78 FR 10117 - Use of Medicare Procedures To Enter Into Provider Agreements for Extended Care Services

Federal Register 2010, 2011, 2012, 2013, 2014

2013-02-13

..., when provided as an alternative to nursing home care. Under this proposed rule, VA would be able to... provide extended care services to eligible veterans, including geriatric evaluation, nursing home care... nursing home care in non-VA facilities of eligible veterans and eligible members of the Armed Forces...

Military and VA general dentistry training: a national resource.

PubMed

Atchison, Kathryn A; Bachand, William; Buchanan, C Richard; Lefever, Karen H; Lin, Sylvia; Engelhardt, Rita

2002-06-01

In 1999, HRSA contracted with the UCLA School of Dentistry to evaluate the postgraduate general dentistry (PDG) training programs. The purpose of this article is to compare the program characteristics of the PGD training programs sponsored by the Armed Services (military) and VA. Surveys mailed to sixty-six VA and forty-two military program directors in fall 2000 sought information regarding the infrastructure of the program, the program emphasis, resident preparation prior to entering the program, and a description of patients served and types of services provided. Of the eighty-one returned surveys (75 percent response rate), thirty were received from military program directors and fifty-one were received from VA program directors. AEGDs reported treating a higher proportion of children patients and GPRs more medically intensive, disadvantaged and HIV/AIDS patients. Over half of the directors reported increases in curriculum emphasis in implantology. The program directors reported a high level of inadequate preparation among incoming dental residents. Having a higher ratio of residents to total number of faculty predicted inadequate preparation (p=.022) although the model was weak. Although HRSA doesn't financially support federally sponsored programs, their goal of improved dental training to care for medically compromised individuals is facilitated through these programs, thus making military and VA general dentistry programs a national resource.

Russia and the Current State of Arms Control

DTIC Science & Technology

2012-09-01

Suite 1204, Arlington VA 22202-4302. Respondents should be aware that notwithstanding any other provision of law , no person shall be subject to a...for the Further Reduction and Limitation of Strategic Offensive Arms (START III) addressed well-covered ground from past arms control efforts and...composed of political, military, business , faith, and civic leaders in late 2008. That group mount- ed an international campaign for the elimination of

Journal of Rehabilitation Research and Development.

DTIC Science & Technology

1984-05-01

results of this study also port VA Contract V1O1(134)P-561, indicated that shoulder-effected position control of 1980 . prosthesis function has considerably...multiple axis artifi- cial arm control. J Biomech Eng 102:199-207, 1980 . 5. Simpson DC: The control and supply of a multimovement externally pow- ered...Above-elbow Prostheses. Final Re- port VA Contract V1O1(134)P-561, 1980 . 8. Carlson LE and Primmer KR: Ex- tended physiological proprioception for

Special home adaptation grants for members of the Armed Forces and veterans with certain vision impairment. Final rule.

PubMed

2014-09-12

The Department of Veterans Affairs (VA) is issuing a final rule to amend its adjudication regulations regarding special home adaptation grants for members of the Armed Forces and veterans with certain vision impairment. This regulatory amendment is necessary to conform the regulations to changes mandated in the Honoring America's Veterans and Caring for Camp Lejeune Families Act of 2012.

U.S. Armed Forces Abroad: Selected Congressional Votes Since 1982

DTIC Science & Technology

2007-09-07

Specialist Knowledge Services Group Report Documentation Page Form ApprovedOMB No. 0704-0188 Public reporting burden for the collection of information is...and Reports , 1215 Jefferson Davis Highway, Suite 1204, Arlington VA 22202-4302. Respondents should be aware that notwithstanding any other provision of...control number. 1. REPORT DATE 07 SEP 2007 2. REPORT TYPE 3. DATES COVERED 00-00-2007 to 00-00-2007 4. TITLE AND SUBTITLE U.S. Armed Forces

Evaluation of Impacts of JP-8+100 on Army Aviation and Ground Vehicles: Phase I Impact Study

DTIC Science & Technology

2000-11-01

Lee VA Newsome, T, MAJ (804) 734-0609 Directorate of Combat Development Combined Arms Support Command Ft. Lee VA Perdue, William (804) 734-0572...151 43,215 McClellan AFB CA 84 42,915 Fairford RAF United Kingdom 17 42,275 Wright- Patterson AFB OH 146 42,058 Eielson AFB AK 103 41,556 Little Rock... WILLIAMS GA 44 20032 340 141830 KJAN JACKSON IAP 2 550 75 22363 KJAX JACKSONVILLE IAP 89 27095 49 40484 KJST CAMBRIA CO. APT/JOHN 801 169445 3 3691 KJUN

77 FR 14707 - Vet Center Services

Federal Register 2010, 2011, 2012, 2013, 2014

2012-03-13

... assessment, individual counseling, group counseling, marital and family counseling for military-related... includes but is not limited to: psychosocial assessment, individual counseling, group counseling, marital... counseling currently provided in VA's Vet Centers to certain veterans of the Armed Forces and members of...

27. DETAIL OF DECK JOINT BETWEEN APPROACH SPAN No. 3 ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

27. DETAIL OF DECK JOINT BETWEEN APPROACH SPAN No. 3 AND NORTH CANTILEVER ANCHOR ARM AND RESPECTIVE BEARINGS AT PIER No. 3, LOOKING EAST - Jackson's Ferry Bridge, Route 52 over New River, 6.3 miles south of Route 94, Austinville, Wythe County, VA

Military Base Realignments and Closures: Impact of Terminating, Relocating, or Outsourcing the Services of the Armed Forces Institute of Pathology

DTIC Science & Technology

2007-11-01

sexes , all races/ethnicities, all ages, as well... Tenn . 2 Ala. 88 Fla. 820 Ga. 1,220 S.C. 291 N.C. 1,371 Va. 1,476 Ohio 467 N.H. 0 Mass. 6 R.I. 0Mich. 1 Calif. 1,974 Wash. 671 Wis. 13 N.Y. 1,614 Maine...809 Tenn . 205 Ala. 102 Fla. 1,109 Ga. 376 S.C. 396 N.C. 769 Va. 331 Ohio 731 N.H. 40 Mass. 97 R.I. 38Mich. 189 Calif. 801 Wash. 59 Wis. 68 N.Y.

77 FR 27863 - Privacy Act of 1974; System of Records

Federal Register 2010, 2011, 2012, 2013, 2014

2012-05-11

... Therapy (CWT), HUD/VA Prevention pilot, and Supportive Services for Veterans and Families (SSVF). This... Veterans and their immediate family members, members of the armed services, current and former employees... Location Addiction Severity Index Veteran Affairs Medical Center, 7180 Highland Drive, Pittsburgh, PA 15206...

38 CFR 77.5 - Selection criteria.

Code of Federal Regulations, 2014 CFR

2014-07-01

... ADAPTIVE SPORTS PROGRAMS FOR DISABLED VETERANS AND DISABLED MEMBERS OF THE ARMED FORCES § 77.5 Selection criteria. (a) VA will review all applications for adaptive sports grants using the following selection criteria: (1) The adaptive sports activities to be provided by the program are clearly stated; (2) The...

Automobile or other conveyance and adaptive equipment certificate of eligibility for veterans or members of the armed forces with amyotrophic lateral sclerosis. Interim final rule.

PubMed

2015-02-25

The Department of Veterans Affairs (VA) is amending its adjudication regulation regarding certificates of eligibility for financial assistance in the purchase of an automobile or other conveyance and adaptive equipment. The amendment authorizes automatic issuance of a certificate of eligibility for financial assistance in the purchase of an automobile or other conveyance and adaptive equipment to all veterans with service-connected amyotrophic lateral sclerosis (ALS) and members of the Armed Forces serving on active duty with ALS.

38 CFR 77.13 - Applications for noncompetitive adaptive sports grants.

Code of Federal Regulations, 2014 CFR

2014-07-01

... noncompetitive adaptive sports grants. 77.13 Section 77.13 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS (CONTINUED) GRANTS FOR ADAPTIVE SPORTS PROGRAMS FOR DISABLED VETERANS AND DISABLED MEMBERS OF THE ARMED FORCES § 77.13 Applications for noncompetitive adaptive sports grants. (a) When VA...

78 FR 32710 - Advisory Committee on Disability Compensation, Notice of Meeting

Federal Register 2010, 2011, 2012, 2013, 2014

2013-05-31

... Armed Forces, provide an ongoing assessment of the effectiveness of the rating schedule, and give advice... DEPARTMENT OF VETERANS AFFAIRS Advisory Committee on Disability Compensation, Notice of Meeting The Department of Veterans Affairs (VA) gives notice under the Federal Advisory Committee Act, 5 U.S.C...

Promotion of Orange-Fleshed Sweet Potato Increased Vitamin A Intakes and Reduced the Odds of Low Retinol-Binding Protein among Postpartum Kenyan Women.

PubMed

Girard, Amy Webb; Grant, Frederick; Watkinson, Michelle; Okuku, Haile Selassie; Wanjala, Rose; Cole, Donald; Levin, Carol; Low, Jan

2017-05-01

Background: Orange-fleshed sweet potato (OFSP) improves vitamin A (VA) status of young children; research with pregnant and lactating women is limited. Objective: We examined the effectiveness of the Mama SASHA (Sweetpotato Action for Security and Health in Africa) program to improve nutrition knowledge, diets, and nutritional status of pregnant and lactating women (PLW) in Western Kenya. Methods: Eight health facilities were allocated to the Mama SASHA intervention or comparison arms. PLW in intervention facilities received enhanced nutrition counseling at health clinics, were linked with community-based maternal support groups, and received vouchers for OFSP vine cuttings. Control PLW received clinic-based nutrition counseling only. A total of 505 women in early and midpregnancy, attending their first antenatal care visit, and with no previous engagement in project activities were enrolled from the 8 facilities. Nutrition and health-seeking knowledge, food security, dietary patterns, and anthropometric measurements were collected at 4 time points at ≤9 mo postpartum. VA intakes were assessed with multipass 24-h recalls in a subsample of 206 mothers at 8-10 mo postpartum. VA status was assessed by using serum retinol-binding protein (RBP). Impacts were estimated with multilevel mixed models adjusted for clustering and differences at enrollment. Results: At enrollment, 22.9% of women had RBP <1.17 μmol/L. By 9 mo postpartum, intervention women had significantly higher intakes of VA [adjusted difference = 297.0 retinol activity equivalent (RAE) units; 95% CI: 82, 513 RAE units; P = 0.01; n = 206], greater consumption of VA-rich fruit and vegetables in the previous 7 d (difference-in-difference estimate: 0.40 d; 95% CI: 0.23, 0.56 d; P < 0.01), and a 45% reduction in the odds of RBP <1.17 μmol/L (OR: 0.55; 95% CI: 0.33, 0.92; P = 0.01). Conclusion: Promotion of OFSP to PLW through health services is a feasible strategy to improve women's nutrition knowledge, VA intakes, and maternal RBP.

Genetic influences on the outcome of anti-vascular endothelial growth factor treatment in neovascular age-related macular degeneration.

PubMed

Abedi, Farshad; Wickremasinghe, Sanjeewa; Richardson, Andrea J; Islam, Amirul F M; Guymer, Robyn H; Baird, Paul N

2013-08-01

To determine the association of genetic variants in known age-related macular degeneration (AMD) risk-associated genes with outcome of anti-vascular endothelial growth factor (VEGF) treatment in neovascular AMD. Prospective cohort study. We enrolled 224 consecutive patients with neovascular AMD at the Royal Victorian Eye and Ear Hospital, Australia. Patients were treated with 3 initial monthly ranibizumab or bevacizumab injections followed by 9 months of "as required" injections based on clinician's decision at each follow-up visit according to retreatment criteria. Seventeen single nucleotide polymorphisms (SNPs) in known AMD risk-associated genes including CFH (rs800292, rs3766404, rs1061170, rs2274700 and rs393955), HTRA1 (rs11200638), CFHR1-5 (rs10922153, rs16840639, rs6667243, and rs1853883), LOC387715/ARMS2 (rs3793917 and rs10490924), C3 (rs2230199 and rs1047286), C2 (rs547154), CFB (rs641153) and F13B (rs6003) were examined. Multivariate analysis was used to determine the role of each SNP in treatment outcome. The influence of selected SNPs on mean change in visual acuity (VA) at 12 months. Mean baseline VA was 51 ± 16.8 Early Treatment Diabetic Retinopathy Study letters. Overall, the mean change in VA from baseline was +3.2 ± 14.9 letters at 12 months. The AA (homozygote risk) genotype at rs11200638 - HTRA1 promoter SNP (P = 0.001) and GG (homozygote risk) genotype at rs10490924 (A69S) in LOC387715/ARMS2 (P = 0.002) were each significantly associated with poorer VA outcome at 12 months after multiple correction. Mean ± standard deviation change in VA from baseline in patients with AA genotype at rs11200638 was -2.9 ± 15.2 letters after 12 months compared with +5.1 ± 14.1 letters in patients with AG or GG genotypes at this SNP. Patients with either of these genotypes were also significantly more likely to lose >15 letters after 12 months. SNPs rs11200638 and rs10490924 were in high linkage disequilibrium (r(2) = 0.92). None of the other examined SNPs was associated with outcome. The HTRA1 promoter SNP (rs11200638) and A69S at LOC387715/ARMS2 were associated with a poorer visual outcome for ranibizumab or bevacizumab treatment in neovascular AMD, suggesting strong pharmacogenetic associations with anti-VEGF treatment. This finding could aid in applying more individualized treatment regimens based on patients' genotype to achieve optimal treatment response in AMD. The authors have no proprietary or commercial interest in any materials discussed in this article. Copyright © 2013 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.

Honoring the Call to Duty: Veterans’ Disability Benefits in the 21st Century

DTIC Science & Technology

2007-10-01

War or the 1899-1901 Philippine Insurrection.14 I.2 World War I By the early 20th century, the reconstituted Armed Forces of the United States...to the tardiness of the current system. Third, when medical evidence, possibly new, about the veteran from non-VA medical facilities is critical to

The role of propriospinal neuronal network in transmitting the alternating muscular activities of flexor and extensor in parkinsonian tremor.

