Methodology: A Nontechnical Guide for the Social Sciences, 5th ed., by W. Paul Vogt and R. Burke Johnson. 
7. Stewardship: Choosing Service over Self-Interest, 2nd ed., by Peter Block.


To check out any of the following ebooks, go to Library Services at http://online.dshs.state.tx.us/library.aspx. Click on Electronic Library (left-hand side). Click on Books in the center of the screen and then type in the title in the search box below. If you have difficulties, please contact library@dshs.state.tx.us or call 512-776-7559.

1. Childhood Obesity in America by Laura Dawes.
2. GIS for Critical Infrastructure Protection by Robert F. Austin.
3. Health Policy Analysis, 2nd ed., by Curtis P. McLaughlin 
4. How the Immune System Works by Lauren Sompayrac.
5. Interact and Engage!: 50+ Activities for Virtual Training, Meetings, and Webinars by Kassy LaBorie.
6. Leading When There's Too Much Change by Kristin Cullen-Lester. 
7. Medical Statistics Made Easy by Michael Harris.
8. Modern Mentoring by Randy Emelo. 
9. Population Health: An Implementation Guide to Improve Outcomes and Lower Costs by George
10. Practicing Organization Development: Leading Transformation and Change by William J. Rothwell.
11. Preterm Birth in the United States: A Sociocultural Approach by Janet M. Bronstein.
12. The Effective Manager by Mark Horstman. 
13. Zoonoses: Infectious Diseases Transmissible from Animals to Humans, 4th ed., by Tino F.  Schwarz.

*For More Information:  Employees may contact the Medical and Research Library at library@dshs.state.tx.us, call 512-776-7559, or come by Moreton Building, Room M-652, to borrow a print book, receive password access to a journal, receive other research assistance, or to obtain full-text of the articles mentioned in this month's news. If you are not located on the main campus in Austin, simply let us know what you would like to borrow and we will mail it to you.

Fine print section: If any of the internet links do not open for you, please let us know and we will send you what you need. The MRL Library News e-mail is sent about once a month or when important library news or events occur. If you have co-workers who would like to subscribe, please e-mail library@dshs.state.tx.us. If for any reason you would like to unsubscribe, please send an e-mail to library@dshs.state.tx.us with Unsubscribe in the subject line. Recent issues of this newsletter are on the web at http://www.dshs.texas.gov/library/news.shtm. Thank you!

Return to top

Last updated December 9, 2016