PubMed

Hao, M; He, X; Lan, N

2012-01-01

It has been shown that normal cyclic movement of human arm and resting limb tremor in Parkinson's disease (PD) are associated with the oscillatory neuronal activities in different cerebral networks, which are transmitted to the antagonistic muscles via the same spinal pathway. There are mono-synaptic and multi-synaptic corticospinal pathways for conveying motor commands. This study investigates the plausible role of propriospinal neuronal (PN) network in the C3-C4 levels in multi-synaptic transmission of cortical commands for oscillatory movements. A PN network model is constructed based on known neurophysiological connections, and is hypothesized to achieve the conversion of cortical oscillations into alternating antagonistic muscle bursts. Simulations performed with a virtual arm (VA) model indicate that without the PN network, the alternating bursts of antagonistic muscle EMG could not be reliably generated, whereas with the PN network, the alternating pattern of bursts were naturally displayed in the three pairs of antagonist muscles. Thus, it is suggested that oscillations in the primary motor cortex (M1) of single and double tremor frequencies are processed at the PN network to compute the alternating burst pattern in the flexor and extensor muscles.

Telemedicine-based collaborative care for posttraumatic stress disorder: a randomized clinical trial.

PubMed

Fortney, John C; Pyne, Jeffrey M; Kimbrell, Timothy A; Hudson, Teresa J; Robinson, Dean E; Schneider, Ronald; Moore, William M; Custer, Paul J; Grubbs, Kathleen M; Schnurr, Paula P

2015-01-01

Posttraumatic stress disorder (PTSD) is prevalent, persistent, and disabling. Although psychotherapy and pharmacotherapy have proven efficacious in randomized clinical trials, geographic barriers impede rural veterans from engaging in these evidence-based treatments. To test a telemedicine-based collaborative care model designed to improve engagement in evidence-based treatment of PTSD. The Telemedicine Outreach for PTSD (TOP) study used a pragmatic randomized effectiveness trial design with intention-to-treat analyses. Outpatients were recruited from 11 Department of Veterans Affairs (VA) community-based outpatient clinics serving predominantly rural veterans. Inclusion required meeting diagnostic criteria for current PTSD according to the Clinician-Administered PTSD Scale. Exclusion criteria included receiving PTSD treatment at a VA medical center or a current diagnosis of schizophrenia, bipolar disorder, or substance dependence. Two hundred sixty-five veterans were enrolled from November 23, 2009, through September 28, 2011, randomized to usual care (UC) or the TOP intervention, and followed up for 12 months. Off-site PTSD care teams located at VA medical centers supported on-site community-based outpatient clinic providers. Off-site PTSD care teams included telephone nurse care managers, telephone pharmacists, telepsychologists, and telepsychiatrists. Nurses conducted care management activities. Pharmacists reviewed medication histories. Psychologists delivered cognitive processing therapy via interactive video. Psychiatrists supervised the team and conducted interactive video psychiatric consultations. The primary outcome was PTSD severity as measured by the Posttraumatic Diagnostic Scale. Process-of-care outcomes included medication prescribing and regimen adherence and initiation of and adherence to cognitive processing therapy. During the 12-month follow-up period, 73 of the 133 patients randomized to TOP (54.9%) received cognitive processing therapy compared with 16 of 132 randomized to UC (12.1%) (odds ratio, 18.08 [95% CI, 7.96-41.06]; P < .001). Patients in the TOP arm had significantly larger decreases in Posttraumatic Diagnostic Scale scores (from 35.0 to 29.1) compared with those in the UC arm (from 33.5 to 32.1) at 6 months (β = -3.81; P = .002). Patients in the TOP arm also had significantly larger decreases in Posttraumatic Diagnostic Scale scores (from 35.0 to 30.1) compared with those in the UC arm (from 33.5 to 31.7) at 12 months (β = -2.49; P=.04). There were no significant group differences in the number of PTSD medications prescribed and adherence to medication regimens were not significant. Attendance at 8 or more sessions of cognitive processing therapy significantly predicted improvement in Posttraumatic Diagnostic Scale scores (β = -3.86 [95% CI, -7.19 to -0.54]; P = .02) and fully mediated the intervention effect at 12 months. Telemedicine-based collaborative care can successfully engage rural veterans in evidence-based psychotherapy to improve PTSD outcomes. clinicaltrials.gov Identifier: NCT00821678.

Comparative Analysis of VaR Estimation of Double Long-Memory GARCH Models: Empirical Analysis of China's Stock Market

NASA Astrophysics Data System (ADS)

Cao, Guangxi; Guo, Jianping; Xu, Lin

GARCH models are widely used to model the volatility of financial assets and measure VaR. Based on the characteristics of long-memory and lepkurtosis and fat tail of stock market return series, we compared the ability of double long-memory GARCH models with skewed student-t-distribution to compute VaR, through the empirical analysis of Shanghai Composite Index (SHCI) and Shenzhen Component Index (SZCI). The results show that the ARFIMA-HYGARCH model performance better than others, and at less than or equal to 2.5 percent of the level of VaR, double long-memory GARCH models have stronger ability to evaluate in-sample VaRs in long position than in short position while there is a diametrically opposite conclusion for ability of out-of-sample VaR forecast.

The effects of a flexible visual acuity-driven ranibizumab treatment regimen in age-related macular degeneration: outcomes of a drug and disease model.

PubMed

Holz, Frank G; Korobelnik, Jean-François; Lanzetta, Paolo; Mitchell, Paul; Schmidt-Erfurth, Ursula; Wolf, Sebastian; Markabi, Sabri; Schmidli, Heinz; Weichselberger, Andreas

2010-01-01

Differences in treatment responses to ranibizumab injections observed within trials involving monthly (MARINA and ANCHOR studies) and quarterly (PIER study) treatment suggest that an individualized treatment regimen may be effective in neovascular age-related macular degeneration. In the present study, a drug and disease model was used to evaluate the impact of an individualized, flexible treatment regimen on disease progression. For visual acuity (VA), a model was developed on the 12-month data from ANCHOR, MARINA, and PIER. Data from untreated patients were used to model patient-specific disease progression in terms of VA loss. Data from treated patients from the period after the three initial injections were used to model the effect of predicted ranibizumab vitreous concentration on VA loss. The model was checked by comparing simulations of VA outcomes after monthly and quarterly injections during this period with trial data. A flexible VA-guided regimen (after the three initial injections) in which treatment is initiated by loss of >5 letters from best previously observed VA scores was simulated. Simulated monthly and quarterly VA-guided regimens showed good agreement with trial data. Simulation of VA-driven individualized treatment suggests that this regimen, on average, sustains the initial gains in VA seen in clinical trials at month 3. The model predicted that, on average, to maintain initial VA gains, an estimated 5.1 ranibizumab injections are needed during the 9 months after the three initial monthly injections, which amounts to a total of 8.1 injections during the first year. A flexible, individualized VA-guided regimen after the three initial injections may sustain vision improvement with ranibizumab and could improve cost-effectiveness and convenience and reduce drug administration-associated risks.

U.S. Overseas Military Presence: What Are the Strategic Choices?

DTIC Science & Technology

2012-01-01

influence in key regions • dissuade military competition and arms races • protect Americans from terrorist attacks • restrict the flow of illegal trade ...1215 Jefferson Davis Highway, Suite 1204, Arlington VA 22202-4302. Respondents should be aware that notwithstanding any other provision of law, no...Terrorist Attacks . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22 Restrict Flow of Illegal Trade and Ensure Flow of Commerce

Scheduled versus Pro Re Nata Dosing in the VIEW Trials.

PubMed

Richard, Gisbert; Monés, Jordi; Wolf, Sebastian; Korobelnik, Jean François; Guymer, Robyn; Goldstein, Michaella; Norenberg, Christiane; Sandbrink, Rupert; Zeitz, Oliver

2015-12-01

To analyze visual acuity (VA) outcomes before and after preplanned treatment regimen change in the VIEW studies at week 52 (W52). Multiple post hoc analyses for retrospectively defined subgroups in 2 multicenter, multinational, double-masked trials. Two thousand four hundred fifty-seven neovascular age-related macular degeneration (AMD) patients. Patients were randomized to treatment with 0.5 mg ranibizumab given monthly, a 0.5-mg or 2-mg intravitreal aflibercept injection given monthly, or 2 mg intravitreal aflibercept given every other month, after 3 initial monthly doses, up to W52. From W52 through W96, patients received their original dosing assignment using a capped pro re nata (PRN) regimen, with defined retreatment criteria based on VA and morphologic signs of disease activity and mandatory dosing at least every 12 weeks. Best-corrected VA (BCVA) and optical coherence tomography assessments were mandatory at all visits from baseline to W96. Outcomes were changes in BCVA and central retinal thickness. Outcomes were evaluated in all patients who completed 2 years of the VIEW studies using the last observation carried forward method for missing data at interim visits. After W52, approximately 20% of patients lost 5 Early Treatment Diabetic Retinopathy Study (ETDRS) letters or more across all treatment arms with PRN treatment. Patients who met the retreatment criterion of loss of 5 ETDRS letters or more in the first quarter of the PRN dosing phase did not recover; mean final VA loss across the 4 study arms was -4.4 to -5.8 letters. Outcomes of these patients up to W52 were indistinguishable from those of the overall population. There were no differences between groups in serious ocular adverse events or Anti-Platelet Trialists' Collaboration arterial thromboembolic events through W96. These analyses suggest that there are subgroups of patients for whom VA outcomes in the second year of the VIEW studies were less stable than in the first year and for whom W52 seems to be an important inflection point. Although alternate reasons specific to the nature of the underlying AMD cannot be fully excluded, the switch in treatment regimen at W52 is a plausible explanation. Copyright © 2015 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.

Insurance based lie detection: Enhancing the verifiability approach with a model statement component.

PubMed

Harvey, Adam C; Vrij, Aldert; Leal, Sharon; Lafferty, Marcus; Nahari, Galit

2017-03-01

The Verifiability Approach (VA) is verbal lie detection tool that has shown promise when applied to insurance claims settings. This study examined the effectiveness of incorporating a Model Statement comprised of checkable information to the VA protocol for enhancing the verbal differences between liars and truth tellers. The study experimentally manipulated supplementing (or withholding) the VA with a Model Statement. It was hypothesised that such a manipulation would (i) encourage truth tellers to provide more verifiable details than liars and (ii) encourage liars to report more unverifiable details than truth tellers (compared to the no model statement control). As a result, it was hypothesized that (iii) the model statement would improve classificatory accuracy of the VA. Participants reported 40 genuine and 40 fabricated insurance claim statements, in which half the liars and truth tellers where provided with a model statement as part of the VA procedure, and half where provide no model statement. All three hypotheses were supported. In terms of accuracy, the model statement increased classificatory rates by the VA considerably from 65.0% to 90.0%. Providing interviewee's with a model statement prime consisting of checkable detail appears to be a useful refinement to the VA procedure. Copyright © 2017 Elsevier B.V. All rights reserved.

The Effect of a Constant Level Lighting Control System on Small Offices With Windows

DTIC Science & Technology

1992-01-01

Scientific 2101 Digital Power Analyzer. The power factor was calculated by dividing the real power by the apparent power (current multiplied by voltage...CBNSC-TT-P 22060 INSODM - Cb. huad. Div. Delace Tockslcol to. C 2M30 US Arm Bo~kuau Disvriaw Pt Dalvoir VA 22M6 AWN: DTIC-AB (2) ATTN: Libary (41) ATmN

Development of Medical Technology for Contingency Response to Marrow Toxic Agents

DTIC Science & Technology

2012-07-26

Armed Forces Radiobiology Research Institute’s (AFRRI) conference on advances in treating combined injuries resulting from a radiological disaster... Research on Health Effects of Radiation B-LCLs B-Lymphoblastoid Cell Lines IND Investigational New Drug BARDA Biomedical Advanced Research and...Naval Research (ONR 342) 875 N. Randolph St. Arlington, VA 22203-1995 Subject: Quartcrl~ Performance/Technical Report of the National Marrow Donor

JPRS Report, Latin America.

DTIC Science & Technology

1987-07-15

INFORMATIONSERVICE SPRINGFIELD, VA 22161 CHILE Pinochet on Domestic Political Situation, Elections (Augusto Pinochet Interview; LA NACION, 28 May 87...at that level xn coming months. [Text] [Rio de Janeiro 0 GLOBO in Portuguese 20 May 87 p 20] 8908 CSO: 3342/129 21 CHILE PINOCHET ON DOMESTIC...to the Armed Forces and the victory of 1973, Chile regained its freedom and is building its democracy. They are incapable of understanding that, as

Proceedings of the Defense Nuclear Agency Conference on Arms Control and Verification Technology ACT Held in Williamsburg, Virginia on 1-4 June 1992

DTIC Science & Technology

1992-12-01

99352 Newington, VA 22122-9998 Steve Kigu Rick King Julia L. Klam NRL USAF IDA 45 Overlook Ave SW MS-4616 21A Eagan Ave. 1801 N. Beauregard St...ATTN: GARY RIPPLE ATTN: B STUPSKI JR ATTN: YANCEY PHILLIPS ATTN: C DIMAGGIO ATTN: C RUSSELL 21ST CENTURY INDUSTRIES ATTN: D BRANDWEIN ATTN: LEONARD M

Lower Respiratory Tract Infection and Short-Term Outcome in Patients With Acute Respiratory Distress Syndrome.

PubMed

Zampieri, Fernando G; Póvoa, Pedro; Salluh, Jorge I; Rodriguez, Alejandro; Valade, Sandrine; Andrade Gomes, José; Reignier, Jean; Molinos, Elena; Almirall, Jordi; Boussekey, Nicolas; Socias, Lorenzo; Ramirez, Paula; Viana, William N; Rouzé, Anahita; Nseir, Saad; Martin-Loeches, Ignacio

2018-01-01

To assess whether ventilator-associated lower respiratory tract infections (VA-LRTIs) are associated with mortality in critically ill patients with acute respiratory distress syndrome (ARDS). Post hoc analysis of prospective cohort study including mechanically ventilated patients from a multicenter prospective observational study (TAVeM study); VA-LRTI was defined as either ventilator-associated tracheobronchitis (VAT) or ventilator-associated pneumonia (VAP) based on clinical criteria and microbiological confirmation. Association between intensive care unit (ICU) mortality in patients having ARDS with and without VA-LRTI was assessed through logistic regression controlling for relevant confounders. Association between VA-LRTI and duration of mechanical ventilation and ICU stay was assessed through competing risk analysis. Contribution of VA-LRTI to a mortality model over time was assessed through sequential random forest models. The cohort included 2960 patients of which 524 fulfilled criteria for ARDS; 21% had VA-LRTI (VAT = 10.3% and VAP = 10.7%). After controlling for illness severity and baseline health status, we could not find an association between VA-LRTI and ICU mortality (odds ratio: 1.07; 95% confidence interval: 0.62-1.83; P = .796); VA-LRTI was also not associated with prolonged ICU length of stay or duration of mechanical ventilation. The relative contribution of VA-LRTI to the random forest mortality model remained constant during time. The attributable VA-LRTI mortality for ARDS was higher than the attributable mortality for VA-LRTI alone. After controlling for relevant confounders, we could not find an association between occurrence of VA-LRTI and ICU mortality in patients with ARDS.

Effects of maternal vitamin supplements on malaria in children born to HIV-infected women.

PubMed

Villamor, Eduardo; Msamanga, Gernard; Saathoff, Elmar; Fataki, Maulidi; Manji, Karim; Fawzi, Wafaie W

2007-06-01

Vitamin deficiencies are frequent in children suffering from malaria. The effects of maternal multivitamin supplementation on the risk of malaria in children are unknown. We examined the impact of providing multivitamins or vitamin A/beta-carotene supplements during pregnancy and lactation to HIV-infected women on their children's risk of malaria up to 2 years of age, in a randomized, placebo-controlled trial. Tanzanian women (N = 829) received one of four daily oral regimens during pregnancy and after delivery: 1) vitamins B, C, and E (multivitamins); 2) vitamin A and beta-carotene (VA/BC); 3) multivitamins including VA/BC; or 4) placebo. After 6 months of age, all children received 6-monthly oral vitamin A supplements irrespective of treatment arm. The incidence of childhood malaria was assessed through three-monthly blood smears and at monthly and interim clinic visits from birth to 24 months of age. Compared with placebo, multivitamins excluding VA/BC reduced the incidence of clinical malaria by 71% (95% CI = 11-91%; P = 0.02), whereas VA/BC alone resulted in a nonsignificant 63% reduction (95% CI = -4% to 87%; P = 0.06). Multivitamins including VA/BC significantly reduced the incidence of high parasitemia by 43% (95% CI = 2-67%; P = 0.04). The effects did not vary according to the children's HIV status. Supplementation of pregnant and lactating HIV-infected women with vitamins B, C, and E might be a useful, inexpensive intervention to decrease the burden of malaria in children born to HIV-infected women in sub-Saharan Africa.

Anatomical and neuromuscular variables strongly predict maximum knee extension torque in healthy men.

PubMed

Trezise, J; Collier, N; Blazevich, A J

2016-06-01

This study examined the relative influence of anatomical and neuromuscular variables on maximal isometric and concentric knee extensor torque and provided a comparative dataset for healthy young males. Quadriceps cross-sectional area (CSA) and fascicle length (l f) and angle (θ f) from the four quadriceps components; agonist (EMG:M) and antagonist muscle activity, and percent voluntary activation (%VA); patellar tendon moment arm distance (MA) and maximal voluntary isometric and concentric (60° s(-1)) torques, were measured in 56 men. Linear regression models predicting maximum torque were ranked using Akaike's Information Criterion (AICc), and Pearson's correlation coefficients assessed relationships between variables. The best-fit models explained up to 72 % of the variance in maximal voluntary knee extension torque. The combination of 'CSA + θ f + EMG:M + %VA' best predicted maximum isometric torque (R (2) = 72 %, AICc weight = 0.38) and 'CSA + θ f + MA' (R (2) = 65 %, AICc weight = 0.21) best predicted maximum concentric torque. Proximal quadriceps CSA was included in all models rather than the traditionally used mid-muscle CSA. Fascicle angle appeared consistently in all models despite its weak correlation with maximum torque in isolation, emphasising the importance of examining interactions among variables. While muscle activity was important for torque prediction in both contraction modes, MA only strongly influenced maximal concentric torque. These models identify the main sources of inter-individual differences strongly influencing maximal knee extension torque production in healthy men. The comparative dataset allows the identification of potential variables to target (i.e. weaknesses) in individuals.

A participatory approach to designing and enhancing integrated health information technology systems for veterans: protocol.

PubMed

Haun, Jolie N; Nazi, Kim M; Chavez, Margeaux; Lind, Jason D; Antinori, Nicole; Gosline, Robert M; Martin, Tracey L

2015-02-27

The Department of Veterans Affairs (VA) has developed health information technologies (HIT) and resources to improve veteran access to health care programs and services, and to support a patient-centered approach to health care delivery. To improve VA HIT access and meaningful use by veterans, it is necessary to understand their preferences for interacting with various HIT resources to accomplish health management related tasks and to exchange information. The objective of this paper was to describe a novel protocol for: (1) developing a HIT Digital Health Matrix Model; (2) conducting an Analytic Hierarchy Process called pairwise comparison to understand how and why veterans want to use electronic health resources to complete tasks related to health management; and (3) developing visual modeling simulations that depict veterans' preferences for using VA HIT to manage their health conditions and exchange health information. The study uses participatory research methods to understand how veterans prefer to use VA HIT to accomplish health management tasks within a given context, and how they would like to interact with HIT interfaces (eg, look, feel, and function) in the future. This study includes two rounds of veteran focus groups with self-administered surveys and visual modeling simulation techniques. This study will also convene an expert panel to assist in the development of a VA HIT Digital Health Matrix Model, so that both expert panel members and veteran participants can complete an Analytic Hierarchy Process, pairwise comparisons to evaluate and rank the applicability of electronic health resources for a series of health management tasks. This protocol describes the iterative, participatory, and patient-centered process for: (1) developing a VA HIT Digital Health Matrix Model that outlines current VA patient-facing platforms available to veterans, describing their features and relevant contexts for use; and (2) developing visual model simulations based on direct veteran feedback that depict patient preferences for enhancing the synchronization, integration, and standardization of VA patient-facing platforms. Focus group topics include current uses, preferences, facilitators, and barriers to using electronic health resources; recommendations for synchronizing, integrating, and standardizing VA HIT; and preferences on data sharing and delegation within the VA system. This work highlights the practical, technological, and personal factors that facilitate and inhibit use of current VA HIT, and informs an integrated system redesign. The Digital Health Matrix Model and visual modeling simulations use knowledge of veteran preferences and experiences to directly inform enhancements to VA HIT and provide a more holistic and integrated user experience. These efforts are designed to support the adoption and sustained use of VA HIT to support patient self-management and clinical care coordination in ways that are directly aligned with veteran preferences.

A Participatory Approach to Designing and Enhancing Integrated Health Information Technology Systems for Veterans: Protocol

PubMed Central

Nazi, Kim M; Chavez, Margeaux; Lind, Jason D; Antinori, Nicole; Gosline, Robert M; Martin, Tracey L

2015-01-01

Background The Department of Veterans Affairs (VA) has developed health information technologies (HIT) and resources to improve veteran access to health care programs and services, and to support a patient-centered approach to health care delivery. To improve VA HIT access and meaningful use by veterans, it is necessary to understand their preferences for interacting with various HIT resources to accomplish health management related tasks and to exchange information. Objective The objective of this paper was to describe a novel protocol for: (1) developing a HIT Digital Health Matrix Model; (2) conducting an Analytic Hierarchy Process called pairwise comparison to understand how and why veterans want to use electronic health resources to complete tasks related to health management; and (3) developing visual modeling simulations that depict veterans’ preferences for using VA HIT to manage their health conditions and exchange health information. Methods The study uses participatory research methods to understand how veterans prefer to use VA HIT to accomplish health management tasks within a given context, and how they would like to interact with HIT interfaces (eg, look, feel, and function) in the future. This study includes two rounds of veteran focus groups with self-administered surveys and visual modeling simulation techniques. This study will also convene an expert panel to assist in the development of a VA HIT Digital Health Matrix Model, so that both expert panel members and veteran participants can complete an Analytic Hierarchy Process, pairwise comparisons to evaluate and rank the applicability of electronic health resources for a series of health management tasks. Results This protocol describes the iterative, participatory, and patient-centered process for: (1) developing a VA HIT Digital Health Matrix Model that outlines current VA patient-facing platforms available to veterans, describing their features and relevant contexts for use; and (2) developing visual model simulations based on direct veteran feedback that depict patient preferences for enhancing the synchronization, integration, and standardization of VA patient-facing platforms. Focus group topics include current uses, preferences, facilitators, and barriers to using electronic health resources; recommendations for synchronizing, integrating, and standardizing VA HIT; and preferences on data sharing and delegation within the VA system. Conclusions This work highlights the practical, technological, and personal factors that facilitate and inhibit use of current VA HIT, and informs an integrated system redesign. The Digital Health Matrix Model and visual modeling simulations use knowledge of veteran preferences and experiences to directly inform enhancements to VA HIT and provide a more holistic and integrated user experience. These efforts are designed to support the adoption and sustained use of VA HIT to support patient self-management and clinical care coordination in ways that are directly aligned with veteran preferences. PMID:25803324

Management Modalities for Traumatic Macular Hole: A Systematic Review and Single-Arm Meta-Analysis.

PubMed

Gao, Min; Liu, Kun; Lin, Qiurong; Liu, Haiyun

2017-02-01

The purposes of this study were to (i) determine macular hole (MH) closure rates and visual outcomes by comparing two methods of managing traumatic MH (TMH)-an event resulting in severe loss of visual acuity (VA); (ii) characterize patients who undergo spontaneous TMH closure; (iii) determine which TMH patients should be observed before resorting to surgical repair; and (iv) elucidate factors that influence postoperative visual outcomes. Studies (n=10) of patients who were managed by surgery or observation for TMH were meta-analyzed retrospectively. Management modalities included surgical repair (surgery group) and observation for spontaneous hole closure (observation group). In addition, a 12-case series of articles (1990-2014) on spontaneous hole closure was statistically summarized. SAS and Comprehensive Meta-Analysis (CMA) (version 3.0) were used for analysis. For surgery group patients, the fixed-model pooled event rate for hole closure was 0.919 (range, 0.861-0.954) and for observation group patients, 0.368 (range, 0.236-0.448). The random-model pooled event rate for improvement of visual acuity (VA) for surgery group patients was 0.748 (range, 0.610-0.849) and for observation group patients, 0.505 (range, 0.397-0.613). For patients in both groups, the mean age of spontaneous closure was 18.71±10.64 years; mean size of TMHs, 0.18±0.06 decimal degrees (DD); and mean time for hole closure, 3.38±3.08 months. The pooled event rate for visual improvement was 0.748 (0.610-0.849). Hole closure and VA improvement rates of surgery group patients were significantly higher than those for observation group patients. Patients of ≤ 24 years of age with MH sizes of ≤ 0.2DD were more likely to achieve spontaneous hole closure. The interval of time from injury to surgery was statistically significantly associated with the level of visual improvement.

Analysis of Servicemembers’ Group Life Insurance (SGLI) Program: History, Current Issues and Future Implications

DTIC Science & Technology

2011-06-01

provide coverage for servicemembers. Even though insurance actuaries are fairly reliable in predicting deaths in the armed services during peacetime... disability . Mr. Wurtz continues: The SGLI program has insurance companies that have agreed to be "converters.” When an insured wants to convert...Philadelphia, PA; and Chief, Actuarial Staff, VA Regional Office and Insurance Center, Philadelphia, PA. A copy of the 1998 (Thursday, December 17

Comparative Effectiveness of an Internet-Based Smoking Cessation Intervention Versus Clinic-Based Specialty Care for Veterans.

PubMed

Calhoun, Patrick S; Datta, Santanu; Olsen, Maren; Smith, Valerie A; Moore, Scott D; Hair, Lauren P; Dedert, Eric A; Kirby, Angela; Dennis, Michelle; Beckham, Jean C; Bastian, Lori A

2016-10-01

The primary objective of this project was to examine the effectiveness of an Internet-based smoking cessation intervention combined with a tele-health medication clinic for nicotine replacement therapy (NRT) compared to referral to clinic-based smoking cessation care. A total of 413 patients were proactively recruited from the Durham VA Medical Center and followed for 12 months. Patients were randomized to receive either a referral to VA specialty smoking cessation care (control) or to the Internet intervention and tele-health medication clinic. Primary outcomes included (1) intervention reach, (2) self-reported 7-day point prevalence abstinence rates at 3 months and 12 months, and 3) relative cost-effectiveness. Reach of the Internet intervention and use of smoking cessation aids were significantly greater compared to the control. At 3 months-post randomization, however, there were no significant differences in quit rates: 17% (95% CI: 12%–23%) in the Internet-based intervention compared to 12% (95% CI: 8%–17%) in the control arm. Similarly, there were no differences in quit rates at 12 months (13% vs. 16%). While costs associated with the Internet arm were higher due to increased penetration and intensity of NRT use, there were no statistically significant differences in the relative cost effectiveness (e.g., life years gained, quality adjusted life years) between the two arms. Current results suggest that using an electronic medical record to identify smokers and proactively offering smoking cessation services that are consistent with US Public Health Guidelines can significantly reduce smoking in veterans. Novel interventions that increase the reach of intensive treatment are needed to maximize quit rates in this population.

Comparative Effectiveness of an Internet-Based Smoking Cessation Intervention versus Clinic-Based Specialty Care for Veterans

PubMed Central

Calhoun, Patrick S.; Datta, Santanu; Olsen, Maren; Smith, Valerie A.; Moore, Scott D.; Hair, Lauren P.; Dedert, Eric A.; Kirby, Angela; Dennis, Michelle; Beckham, Jean C.; Bastian, Lori A

2016-01-01

Introduction The primary objective of this project was to examine the effectiveness of an internet-based smoking cessation intervention combined with a tele-health medication clinic for nicotine replacement therapy (NRT) compared to referral to clinic-based smoking cessation care. Methods A total of 413 patients were proactively recruited from the Durham VA Medical Center and followed for 12 months. Patients were randomized to receive either a referral to VA specialty smoking cessation care (control) or to the internet intervention and tele-health medication clinic. Primary outcomes included (1) intervention reach, (2) self-reported 7-day point prevalence abstinence rates at 3 months and 12 months, and 3) relative cost-effectiveness. Results Reach of the internet intervention and use of smoking cessation aids were significantly greater compared to the control. At 3 months-post randomization, however, there were no significant differences in quit rates: 17% (95% CI: 12%–23%) in the internet-based intervention compared to 12% (95% CI: 8%–17%) in the control arm. Similarly, there were no differences in quit rates at 12 months (13% vs. 16%). While costs associated with the internet arm were higher due to increased penetration and intensity of NRT use, there were no statistically significant differences in the relative cost effectiveness (e.g., life years gained, quality adjusted life years) between the two arms. Conclusions Current results suggest that using an electronic medical record to identify smokers and proactively offering smoking cessation services that are consistent with US Public Health Guidelines can significantly reduce smoking in veterans. Novel interventions that increase the reach of intensive treatment are needed to maximize quit rates in this population. PMID:27568506

Correlations and risk contagion between mixed assets and mixed-asset portfolio VaR measurements in a dynamic view: An application based on time varying copula models

NASA Astrophysics Data System (ADS)

Han, Yingying; Gong, Pu; Zhou, Xiang

2016-02-01

In this paper, we apply time varying Gaussian and SJC copula models to study the correlations and risk contagion between mixed assets: financial (stock), real estate and commodity (gold) assets in China firstly. Then we study the dynamic mixed-asset portfolio risk through VaR measurement based on the correlations computed by the time varying copulas. This dynamic VaR-copula measurement analysis has never been used on mixed-asset portfolios. The results show the time varying estimations fit much better than the static models, not only for the correlations and risk contagion based on time varying copulas, but also for the VaR-copula measurement. The time varying VaR-SJC copula models are more accurate than VaR-Gaussian copula models when measuring more risky portfolios with higher confidence levels. The major findings suggest that real estate and gold play a role on portfolio risk diversification and there exist risk contagion and flight to quality between mixed-assets when extreme cases happen, but if we take different mixed-asset portfolio strategies with the varying of time and environment, the portfolio risk will be reduced.

Efficacy of Ranibizumab in Eyes with Diabetic Macular Edema and Macular Nonperfusion in RIDE and RISE.

PubMed

Reddy, Rahul K; Pieramici, Dante J; Gune, Shamika; Ghanekar, Avanti; Lu, Na; Quezada-Ruiz, Carlos; Baumal, Caroline R

2018-05-08

To determine whether there are baseline characteristics that distinguish patients with diabetic macular edema (DME) with coexisting macular nonperfusion (MNP) at baseline and assess these patients' potential to achieve favorable visual acuity (VA), anatomic, and diabetic retinopathy (DR) outcomes over 24 months. Post hoc analysis of RIDE/RISE, 2 phase 3, parallel, randomized, multicenter, double-masked trials (ClinicalTrials.gov: NCT00473382; NCT00473330). Study eyes with best-corrected VA (BCVA)/fluorescein angiogram (FA) data at baseline. To measure MNP, the Early Treatment for Diabetic Retinopathy Study (ETDRS) grid was overlaid on FAs of the macula. The MNP area was calculated by estimating the percentage of capillary loss in the central, inner, and outer subfields and converting into disc areas (DAs) using a software algorithm. Summary statistics and P values, respectively, were provided for all outcomes and comparisons of interest. Baseline characteristics; MNP area, BCVA, and central subfield thickness (CST) at months 12 and 24; and incidence of study eyes with ≥2-step DR improvement at months 3, 6, 12, 18, and 24. Baseline MNP was detected in 28.2%, 25.8%, and 26.3% of study eyes in the ranibizumab 0.3 mg (n = 213), ranibizumab 0.5 mg (n = 225), and sham (n = 228) arms, respectively. At baseline, patients with MNP were younger and had shorter diabetes duration, worse vision, increased CST, and worse DR severity (P values < 0.01 vs. those without MNP). In the ranibizumab 0.3 mg arm, eyes with baseline MNP had lower mean baseline BCVA (53.4 vs. 57.2 ETDRS letters for those without baseline MNP; P = 0.05), but mean BCVA gain at month 24 was comparable (+15.6 vs. +13.4 ETDRS letters, respectively; P = 0.2). Eyes with baseline MNP had increased CST at baseline, but experienced a greater decrease in CST by month 24. The proportion of eyes with ≥2-step DR improvement was greater for eyes with versus without baseline MNP in each ranibizumab arm. Despite having worse vision/increased CST versus those without baseline MNP, eyes with concurrent DME and baseline MNP entering RIDE/RISE experienced robust VA and anatomic improvement with ranibizumab and therefore should not be excluded from therapy. Copyright © 2018 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.

Financial Incentives and Physician Commitment to Guideline-Recommended Hypertension Management: A Mixed Methods Approach

PubMed Central

Hysong, Sylvia J.; Simpson, Kate; Pietz, Kenneth; SoRelle, Richard; Broussard, Kristen; Petersen, Laura A.

2014-01-01

Objective To examine the impact of financial incentives on physician goal commitment to guideline-recommended hypertension care. Study design Clinic-level cluster-randomized controlled trial with four arms: control, individual-, group-, or combined incentives. Intervention arm participants received performance-based incentives every four months for five periods. All participants received guideline education at baseline and audit and feedback every four months. Methods 83 full-time primary care physicians at 12 VA Medical Centers completed web-based survey responses to Hollenbeck’s goal commitment scale every four months and telephone interviews at months 8 and 16. Results Physician goal commitment did not vary over time or across arms. Participants reported patient non-adherence and consistent follow-up as perceived barriers and facilitators to successful hypertension care, suggesting providers may perceive hypertension management as more of a patient responsibility (external locus of control). Conclusions Financial incentives may constitute an insufficiently strong intervention to influence goal commitment when providers attribute performance to external forces beyond their control. PMID:23145846

Superior Patency of Upper Arm Arteriovenous Fistulae in High Risk Patients

PubMed Central

Chiulli, Larissa C; Vasilas, Penny; Dardik, Alan

2011-01-01

Background Despite an increased propensity to primary failure in forearm arteriovenous fistulae compared to upper arm fistulae, forearm fistulae remain the preferred primary access type for chronic hemodialysis patients. In a high risk patient population with multiple medical comorbidities associated with requirement for intravenous access we compared the rates of access failure in forearm and upper arm fistulae. Materials and Methods The records of all patients having primary native arteriovenous fistulae placed between 2004 and 2009 at the VA Connecticut Healthcare system were reviewed (n=118). Primary and secondary patency of upper arm and forearm fistulae were evaluated using Kaplan-Meier survival analysis. The effects of medical comorbidities on access patency were analyzed with Cox regression. Results The median time to primary failure of the vascular access was 0.288 years in the forearm group compared to 0.940 years in the upper arm group (p=0.028). Secondary patency was 52% at 4.9 years in upper arm fistulae compared to 52% at 1.1 years in the forearm group (p=0.036). There was no significant effect of patient comorbidities on fistula failure; however, there was a trend toward upper arm surgical site as a protective factor for primary fistula patency (Hazard Ratio=0.573, p=0.076). Conclusions In veterans needing hemodialysis, a high risk population with extensive comorbid factors often requiring intravascular access, upper arm fistulae are not only a viable option for primary vascular access, but are likely to be a superior option to classic forearm fistulae. PMID:21571318

Risk stratification for death and all-cause hospitalization in heart failure clinic outpatients.

PubMed

Hummel, Scott L; Ghalib, Hussam H; Ratz, David; Koelling, Todd M

2013-11-01

Most heart failure (HF) risk stratification models were developed for inpatient use, and available outpatient models use a complex set of variables. We hypothesized that routinely collected clinical data could predict the 6-month risk of death and all-cause medical hospitalization in HF clinic outpatients. Using a quality improvement database and multivariable Cox modeling, we derived the Heart Failure Patient Severity Index (HFPSI) in the University of Michigan HF clinic (UM cohort, n = 1,536; 314 reached primary outcome). We externally validated the HFPSI in the Ann Arbor Veterans' Affairs HF clinic (VA cohort, n = 445; 106 outcomes) and explored "real-time" HFPSI use (VA-RT cohort, n = 486; 141 outcomes) by tracking VA patients for 6 months from their most recently calculated HFPSI, rather than using an arbitrary start date for the cohort. The HFPSI model included blood urea nitrogen, B-type natriuretic peptide, New York Heart Association class, diabetes status, history of atrial fibrillation/flutter, and all-cause hospitalization within the prior 1 and 2 to 6 months. The concordance c statistics in the UM/VA/VA-RT cohorts were 0.71/0.68/0.74. Kaplan-Meier curves and log-rank testing demonstrated excellent risk stratification, particularly between a large, low-risk group (40% of patients, 6-month event rates in the UM/VA/VA-RT cohorts 8%/12%/12%) and a small, high-risk group (10% of patients, 6-month event rates in the UM/VA/VA-RT cohorts 57%/58%/79%). The HFPSI uses readily available data to predict the 6-month risk of death and/or all-cause medical hospitalization in HF clinic outpatients and could potentially help allocate specialized HF resources within health systems. © 2013.

Forecasting VaR and ES of stock index portfolio: A Vine copula method

NASA Astrophysics Data System (ADS)

Zhang, Bangzheng; Wei, Yu; Yu, Jiang; Lai, Xiaodong; Peng, Zhenfeng

2014-12-01

Risk measurement has both theoretical and practical significance in risk management. Using daily sample of 10 international stock indices, firstly this paper models the internal structures among different stock markets with C-Vine, D-Vine and R-Vine copula models. Secondly, the Value-at-Risk (VaR) and Expected Shortfall (ES) of the international stock markets portfolio are forecasted using Monte Carlo method based on the estimated dependence of different Vine copulas. Finally, the accuracy of VaR and ES measurements obtained from different statistical models are evaluated by UC, IND, CC and Posterior analysis. The empirical results show that the VaR forecasts at the quantile levels of 0.9, 0.95, 0.975 and 0.99 with three kinds of Vine copula models are sufficiently accurate. Several traditional methods, such as historical simulation, mean-variance and DCC-GARCH models, fail to pass the CC backtesting. The Vine copula methods can accurately forecast the ES of the portfolio on the base of VaR measurement, and D-Vine copula model is superior to other Vine copulas.

Mathematical modeling of serum 13C-retinol in captive rhesus monkeys provides new insights on hypervitaminosis A.

PubMed

Escaron, Anne L; Green, Michael H; Howe, Julie A; Tanumihardjo, Sherry A

2009-10-01

Hypervitaminosis A is increasingly a public health concern, and thus noninvasive quantitative methods merit exploration. In this study, we applied the (13)C-retinol isotope dilution test to a nonhuman primate model with excessive liver stores. After baseline serum chemistries, rhesus macaques (Macaca mulatta; n = 16) were administered 3.5 mumol (13)C(2)-retinyl acetate. Blood was drawn at baseline, 5 h, and 2, 4, 7, 14, 21, and 28 d following the dose. Liver biopsies were collected 7 d before and 2 d after dosing (n = 4) and at 7, 14, and 28 d (n = 4/time) after dosing. Serum and liver were analyzed by HPLC and GC-combustion-isotope ratio MS for retinol and its enrichment, respectively. Model-based compartmental analysis was applied to serum data. Lactate dehydrogenase was elevated in 50% of the monkeys. Total body reserves (TBR) of vitamin A (VA) were calculated at 28 d. Predicted TBR (3.52 +/- 2.01 mmol VA) represented measured liver stores (4.56 +/- 1.38 mmol VA; P = 0.124). Predicted liver VA concentrations (13.3 +/- 9.7 micromol/g) were similar to measured liver VA concentrations (16.4 +/- 5.3 micromol/g). The kinetic models predict that 27-52% of extravascular VA is exchanging with serum in hypervitaminotic A monkeys. The test correctly diagnosed hypervitaminosis A in all monkeys, i.e. 100% sensitivity. Stable isotope techniques have important public health potential for the classification of VA status, including hypervitaminosis, because no other technique besides invasive liver biopsies, correctly identifies excessive liver VA stores.

Forecasting the value-at-risk of Chinese stock market using the HARQ model and extreme value theory

NASA Astrophysics Data System (ADS)

Liu, Guangqiang; Wei, Yu; Chen, Yongfei; Yu, Jiang; Hu, Yang

2018-06-01

Using intraday data of the CSI300 index, this paper discusses value-at-risk (VaR) forecasting of the Chinese stock market from the perspective of high-frequency volatility models. First, we measure the realized volatility (RV) with 5-minute high-frequency returns of the CSI300 index and then model it with the newly introduced heterogeneous autoregressive quarticity (HARQ) model, which can handle the time-varying coefficients of the HAR model. Second, we forecast the out-of-sample VaR of the CSI300 index by combining the HARQ model and extreme value theory (EVT). Finally, using several popular backtesting methods, we compare the VaR forecasting accuracy of HARQ model with other traditional HAR-type models, such as HAR, HAR-J, CHAR, and SHAR. The empirical results show that the novel HARQ model can beat other HAR-type models in forecasting the VaR of the Chinese stock market at various risk levels.

Refining value-at-risk estimates using a Bayesian Markov-switching GJR-GARCH copula-EVT model.

PubMed

Sampid, Marius Galabe; Hasim, Haslifah M; Dai, Hongsheng

2018-01-01

In this paper, we propose a model for forecasting Value-at-Risk (VaR) using a Bayesian Markov-switching GJR-GARCH(1,1) model with skewed Student's-t innovation, copula functions and extreme value theory. A Bayesian Markov-switching GJR-GARCH(1,1) model that identifies non-constant volatility over time and allows the GARCH parameters to vary over time following a Markov process, is combined with copula functions and EVT to formulate the Bayesian Markov-switching GJR-GARCH(1,1) copula-EVT VaR model, which is then used to forecast the level of risk on financial asset returns. We further propose a new method for threshold selection in EVT analysis, which we term the hybrid method. Empirical and back-testing results show that the proposed VaR models capture VaR reasonably well in periods of calm and in periods of crisis.

Challenges Associated with Estimating Utility in Wet Age-Related Macular Degeneration: A Novel Regression Analysis to Capture the Bilateral Nature of the Disease.

PubMed

Hodgson, Robert; Reason, Timothy; Trueman, David; Wickstead, Rose; Kusel, Jeanette; Jasilek, Adam; Claxton, Lindsay; Taylor, Matthew; Pulikottil-Jacob, Ruth

2017-10-01

The estimation of utility values for the economic evaluation of therapies for wet age-related macular degeneration (AMD) is a particular challenge. Previous economic models in wet AMD have been criticized for failing to capture the bilateral nature of wet AMD by modelling visual acuity (VA) and utility values associated with the better-seeing eye only. Here we present a de novo regression analysis using generalized estimating equations (GEE) applied to a previous dataset of time trade-off (TTO)-derived utility values from a sample of the UK population that wore contact lenses to simulate visual deterioration in wet AMD. This analysis allows utility values to be estimated as a function of VA in both the better-seeing eye (BSE) and worse-seeing eye (WSE). VAs in both the BSE and WSE were found to be statistically significant (p < 0.05) when regressed separately. When included without an interaction term, only the coefficient for VA in the BSE was significant (p = 0.04), but when an interaction term between VA in the BSE and WSE was included, only the constant term (mean TTO utility value) was significant, potentially a result of the collinearity between the VA of the two eyes. The lack of both formal model fit statistics from the GEE approach and theoretical knowledge to support the superiority of one model over another make it difficult to select the best model. Limitations of this analysis arise from the potential influence of collinearity between the VA of both eyes, and the use of contact lenses to reflect VA states to obtain the original dataset. Whilst further research is required to elicit more accurate utility values for wet AMD, this novel regression analysis provides a possible source of utility values to allow future economic models to capture the quality of life impact of changes in VA in both eyes. Novartis Pharmaceuticals UK Limited.

The Impact of a Change in the Price of VA Health Care on Utilization of VA and Medicare Services.

PubMed

Nelson, Richard E; Hicken, Bret; Vanneman, Megan; Liu, Chuan-Fen; Rupper, Randall

2018-05-15

The passage of the Veterans Access, Choice, and Accountability Act of 2014 has expanded the non-Veteran Affairs (VA) care options for eligible US Veterans. In order for these new arrangements to provide the best care possible for Veterans, it is important to understand the relationship between VA and non-VA care options. The purpose of this study was to use another recent VA policy change, one that increased the reimbursement rate that eligible Veterans receive for travel for health care to VA, to understand the use of VA and Medicare services among Medicare-enrolled Veterans. We used a difference-in-difference technique to compare inpatient and outpatient utilization and cost in VA and Medicare between Veterans who were eligible for travel reimbursement and those who were not eligible following 2 increases in the travel reimbursement rate. We used generalized estimating equation models and 2-part models when cost outcomes were rare. Our cohort consisted of 110,007 Medicare-enrolled Veterans, including 25,076 under 65 and 84,931 over 65 years old. Following the travel reimbursement rate increases, the number of VA outpatient encounters increased for Veterans in our cohort regardless of age group or whether living in an urban or rural area. The number of non-VA outpatient encounters decreased significantly for Veterans in both age groups living in rural areas following these policy changes. Our estimates suggest that VA outpatient care may be a substitute for Medicare outpatient care for Medicare-enrolled Veterans living in rural areas. These results are important because they indicate how Veteran health care utilization might be affected by future policy changes designed to increase access to VA services. They also indicate the ripple effects that may occur in other health systems due to changes in the VA system.

Effect of Kollidon VA®64 particle size and morphology as directly compressible excipient on tablet compression properties.

PubMed

Chaudhary, R S; Patel, C; Sevak, V; Chan, M

2018-01-01

The study evaluates use of Kollidon VA ® 64 and a combination of Kollidon VA ® 64 with Kollidon VA ® 64 Fine as excipient in direct compression process of tablets. The combination of the two grades of material is evaluated for capping, lamination and excessive friability. Inter particulate void space is higher for such excipient due to the hollow structure of the Kollidon VA ® 64 particles. During tablet compression air remains trapped in the blend exhibiting poor compression with compromised physical properties of the tablets. Composition of Kollidon VA ® 64 and Kollidon VA ® 64 Fine is evaluated by design of experiment (DoE). A scanning electron microscopy (SEM) of two grades of Kollidon VA ® 64 exhibits morphological differences between coarse and fine grade. The tablet compression process is evaluated with a mix consisting of entirely Kollidon VA ® 64 and two mixes containing Kollidon VA ® 64 and Kollidon VA ® 64 Fine in ratio of 77:23 and 65:35. A statistical modeling on the results from the DoE trials resulted in the optimum composition for direct tablet compression as combination of Kollidon VA ® 64 and Kollidon VA ® 64 Fine in ratio of 77:23. This combination compressed with the predicted parameters based on the statistical modeling and applying main compression force between 5 and 15 kN, pre-compression force between 2 and 3 kN, feeder speed fixed at 25 rpm and compression range of 45-49 rpm produced tablets with hardness ranging between 19 and 21 kp, with no friability, capping, or lamination issue.

PVP VA64 as a novel release-modifier for sustained-release mini-matrices prepared via hot melt extrusion.

PubMed

Li, Yongcheng; Lu, Ming; Wu, Chuanbin

2017-11-10

The purpose of this study was to explore poly(vinylpyrrolidone-co-vinyl acetate) (PVP VA64) as a novel release-modifier to tailor the drug release from ethylcellulose (EC)-based mini-matrices prepared via hot melt extrusion (HME). Quetiapine fumarate (QF) was selected as model drug. QF/EC/PVP VA64 mini-matrices were extruded with 30% drug loading. The physical state of QF in extruded mini-matrices was characterized using differential scanning calorimetry, X-ray powder diffraction, and confocal Raman microscopy. The release-controlled ability of PVP VA64 was investigated and compared with that of xanthan gum, crospovidone, and low-substituted hydroxypropylcellulose. The influences of PVP VA64 content and processing temperature on QF release behavior and mechanism were also studied. The results indicated QF dispersed as the crystalline state in all mini-matrices. The release of QF from EC was very slow as only 4% QF was released in 24 h. PVP VA64 exhibited the best ability to enhance the drug release as compared with other three release-modifiers. The drug release increased to 50-100% in 24 h with the addition of 20-40% PVP VA64. Increasing processing temperature slightly slowed down the drug release by decreasing free volume and pore size. The release kinetics showed good fit with the Ritger-Peppas model. The values of release exponent (n) increased as PVP VA64 is added (0.14 for pure EC, 0.41 for 20% PVP VA64, and 0.61 for 40% PVP VA64), revealing that the addition of PVP VA64 enhanced the erosion mechanism. This work presented a new polymer blend system of EC with PVP VA64 for sustained-release prepared via HME.

Hospital Distance and Readmissions Among VA-Medicare Dual-Enrolled Veterans.

PubMed

Wong, Edwin S; Rinne, Seppo T; Hebert, Paul L; Cook, Meredith A; Liu, Chuan-Fen

2016-09-01

Geographic access to inpatient care at the Veterans Affairs (VA) Health Care System is challenging for many veterans with chronic obstructive pulmonary disease (COPD) given relatively few VA hospitals nationwide. Veterans with lengthy travel distances may obtain non-VA care, particularly those dually enrolled in Medicare. Our primary objective was to assess whether distance from VA patients' residence to the nearest VA and non-VA hospitals was associated with 30-day all-cause readmission and the system where patients were readmitted (VA or Medicare). Using VA and Medicare administrative data, we identified 21,273 patients hospitalized for COPD between October 2008 and September 2011 and dually enrolled in VA and fee-for-service Medicare. Outcome variables were dichotomous measures denoting readmission for any cause within 30 days following discharge and whether the readmission occurred in a non-VA hospital through Medicare. Distance to the nearest hospital was defined as the number of miles between patients' residence ZIP code and the ZIP code of the nearest VA and non-VA hospital accepting Medicare, respectively. Probit models with sample selection were applied to examine the relationship between hospital distance and outcome measures. Respective distances to the nearest VA and non-VA hospital were not associated with 30-day all-cause readmission. Greater distance to the nearest VA hospital was associated with a greater conditional probability of choosing non-VA hospitals for readmission. COPD patients with poor geographic access to VA hospitals did not forgo subsequent inpatient care following their index hospitalization, but they were more likely to seek non-VA substitutes. © 2016 National Rural Health Association.

Mathematical Modeling of Serum 13C-Retinol in Captive Rhesus Monkeys Provides New Insights on Hypervitaminosis A1–3

PubMed Central

Escaron, Anne L.; Green, Michael H.; Howe, Julie A.; Tanumihardjo, Sherry A.

2009-01-01

Hypervitaminosis A is increasingly a public health concern, and thus noninvasive quantitative methods merit exploration. In this study, we applied the 13C-retinol isotope dilution test to a nonhuman primate model with excessive liver stores. After baseline serum chemistries, rhesus macaques (Macaca mulatta; n = 16) were administered 3.5 μmol 13C2-retinyl acetate. Blood was drawn at baseline, 5 h, and 2, 4, 7, 14, 21, and 28 d following the dose. Liver biopsies were collected 7 d before and 2 d after dosing (n = 4) and at 7, 14, and 28 d (n = 4/time) after dosing. Serum and liver were analyzed by HPLC and GC-combustion-isotope ratio MS for retinol and its enrichment, respectively. Model-based compartmental analysis was applied to serum data. Lactate dehydrogenase was elevated in 50% of the monkeys. Total body reserves (TBR) of vitamin A (VA) were calculated at 28 d. Predicted TBR (3.52 ± 2.01 mmol VA) represented measured liver stores (4.56 ± 1.38 mmol VA; P = 0.124). Predicted liver VA concentrations (13.3 ± 9.7 μmol/g) were similar to measured liver VA concentrations (16.4 ± 5.3 μmol/g). The kinetic models predict that 27–52% of extravascular VA is exchanging with serum in hypervitaminotic A monkeys. The test correctly diagnosed hypervitaminosis A in all monkeys, i.e. 100% sensitivity. Stable isotope techniques have important public health potential for the classification of VA status, including hypervitaminosis, because no other technique besides invasive liver biopsies, correctly identifies excessive liver VA stores. PMID:19710158

Automobile or Other Conveyance and Adaptive Equipment Certificate of Eligibility for Veterans or Members of the Armed Forces With Amyotrophic Lateral Sclerosis Connected to Military Service. Final rule.

PubMed

2016-01-13

The Department of Veterans Affairs (VA) published an Interim Final Rule on February 25, 2015, to amend its adjudication regulations to provide a certificate of eligibility for financial assistance in the purchase of an automobile or other conveyance and adaptive equipment for all veterans with service-connected amyotrophic lateral sclerosis (ALS) and servicemembers serving on active duty with ALS. The amendment authorized automatic issuance of a certificate of eligibility for financial assistance in the purchase of an automobile or other conveyance and adaptive equipment to all veterans with service-connected ALS and members of the Armed Forces serving on active duty with ALS. The intent of this final rule is to confirm the amendment made by the interim final rule without change.

Evaluation of Visual Acuity Measurements after Autorefraction versus Manual Refraction in Eyes with and without Diabetic Macular Edema

PubMed Central

Sun, Jennifer K.; Qin, Haijing; Aiello, Lloyd Paul; Melia, Michele; Beck, Roy W.; Andreoli, Christopher M.; Edwards, Paul A.; Glassman, Adam R.; Pavlica, Michael R.

2012-01-01

Objective To compare visual acuity (VA) scores after autorefraction versus research protocol manual refraction in eyes of patients with diabetes and a wide range of VA. Methods Electronic Early Treatment Diabetic Retinopathy Study (E-ETDRS) VA Test© letter score (EVA) was measured after autorefraction (AR-EVA) and after Diabetic Retinopathy Clinical Research Network (DRCR.net) protocol manual refraction (MR-EVA). Testing order was randomized, study participants and VA examiners were masked to refraction source, and a second EVA utilizing an identical manual refraction (MR-EVAsupl) was performed to determine test-retest variability. Results In 878 eyes of 456 study participants, median MR-EVA was 74 (Snellen equivalent approximately 20/32). Spherical equivalent was often similar for manual and autorefraction (median difference: 0.00, 5th and 95th percentiles −1.75 to +1.13 Diopters). However, on average, MR-EVA results were slightly better than AR-EVA results across the entire VA range. Furthermore, variability between AR-EVA and MR-EVA was substantially greater than the test-retest variability of MR-EVA (P<0.001). Variability of differences was highly dependent on autorefractor model. Conclusions Across a wide range of VA at multiple sites using a variety of autorefractors, VA measurements tend to be worse with autorefraction than manual refraction. Differences between individual autorefractor models were identified. However, even among autorefractor models comparing most favorably to manual refraction, VA variability between autorefraction and manual refraction is higher than the test-retest variability of manual refraction. The results suggest that with current instruments, autorefraction is not an acceptable substitute for manual refraction for most clinical trials with primary outcomes dependent on best-corrected VA. PMID:22159173

Analytic model of a magnetically insulated transmission line with collisional flow electrons

NASA Astrophysics Data System (ADS)

Stygar, W. A.; Wagoner, T. C.; Ives, H. C.; Corcoran, P. A.; Cuneo, M. E.; Douglas, J. W.; Gilliland, T. L.; Mazarakis, M. G.; Ramirez, J. J.; Seamen, J. F.; Seidel, D. B.; Spielman, R. B.

2006-09-01

We have developed a relativistic-fluid model of the flow-electron plasma in a steady-state one-dimensional magnetically insulated transmission line (MITL). The model assumes that the electrons are collisional and, as a result, drift toward the anode. The model predicts that in the limit of fully developed collisional flow, the relation between the voltage Va, anode current Ia, cathode current Ik, and geometric impedance Z0 of a 1D planar MITL can be expressed as Va=IaZ0h(χ), where h(χ)≡[(χ+1)/4(χ-1)]1/2-ln⁡⌊χ+(χ2-1)1/2⌋/2χ(χ-1) and χ≡Ia/Ik. The relation is valid when Va≳1MV. In the minimally insulated limit, the anode current Ia,min⁡=1.78Va/Z0, the electron-flow current If,min⁡=1.25Va/Z0, and the flow impedance Zf,min⁡=0.588Z0. {The electron-flow current If≡Ia-Ik. Following Mendel and Rosenthal [Phys. Plasmas 2, 1332 (1995)PHPAEN1070-664X10.1063/1.871345], we define the flow impedance Zf as Va/(Ia2-Ik2)1/2.} In the well-insulated limit (i.e., when Ia≫Ia,min⁡), the electron-flow current If=9Va2/8IaZ02 and the flow impedance Zf=2Z0/3. Similar results are obtained for a 1D collisional MITL with coaxial cylindrical electrodes, when the inner conductor is at a negative potential with respect to the outer, and Z0≲40Ω. We compare the predictions of the collisional model to those of several MITL models that assume the flow electrons are collisionless. We find that at given values of Va and Z0, collisions can significantly increase both Ia,min⁡ and If,min⁡ above the values predicted by the collisionless models, and decrease Zf,min⁡. When Ia≫Ia,min⁡, we find that, at given values of Va, Z0, and Ia, collisions can significantly increase If and decrease Zf. Since the steady-state collisional model is valid only when the drift of electrons toward the anode has had sufficient time to establish fully developed collisional flow, and collisionless models assume there is no net electron drift toward the anode, we expect these two types of models to provide theoretical bounds on Ia, If, and Zf.

Modeling and experimental study of resistive switching in vertically aligned carbon nanotubes

NASA Astrophysics Data System (ADS)

Ageev, O. A.; Blinov, Yu F.; Ilina, M. V.; Ilin, O. I.; Smirnov, V. A.

2016-08-01

Model of the resistive switching in vertically aligned carbon nanotube (VA CNT) taking into account the processes of deformation, polarization and piezoelectric charge accumulation have been developed. Origin of hysteresis in VA CNT-based structure is described. Based on modeling results the VACNTs-based structure has been created. The ration resistance of high-resistance to low-resistance states of the VACNTs-based structure amounts 48. The correlation the modeling results with experimental studies is shown. The results can be used in the development nanoelectronics devices based on VA CNTs, including the nonvolatile resistive random-access memory.

Exploring the role narrative free-text plays in discrepancies between physician coding and the InterVA regarding determination of malaria as cause of death, in a malaria holo-endemic region

PubMed Central

2012-01-01

Background In countries where tracking mortality and clinical cause of death are not routinely undertaken, gathering verbal autopsies (VA) is the principal method of estimating cause of death. The most common method for determining probable cause of death from the VA interview is Physician-Certified Verbal Autopsy (PCVA). A recent alternative method to interpret Verbal Autopsy (InterVA) is a computer model using a Bayesian approach to derive posterior probabilities for causes of death, given an a priori distribution at population level and a set of interview-based indicators. The model uses the same input information as PCVA, with the exception of narrative text information, which physicians can consult but which were not inputted into the model. Comparing the results of physician coding with the model, large differences could be due to difficulties in diagnosing malaria, especially in holo-endemic regions. Thus, the aim of the study was to explore whether physicians' access to electronically unavailable narrative text helps to explain the large discrepancy in malaria cause-specific mortality fractions (CSMFs) in physician coding versus the model. Methods Free-texts of electronically available records (N = 5,649) were summarised and incorporated into the InterVA version 3 (InterVA-3) for three sub-groups: (i) a 10%-representative subsample (N = 493) (ii) records diagnosed as malaria by physicians and not by the model (N = 1035), and (iii) records diagnosed by the model as malaria, but not by physicians (N = 332). CSMF results before and after free-text incorporation were compared. Results There were changes of between 5.5-10.2% between models before and after free-text incorporation. No impact on malaria CSMFs was seen in the representative sub-sample, but the proportion of malaria as cause of death increased in the physician sub-sample (2.7%) and saw a large decrease in the InterVA subsample (9.9%). Information on 13/106 indicators appeared at least once in the free-texts that had not been matched to any item in the structured, electronically available portion of the Nouna questionnaire. Discussion Free-texts are helpful in gathering information not adequately captured in VA questionnaires, though access to free-text does not explain differences in physician and model determination of malaria as cause of death. PMID:22353802

Exploring the role narrative free-text plays in discrepancies between physician coding and the InterVA regarding determination of malaria as cause of death, in a malaria holo-endemic region.

PubMed

Rankin, Johanna C; Lorenz, Eva; Neuhann, Florian; Yé, Maurice; Sié, Ali; Becher, Heiko; Ramroth, Heribert

2012-02-21

In countries where tracking mortality and clinical cause of death are not routinely undertaken, gathering verbal autopsies (VA) is the principal method of estimating cause of death. The most common method for determining probable cause of death from the VA interview is Physician-Certified Verbal Autopsy (PCVA). A recent alternative method to interpret Verbal Autopsy (InterVA) is a computer model using a Bayesian approach to derive posterior probabilities for causes of death, given an a priori distribution at population level and a set of interview-based indicators. The model uses the same input information as PCVA, with the exception of narrative text information, which physicians can consult but which were not inputted into the model. Comparing the results of physician coding with the model, large differences could be due to difficulties in diagnosing malaria, especially in holo-endemic regions. Thus, the aim of the study was to explore whether physicians' access to electronically unavailable narrative text helps to explain the large discrepancy in malaria cause-specific mortality fractions (CSMFs) in physician coding versus the model. Free-texts of electronically available records (N = 5,649) were summarised and incorporated into the InterVA version 3 (InterVA-3) for three sub-groups: (i) a 10%-representative subsample (N = 493) (ii) records diagnosed as malaria by physicians and not by the model (N = 1035), and (iii) records diagnosed by the model as malaria, but not by physicians (N = 332). CSMF results before and after free-text incorporation were compared. There were changes of between 5.5-10.2% between models before and after free-text incorporation. No impact on malaria CSMFs was seen in the representative sub-sample, but the proportion of malaria as cause of death increased in the physician sub-sample (2.7%) and saw a large decrease in the InterVA subsample (9.9%). Information on 13/106 indicators appeared at least once in the free-texts that had not been matched to any item in the structured, electronically available portion of the Nouna questionnaire. Free-texts are helpful in gathering information not adequately captured in VA questionnaires, though access to free-text does not explain differences in physician and model determination of malaria as cause of death.

New estimate of valvuloarterial impedance in aortic valve stenosis: A cardiac magnetic resonance study.

PubMed

Soulat, Gilles; Kachenoura, Nadjia; Bollache, Emilie; Perdrix, Ludivine; Diebold, Benoit; Zhygalina, Valentina; Latremouille, Christian; Laurent, Stephane; Fabiani, Jean-Noel; Mousseaux, Elie

2017-03-01

Valvuloarterial impedance (Z VA ), estimating left ventricle (LV) afterload, has been proposed in transthoracic echocardiography (TTE) as a predictor of mortality in aortic valve stenosis (AVS). However, its calculation differs from arterial characteristic impedance (Z C ). Our aim was to apply the concept of Z C calculation to estimate Z VA from MR with carotid tonometry and to evaluate these indices through their associations with symptoms, LV diastolic function and aortic stiffness. In 40 patients with AVS (76 ± 13 years), Z VA-TI derived from velocity time integral and E/Ea were estimated by TTE. Z VA-INS , based on Z C formula, calculated as the instantaneous pressure gradient to peak flow ratio and aortic compliance were estimated by using MRI at 1.5 Tesla. Both Z VA estimates were higher in symptomatic than asymptomatic patients (707 ± 22 versus 579 ± 53 dyne.s/cm 5 , P = 0.031 for Z VA-INS and 4.35 ± 0.16 versus 3.33 ± 0.38 mmHg.m 2 /mL, P = 0.018 for Z VA-TI ). Although they were both associated with aortic compliance (r = -0.45; P = 0.006 for Z VA-INS and r = -0.43; P = 0.008 for Z VA-TI ) only Z VA-INS was associated with E/Ea (r = 0.50; P < 0.001). In multivariate analysis to identify determinants of E/Ea, a model including age, mean blood pressure, LV ejection fraction, LV mass, and aortic valve area was performed (R 2  = 0.41; P < 0.01). When Z VA-INS was added to the model, its overall significance was higher R 2  = 0.56 (P < 0.01) and Z VA-INS and LV mass were the only significant determinants. Z VA-INS was more strongly associated with diastolic dysfunction than usual parameters quantifying AVS severity. This new Z VA estimate could improve LV afterload evaluation. 1 J. Magn. Reson. Imaging 2017;45:795-803. © 2016 International Society for Magnetic Resonance in Medicine.

Recurrence risk model for esophageal cancer after radical surgery.

PubMed

Lu, Jincheng; Tao, Hua; Song, Dan; Chen, Cheng

2013-10-01

The aim of the present study was to construct a risk assessment model which was tested by disease-free survival (DFS) of esophageal cancer after radical surgery. A total of 164 consecutive esophageal cancer patients who had undergone radical surgery between January 2005 and December 2006 were retrospectively analyzed. The cutpoint of value at risk (VaR) was inferred by stem-and-leaf plot, as well as by independent-samples t-test for recurrence-free time, further confirmed by crosstab chi-square test, univariate analysis and Cox regression analysis for DFS. The cutpoint of VaR was 0.3 on the basis of our model. The rate of recurrence was 30.3% (30/99) and 52.3% (34/65) in VaR <0.3 and VaR ≥0.3 (chi-square test, (χ) (2) =7.984, P=0.005), respectively. The 1-, 3-, and 5-year DFS of esophageal cancer after radical surgery was 70.4%, 48.7%, and 45.3%, respectively in VaR ≥0.3, whereas 91.5%, 75.8%, and 67.3%, respectively in VaR <0.3 (Log-rank test, (χ) (2) =9.59, P=0.0020), and further confirmed by Cox regression analysis [hazard ratio =2.10, 95% confidence interval (CI): 1.2649-3.4751; P=0.0041]. The model could be applied for integrated assessment of recurrence risk after radical surgery for esophageal cancer.

Recurrence risk model for esophageal cancer after radical surgery

PubMed Central

Tao, Hua; Song, Dan; Chen, Cheng

2013-01-01

Objective The aim of the present study was to construct a risk assessment model which was tested by disease-free survival (DFS) of esophageal cancer after radical surgery. Methods A total of 164 consecutive esophageal cancer patients who had undergone radical surgery between January 2005 and December 2006 were retrospectively analyzed. The cutpoint of value at risk (VaR) was inferred by stem-and-leaf plot, as well as by independent-samples t-test for recurrence-free time, further confirmed by crosstab chi-square test, univariate analysis and Cox regression analysis for DFS. Results The cutpoint of VaR was 0.3 on the basis of our model. The rate of recurrence was 30.3% (30/99) and 52.3% (34/65) in VaR <0.3 and VaR ≥0.3 (chi-square test, χ2 =7.984, P=0.005), respectively. The 1-, 3-, and 5-year DFS of esophageal cancer after radical surgery was 70.4%, 48.7%, and 45.3%, respectively in VaR ≥0.3, whereas 91.5%, 75.8%, and 67.3%, respectively in VaR <0.3 (Log-rank test, χ2 =9.59, P=0.0020), and further confirmed by Cox regression analysis [hazard ratio =2.10, 95% confidence interval (CI): 1.2649-3.4751; P=0.0041]. Conclusions The model could be applied for integrated assessment of recurrence risk after radical surgery for esophageal cancer. PMID:24255579

A probabilistic approach to interpreting verbal autopsies: methodology and preliminary validation in Vietnam.

PubMed

Byass, Peter; Huong, Dao Lan; Minh, Hoang Van

2003-01-01

Verbal autopsy (VA) has become an important tool in the past 20 years for determining cause of death in communities where there is no routine registration. In many cases, expert physicians have been used to interpret the VA findings and so assign individual causes of death. However, this is time consuming and not always repeatable. Other approaches such as algorithms and neural networks have been developed in some settings. This paper aims to develop a method that is simple, reliable and consistent, which could represent an advance in VA interpretation. This paper describes the development of a Bayesian probability model for VA interpretation as an attempt to find a better approach. This methodology and a preliminary implementation are described, with an evaluation based on VA material from rural Vietnam. The new model was tested against a series of 189 VA interviews from a rural community in Vietnam. Using this very basic model, over 70% of individual causes of death corresponded with those determined by two physicians increasing to over 80% if those cases ascribed to old age or as being indeterminate by the physicians were excluded. Although there is a clear need to improve the preliminary model and to test more extensively with larger and more varied datasets, these preliminary results suggest that there may be good potential in this probabilistic approach.

The quantitative genetics of maximal and basal rates of oxygen consumption in mice.

PubMed Central

Dohm, M R; Hayes, J P; Garland, T

2001-01-01

A positive genetic correlation between basal metabolic rate (BMR) and maximal (VO(2)max) rate of oxygen consumption is a key assumption of the aerobic capacity model for the evolution of endothermy. We estimated the genetic (V(A), additive, and V(D), dominance), prenatal (V(N)), and postnatal common environmental (V(C)) contributions to individual differences in metabolic rates and body mass for a genetically heterogeneous laboratory strain of house mice (Mus domesticus). Our breeding design did not allow the simultaneous estimation of V(D) and V(N). Regardless of whether V(D) or V(N) was assumed, estimates of V(A) were negative under the full models. Hence, we fitted reduced models (e.g., V(A) + V(N) + V(E) or V(A) + V(E)) and obtained new variance estimates. For reduced models, narrow-sense heritability (h(2)(N)) for BMR was <0.1, but estimates of h(2)(N) for VO(2)max were higher. When estimated with the V(A) + V(E) model, the additive genetic covariance between VO(2)max and BMR was positive and statistically different from zero. This result offers tentative support for the aerobic capacity model for the evolution of vertebrate energetics. However, constraints imposed on the genetic model may cause our estimates of additive variance and covariance to be biased, so our results should be interpreted with caution and tested via selection experiments. PMID:11560903

Veterans' experiences initiating VA-based mental health care.

PubMed

Bovin, Michelle J; Miller, Christopher J; Koenig, Christopher J; Lipschitz, Jessica M; Zamora, Kara A; Wright, Patricia B; Pyne, Jeffrey M; Burgess, James F

2018-05-21

Military veterans who could benefit from mental health services often do not access them. Research has revealed a range of barriers associated with initiating United States Department of Veterans Affairs (VA) care, including those specific to accessing mental health care (e.g., fear of stigmatization). More work is needed to streamline access to VA mental health-care services for veterans. In the current study, we interviewed 80 veterans from 9 clinics across the United States about initiation of VA mental health care to identify barriers to access. Results suggested that five predominant factors influenced veterans' decisions to initiate care: (a) awareness of VA mental health services; (b) fear of negative consequences of seeking care; (c) personal beliefs about mental health treatment; (d) input from family and friends; and (e) motivation for treatment. Veterans also spoke about the pathways they used to access this care. The four most commonly reported pathways included (a) physical health-care appointments; (b) the service connection disability system; (c) non-VA care; and (d) being mandated to care. Taken together, these data lend themselves to a model that describes both modifiers of, and pathways to, VA mental health care. The model suggests that interventions aimed at the identified pathways, in concert with efforts designed to reduce barriers, may increase initiation of VA mental health-care services by veterans. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

The Art and Science of Operational Maneuver,

DTIC Science & Technology

1988-05-04

Classification) The Art and Science of Operational Maneuver (U) 12. PERSONAL AUTHOR(S) MAJ Joseph Schroedel 13a. TYPE OF REPORT 13b. TIME COVERED 14...CLASSIFICATION OF THIS PAGE VA) CL LA S F1 EP {fJE ART ANQ SCIENCE OlF OPERAIl NAL MANUVER By6 Mal or Josepi~ Schroeci, L U. S. Arm~y H Aciv -darILC Ced M ili t...Studies ,nIgz’raph ApprovwA. Name of Student: Major Jonevh Schroedel. U.S. Army Title ot Monograph: The Art and Science of Operational Maneuver Approved By

Modeling of Mean-VaR portfolio optimization by risk tolerance when the utility function is quadratic

NASA Astrophysics Data System (ADS)

Sukono, Sidi, Pramono; Bon, Abdul Talib bin; Supian, Sudradjat

2017-03-01

The problems of investing in financial assets are to choose a combination of weighting a portfolio can be maximized return expectations and minimizing the risk. This paper discusses the modeling of Mean-VaR portfolio optimization by risk tolerance, when square-shaped utility functions. It is assumed that the asset return has a certain distribution, and the risk of the portfolio is measured using the Value-at-Risk (VaR). So, the process of optimization of the portfolio is done based on the model of Mean-VaR portfolio optimization model for the Mean-VaR done using matrix algebra approach, and the Lagrange multiplier method, as well as Khun-Tucker. The results of the modeling portfolio optimization is in the form of a weighting vector equations depends on the vector mean return vector assets, identities, and matrix covariance between return of assets, as well as a factor in risk tolerance. As an illustration of numeric, analyzed five shares traded on the stock market in Indonesia. Based on analysis of five stocks return data gained the vector of weight composition and graphics of efficient surface of portfolio. Vector composition weighting weights and efficient surface charts can be used as a guide for investors in decisions to invest.

Use of VA and Medicare Services By Dually Eligible Veterans with Psychiatric Problems

PubMed Central

Carey, Kathleen; Montez-Rath, Maria E; Rosen, Amy K; Christiansen, Cindy L; Loveland, Susan; Ettner, Susan L

2008-01-01

Objective To examine how service accessibility measured by geographic distance affects service sector choices for veterans who are dually eligible for veterans affairs (VA) and Medicare services and who are diagnosed with mental health and/or substance abuse (MH/SA) disorders. Data Sources Primary VA data sources were the Patient Treatment (acute care), Extended Care (long-term care), and Outpatient Clinic files. VA cost data were obtained from (1) inpatient and outpatient cost files developed by the VA Health Economics and Resource Center and (2) outpatient VA Decision Support System files. Medicare data sources were the denominator, Medicare Provider Analysis Review (MEDPAR), Provider-of-Service, Outpatient Standard Analytic and Physician/Supplier Standard Analytic files. Additional sources included the Area Resource File and Census Bureau data. Study Design We identified dually eligible veterans who had either an inpatient or outpatient MH/SA diagnosis in the VA system during fiscal year (FY)'99. We then estimated one- and two-part regression models to explain the effects of geographic distance on both VA and Medicare total and MH/SA costs. Principal Findings Results provide evidence for substitution between the VA and Medicare, demonstrating that poorer geographic access to VA inpatient and outpatient clinics decreased VA expenditures but increased Medicare expenditures, while poorer access to Medicare-certified general and psychiatric hospitals decreased Medicare expenditures but increased VA expenditures. Conclusions As geographic distance to VA medical facility increases, Medicare plays an increasingly important role in providing mental health services to veterans. PMID:18355256

Use of a "Super-child" Approach to Assess the Vitamin A Equivalence of Moringa oleifera Leaves, Develop a Compartmental Model for Vitamin A Kinetics, and Estimate Vitamin A Total Body Stores in Young Mexican Children.

PubMed

Lopez-Teros, Veronica; Ford, Jennifer Lynn; Green, Michael H; Tang, Guangwen; Grusak, Michael A; Quihui-Cota, Luis; Muzhingi, Tawanda; Paz-Cassini, Mariela; Astiazaran-Garcia, Humberto

2017-12-01

Background: Worldwide, an estimated 250 million children <5 y old are vitamin A (VA) deficient. In Mexico, despite ongoing efforts to reduce VA deficiency, it remains an important public health problem; thus, food-based interventions that increase the availability and consumption of provitamin A-rich foods should be considered. Objective: The objectives were to assess the VA equivalence of 2 H-labeled Moringa oleifera (MO) leaves and to estimate both total body stores (TBS) of VA and plasma retinol kinetics in young Mexican children. Methods: β-Carotene was intrinsically labeled by growing MO plants in a 2 H 2 O nutrient solution. Fifteen well-nourished children (17-35 mo old) consumed puréed MO leaves (1 mg β-carotene) and a reference dose of [ 13 C 10 ]retinyl acetate (1 mg) in oil. Blood (2 samples/child) was collected 10 times (2 or 3 children each time) over 35 d. The bioefficacy of MO leaves was calculated from areas under the composite "super-child" plasma isotope response curves, and MO VA equivalence was estimated through the use of these values; a compartmental model was developed to predict VA TBS and retinol kinetics through the use of composite plasma [ 13 C 10 ]retinol data. TBS were also estimated with isotope dilution. Results: The relative bioefficacy of β-carotene retinol activity equivalents from MO was 28%; VA equivalence was 3.3:1 by weight (0.56 μmol retinol:1 μmol β-carotene). Kinetics of plasma retinol indicate more rapid plasma appearance and turnover and more extensive recycling in these children than are observed in adults. Model-predicted mean TBS (823 μmol) was similar to values predicted using a retinol isotope dilution equation applied to data from 3 to 6 d after dosing (mean ± SD: 832 ± 176 μmol; n = 7). Conclusions: The super-child approach can be used to estimate population carotenoid bioefficacy and VA equivalence, VA status, and parameters of retinol metabolism from a composite data set. Our results provide initial estimates of retinol kinetics in well-nourished young children with adequate VA stores and demonstrate that MO leaves may be an important source of VA. © 2017 American Society for Nutrition.

Attrition and retention in upper limb prosthetics research: experience of the VA home study of the DEKA arm.

PubMed

Resnik, Linda; Klinger, Shana

2017-11-01

(1) Describe study attrition; (2) identify reasons for attrition, and (3) discuss implications for prosthetic prescription and design of future device studies. Design and methodological procedures used: Completion phase (during in-laboratory training, after training, or home use) was identified for 42 participants. Qualitative data were analyzed to identify attrition reasons. Reasons were classified as related to the DEKA arm, or not. Study attrition was 57%, with 43% completing the full study. Attrition during the in-laboratory portion was 21%. Reasons for attrition were related to the DEKA arm entirely or in-part for 42%, 25%, respectively. Most common reasons were scheduling/personal (54%); device weight (29%); and dissatisfaction with device (25%). About 21% withdrew because of concerns about compliance with study protocol. This study had a high attrition rate with evidence of selective attrition due to device characteristics. Strategies to minimize attrition and the importance of tracking reasons for withdrawal are discussed. Given that retention could be an indicator of willingness to adopt the DEKA arm, findings suggest that it would be prudent to provide patients with the opportunity to train with the DEKA arm before a decision is made regarding the appropriateness of the device for the patient. Implications for Rehabilitation This study of a new upper limb prosthesis, the DEKA arm, had a 57% attrition rate with evidence of selective attrition due to characteristics of the DEKA arm. Findings point to the need for strategies to minimize attrition in future studies. Findings also illustrate the importance of tracking reasons for subject withdrawal in longitudinal prosthesis device studies. Because participant retention in longitudinal device studies may be an indicator of future willingness to adopt a device, our findings suggest that it would be prudent to provide patients with the opportunity to train with the DEKA arm before a final decision is made regarding the appropriateness of the device for the patient.

Testing V-A in Top Decay at CDF at √s = 1.8 TeV

NASA Astrophysics Data System (ADS)

Kilminster, Ben

2004-02-01

The structure of the tbW vertex can be probed by measuring the polarization of the W in t → W + b → l + ν + b. The invariant mass of the the lepton and b quark measures the W decay angle which in turn allows a comparison with polarizations expected from a V-A and V+A tbW vertex. We measure the fraction by rate of Ws produced with a V+A coupling in lieu of the Standard Model V-A to be fV+A = -0.21-0.24+0.42 (stat) ± 0.21 (sys). We assign a limit of fV+A < 0.80 @ 95% CL. By combining this result with a complementary observable in the same data, we assign a limit of fV+A < 0.61 @ 95% CL. From this CDF Run I preliminary result, we find no evidence for a non-standard Model tbW vertex.

Vanillic acid attenuates testosterone-induced benign prostatic hyperplasia in rats and inhibits proliferation of prostatic epithelial cells.

PubMed

Jung, Yunu; Park, Jinbong; Kim, Hye-Lin; Youn, Dong-Hyun; Kang, JongWook; Lim, Seona; Jeong, Mi-Young; Sethi, Gautam; Park, Sung-Joo; Ahn, Kwang Seok; Um, Jae-Young

2017-10-20

Benign prostatic hyperplasia (BPH) is a common disease in the male population, especially in elderly men. Vanillic acid (VA), a dihydroxybenzoic derivative used as a flavoring agent, is reported to have an anti-inflammatory effect. However, there are no reports of its effects on BPH to date. BPH was induced with a pre-4-week treatment of daily subcutaneous injections of testosterone propionate (TP), and the normal control group received injections of ethanol with corn oil instead. Six weeks of further injections were done with (a) ethanol with corn oil, (b) TP only, (c) TP + finasteride, and (d) TP + VA. Finasteride was used as a positive control group. VA had protective effects on the TP-induced BPH. In the VA treatment group, the prostate weight was reduced, and the histological changes including the epithelial thickness and lumen area were restored like in the normal control group. Furthermore, in the VA treatment group, two proliferation related factors, high molecular weight cytokeratin 34βE12 and α smooth muscle actin, were significantly down-regulated compared to the TP-induced BPH group. The expressions of dihydrotestosterone and 5α-reductase, the most crucial factors in BPH development, were suppressed by VA treatment. Expressions of the androgen receptor, estrogen receptor α and steroid receptor coactivator 1 were also significantly inhibited by VA compared to the TP-induced BPH group. In addition, we established an in vitro model for BPH by treating a normal human prostatic epithelial cell line RWPE-1 with TP. VA successfully inhibited proliferation and BPH-related factors in a concentration-dependent manner in this newly established model. These results suggest a new and potential pharmaceutical therapy of VA in the treatment of BPH.

Vanillic acid attenuates testosterone-induced benign prostatic hyperplasia in rats and inhibits proliferation of prostatic epithelial cells

PubMed Central

Kim, Hye-Lin; Youn, Dong-Hyun; Kang, JongWook; Lim, Seona; Jeong, Mi-Young; Sethi, Gautam; Park, Sung-Joo; Ahn, Kwang Seok; Um, Jae-Young

2017-01-01

Benign prostatic hyperplasia (BPH) is a common disease in the male population, especially in elderly men. Vanillic acid (VA), a dihydroxybenzoic derivative used as a flavoring agent, is reported to have an anti-inflammatory effect. However, there are no reports of its effects on BPH to date. BPH was induced with a pre-4-week treatment of daily subcutaneous injections of testosterone propionate (TP), and the normal control group received injections of ethanol with corn oil instead. Six weeks of further injections were done with (a) ethanol with corn oil, (b) TP only, (c) TP + finasteride, and (d) TP + VA. Finasteride was used as a positive control group. VA had protective effects on the TP-induced BPH. In the VA treatment group, the prostate weight was reduced, and the histological changes including the epithelial thickness and lumen area were restored like in the normal control group. Furthermore, in the VA treatment group, two proliferation related factors, high molecular weight cytokeratin 34βE12 and α smooth muscle actin, were significantly down-regulated compared to the TP-induced BPH group. The expressions of dihydrotestosterone and 5α-reductase, the most crucial factors in BPH development, were suppressed by VA treatment. Expressions of the androgen receptor, estrogen receptor α and steroid receptor coactivator 1 were also significantly inhibited by VA compared to the TP-induced BPH group. In addition, we established an in vitro model for BPH by treating a normal human prostatic epithelial cell line RWPE-1 with TP. VA successfully inhibited proliferation and BPH-related factors in a concentration-dependent manner in this newly established model. These results suggest a new and potential pharmaceutical therapy of VA in the treatment of BPH. PMID:29152074

The Integrated Care Team Approach of the Department of Veterans Affairs (VA): Geriatric Primary Care.

PubMed

Rasin-Waters, Donna; Abel, Valerie; Kearney, Lisa K; Zeiss, Antonette

2018-05-01

Historically, integrated mental and behavioral healthcare in the Department of Veterans Affairs (VA) commenced with initiatives in geriatrics. Innovation and system-wide expansion has occurred over decades and culminated in a unified vision for training and practice in the VA medical home model: Patient Aligned Care Team or PACT approach. In one VA hospital, the integration of neuropsychological services in geriatric primary care is pivotal and increases access for patients, as well as contributing to timely and effective care on an interprofessional team. The development and innovative use of an algorithm to identify problems with cognition, health literacy, and mental and behavioral health has been pragmatic and provides useful information for collaborative treatment planning in GeriPACT, VA geriatric primary care. Use of the algorithm also assists with decision-making regarding brief versus comprehensive neuropsychological assessment in the primary care setting. The model presented here was developed by supervising neuropsychologists as part of a postdoctoral residency program in geropsychology. However, postdoctoral residency programs in neuropsychology, as well as neuropsychological clinics, can also use this model to integrate neuropsychological assessment and interventions in geriatric primary care settings.

A natural-language interface to a mobile robot

NASA Technical Reports Server (NTRS)

Michalowski, S.; Crangle, C.; Liang, L.

1987-01-01

The present work on robot instructability is based on an ongoing effort to apply modern manipulation technology to serve the needs of the handicapped. The Stanford/VA Robotic Aid is a mobile manipulation system that is being developed to assist severely disabled persons (quadriplegics) in performing simple activities of everyday living in a homelike, unstructured environment. It consists of two major components: a nine degree-of-freedom manipulator and a stationary control console. In the work presented here, only the motions of the Robotic Aid's omnidirectional motion base have been considered, i.e., the six degrees of freedom of the arm and gripper have been ignored. The goal has been to develop some basic software tools for commanding the robot's motions in an enclosed room containing a few objects such as tables, chairs, and rugs. In the present work, the environmental model takes the form of a two-dimensional map with objects represented by polygons. Admittedly, such a highly simplified scheme bears little resemblance to the elaborate cognitive models of reality that are used in normal human discourse. In particular, the polygonal model is given a priori and does not contain any perceptual elements: there is no polygon sensor on board the mobile robot.

Redesigning a joint replacement program using Lean Six Sigma in a Veterans Affairs hospital.

PubMed

Gayed, Benjamin; Black, Stephen; Daggy, Joanne; Munshi, Imtiaz A

2013-11-01

In April 2009, an analysis of joint replacement surgical procedures at the Richard L. Roudebush Veterans Affairs Medical Center, Indianapolis, Indiana, revealed that total hip and knee replacements incurred $1.4 million in non-Veterans Affairs (VA) care costs with an average length of stay of 6.1 days during fiscal year 2008. The Joint Replacement Program system redesign project was initiated following the Vision-Analysis-Team-Aim-Map-Measure-Change-Sustain (VA-TAMMCS) model to increase efficiency, decrease length of stay, and reduce non-VA care costs. To determine the effectiveness of Lean Six Sigma process improvement methods applied in a VA hospital. Perioperative processes for patients undergoing total joint replacement were redesigned following the VA-TAMMCS model--the VA's official, branded method of Lean Six Sigma process improvement. A multidisciplinary team including the orthopedic surgeons, frontline staff, and executive management identified waste in the current processes and initiated changes to reduce waste and increase efficiency. Data collection included a 1-year baseline period and a 20-month sustainment period. The primary endpoint was length of stay; a secondary analysis considered non-VA care cost reductions. Length of stay decreased 36% overall, decreasing from 5.3 days during the preproject period to 3.4 days during the 20-month sustainment period (P < .001). Non-VA care was completely eliminated for patients undergoing total hip and knee replacement at the Richard L. Roudebush Veterans Affairs Medical Center, producing an estimated return on investment of $1 million annually when compared with baseline cost and volumes. In addition, the volume of total joint replacements at this center increased during the data collection period. The success of the Joint Replacement Program demonstrates that VA-TAMMCS is an effective tool for Lean and Six Sigma process improvement initiatives in a surgical practice, producing a 36% sustained reduction in length of stay and completely eliminating non-VA care for total hip and knee replacements while increasing total joint replacement volume at this medical center.

76 FR 53162 - Acceptance of Public Submissions Regarding the Study of Stable Value Contracts

Federal Register 2010, 2011, 2012, 2013, 2014

2011-08-25

... the risk of a run on a SVF? To the extent that SVC providers use value-at-risk (``VaR'') models, do such VaR models adequately assess the risk of loss resulting from such events or other possible but extremely unlikely events? Do other loss models more adequately assess the risk of loss, such as the...

Causes of death among persons of all ages within the Kilifi Health and Demographic Surveillance System, Kenya, determined from verbal autopsies interpreted using the InterVA-4 model.

PubMed

Ndila, Carolyne; Bauni, Evasius; Mochamah, George; Nyirongo, Vysaul; Makazi, Alex; Kosgei, Patrick; Tsofa, Benjamin; Nyutu, Gideon; Etyang, Anthony; Byass, Peter; Williams, Thomas N

2014-01-01

The vast majority of deaths in the Kilifi study area are not recorded through official systems of vital registration. As a result, few data are available regarding causes of death in this population. To describe the causes of death (CODs) among residents of all ages within the Kilifi Health and Demographic Surveillance System (KHDSS) on the coast of Kenya. Verbal autopsies (VAs) were conducted using the 2007 World Health Organization (WHO) standard VA questionnaires, and VA data further transformed to align with the 2012 WHO VA instrument. CODs were then determined using the InterVA-4 computer-based probabilistic model. Five thousand one hundred and eighty seven deaths were recorded between January 2008 and December 2011. VA interviews were completed for 4,460 (86%) deaths. Neonatal pneumonia and birth asphyxia were the main CODs in neonates; pneumonia and malaria were the main CODs among infants and children aged 1-4, respectively, while HIV/AIDS was the main COD for adult women of reproductive age. Road traffic accidents were more commonly observed among men than women. Stroke and neoplasms were common CODs among the elderly over the age of 65. We have established the main CODs among people of all ages within the area served by the KHDSS on the coast of Kenya using the 2007 WHO VA questionnaire coded using InterVA-4. We hope that our data will allow local health planners to estimate the burden of various diseases and to allocate their limited resources more appropriately.

Effectiveness and micro-costing of the KiVa school-based bullying prevention programme in Wales: study protocol for a pragmatic definitive parallel group cluster randomised controlled trial.

PubMed

Clarkson, Suzy; Axford, Nick; Berry, Vashti; Edwards, Rhiannon Tudor; Bjornstad, Gretchen; Wrigley, Zoe; Charles, Joanna; Hoare, Zoe; Ukoumunne, Obioha C; Matthews, Justin; Hutchings, Judy

2016-02-01

Bullying refers to verbal, physical or psychological aggression repeated over time that is intended to cause harm or distress to the victims who are unable to defend themselves. It is a key public health priority owing to its widespread prevalence in schools and harmful short- and long-term effects on victims' well-being. There is a need to strengthen the evidence base by testing innovative approaches to preventing bullying. KiVa is a school-based bullying prevention programme with universal and indicated elements and an emphasis on changing bystander behaviour. It achieved promising results in a large trial in Finland, and now requires testing in other countries. This paper describes the protocol for a cluster randomised controlled trial (RCT) of KiVa in Wales. The study uses a two-arm waitlist control pragmatic definitive parallel group cluster RCT design with an embedded process evaluation and calculation of unit cost. Participating schools will be randomised a using a 1:1 ratio to KiVa plus usual provision (intervention group) or usual provision only (control group). The trial has one primary outcome, child self-reported victimisation from bullying, dichotomised as 'victimised' (bullied at least twice a month in the last couple of months) versus 'not victimised'. Secondary outcomes are: bullying perpetration; aspects of child social and emotional well-being (including emotional problems, conduct, peer relations, prosocial behaviour); and school attendance. Follow-up is at 12 months post-baseline. Implementation fidelity is measured through teacher-completed lesson records and independent school-wide observation. A micro-costing analysis will determine the costs of implementing KiVa, including recurrent and non-recurrent unit costs. Factors related to the scalability of the programme will be examined in interviews with head teachers and focus groups with key stakeholders in the implementation of school-based bullying interventions. The results from this trial will provide evidence on whether the KiVa programme is transportable from Finland to Wales in terms of effectiveness and implementation. It will provide information about the costs of delivery and generate insights into factors related to the scalability of the programme. Current Controlled Trials ISRCTN23999021 Date 10-6-13.

Eligibility of disabled veterans and members of the armed forces with severe burn injuries for financial assistance in the purchase of an automobile or other conveyance and adaptive equipment. Final rule.

PubMed

2013-09-19

The Department of Veterans Affairs (VA) adopts as a final rule its proposal to amend its adjudication regulation concerning a certificate of eligibility for financial assistance in the purchase of an automobile or other conveyance and adaptive equipment, which was published in the Federal Register on November 5, 2012, and republished for minor technical corrections on November 26, 2012. The amendment is necessary to incorporate statutory changes made by the Veterans' Benefits Act of 2010.

Islamic Concept of Just War and Laws of Armed Conflict (LoAC): A Contemplative Perspective towards Better Understanding of Jihad and Humanistic Dimensions of Islam

DTIC Science & Technology

2013-04-18

Dimensions of Islam 5a. CONTRACT NUMBER N/A 5b. GRANT NUMBER N/A 5c. PROGRAM ELEMENT NUMBER N/A 6. AUTHOR( S ) Hayat, Amer, Major 5d. PROJECT...NUMBER N/A 5e. TASK NUMBER N/A 5f. WORK UNIT NUMBER N/A 7. PERFORMING ORGANIZATION NAME( S ) AND ADDRESS(ES) USMC Command and Staff College...Marine Corps University 2076 South Street Quantico, VA 22134-5068 8. PERFORMING ORGANIZATION REPORT NUMBER N/A 9. SPONSORING/MONITORING AGENCY NAME( S

Combined exposure of diesel exhaust particles and respirable Soufrière Hills volcanic ash causes a (pro-)inflammatory response in an in vitro multicellular epithelial tissue barrier model.

PubMed

Tomašek, Ines; Horwell, Claire J; Damby, David E; Barošová, Hana; Geers, Christoph; Petri-Fink, Alke; Rothen-Rutishauser, Barbara; Clift, Martin J D

2016-12-12

There are justifiable health concerns regarding the potential adverse effects associated with human exposure to volcanic ash (VA) particles, especially when considering communities living in urban areas already exposed to heightened air pollution. The aim of this study was, therefore, to gain an imperative, first understanding of the biological impacts of respirable VA when exposed concomitantly with diesel particles. A sophisticated in vitro 3D triple cell co-culture model of the human alveolar epithelial tissue barrier was exposed to either a single or repeated dose of dry respirable VA (deposited dose of 0.26 ± 0.09 or 0.89 ± 0.29 μg/cm 2 , respectively) from Soufrière Hills volcano, Montserrat for a period of 24 h at the air-liquid interface (ALI). Subsequently, co-cultures were exposed to co-exposures of single or repeated VA and diesel exhaust particles (DEP; NIST SRM 2975; 0.02 mg/mL), a model urban pollutant, at the pseudo-ALI. The biological impact of each individual particle type was also analysed under these precise scenarios. The cytotoxic (LDH release), oxidative stress (depletion of intracellular GSH) and (pro-)inflammatory (TNF-α, IL-8 and IL-1β) responses were assessed after the particulate exposures. The impact of VA exposure upon cell morphology, as well as its interaction with the multicellular model, was visualised via confocal laser scanning microscopy (LSM) and scanning electron microscopy (SEM), respectively. The combination of respirable VA and DEP, in all scenarios, incited an heightened release of TNF-α and IL-8 as well as significant increases in IL-1β, when applied at sub-lethal doses to the co-culture compared to VA exposure alone. Notably, the augmented (pro-)inflammatory responses observed were not mediated by oxidative stress. LSM supported the quantitative assessment of cytotoxicity, with no changes in cell morphology within the barrier model evident. A direct interaction of the VA with all three cell types of the multicellular system was observed by SEM. Combined exposure of respirable Soufrière Hills VA with DEP causes a (pro-)inflammatory effect in an advanced in vitro multicellular model of the epithelial airway barrier. This finding suggests that the combined exposure to volcanic and urban particulate matter should be further investigated in order to deduce the potential human health hazard, especially how it may influence the respiratory function of susceptible individuals (i.e. with pre-existing lung diseases) in the population.

Combined exposure of diesel exhaust particles and respirable Soufrière Hills volcanic ash causes a (pro-)inflammatory response in an in vitro multicellular epithelial tissue barrier model

USGS Publications Warehouse

Tomašek, Ines; Horwell, Claire J.; Damby, David; Barošová, Hana; Geers, Christoph; Petri-Fink, Alke; Rothen-Rutishauser, Barbara; Clift, Martin J. D.

2016-01-01

BackgroundThere are justifiable health concerns regarding the potential adverse effects associated with human exposure to volcanic ash (VA) particles, especially when considering communities living in urban areas already exposed to heightened air pollution. The aim of this study was, therefore, to gain an imperative, first understanding of the biological impacts of respirable VA when exposed concomitantly with diesel particles.MethodsA sophisticated in vitro 3D triple cell co-culture model of the human alveolar epithelial tissue barrier was exposed to either a single or repeated dose of dry respirable VA (deposited dose of 0.26 ± 0.09 or 0.89 ± 0.29 μg/cm2, respectively) from Soufrière Hills volcano, Montserrat for a period of 24 h at the air-liquid interface (ALI). Subsequently, co-cultures were exposed to co-exposures of single or repeated VA and diesel exhaust particles (DEP; NIST SRM 2975; 0.02 mg/mL), a model urban pollutant, at the pseudo-ALI. The biological impact of each individual particle type was also analysed under these precise scenarios. The cytotoxic (LDH release), oxidative stress (depletion of intracellular GSH) and (pro-)inflammatory (TNF-α, IL-8 and IL-1β) responses were assessed after the particulate exposures. The impact of VA exposure upon cell morphology, as well as its interaction with the multicellular model, was visualised via confocal laser scanning microscopy (LSM) and scanning electron microscopy (SEM), respectively.ResultsThe combination of respirable VA and DEP, in all scenarios, incited an heightened release of TNF-α and IL-8 as well as significant increases in IL-1β, when applied at sub-lethal doses to the co-culture compared to VA exposure alone. Notably, the augmented (pro-)inflammatory responses observed were not mediated by oxidative stress. LSM supported the quantitative assessment of cytotoxicity, with no changes in cell morphology within the barrier model evident. A direct interaction of the VA with all three cell types of the multicellular system was observed by SEM.ConclusionsCombined exposure of respirable Soufrière Hills VA with DEP causes a (pro-)inflammatory effect in an advanced in vitro multicellular model of the epithelial airway barrier. This finding suggests that the combined exposure to volcanic and urban particulate matter should be further investigated in order to deduce the potential human health hazard, especially how it may influence the respiratory function of susceptible individuals (i.e. with pre-existing lung diseases) in the population.

Beyond Pain: Coercing Violent Non-State Actors

DTIC Science & Technology

2010-01-01

October 19 1993.105 In the end, it took independent negotiators with unsurpassed credibility—Jimmy Carter, Sam Nunn, and Colin Powell—to...Penguin Press, 2004. Cooper, Drury . Economic Sanctions and Presidential Decisions: Model of Political Rationality. Gordonsville, VA...also Drury Cooper, Economic Sanctions and Presidential Decisions: Model of Political Rationality (Gordonsville, VA: Palgrave Macmillan, 2006). 71

Estimation of value at risk in currency exchange rate portfolio using asymmetric GJR-GARCH Copula

NASA Astrophysics Data System (ADS)

Nurrahmat, Mohamad Husein; Noviyanti, Lienda; Bachrudin, Achmad

2017-03-01

In this study, we discuss the problem in measuring the risk in a portfolio based on value at risk (VaR) using asymmetric GJR-GARCH Copula. The approach based on the consideration that the assumption of normality over time for the return can not be fulfilled, and there is non-linear correlation for dependent model structure among the variables that lead to the estimated VaR be inaccurate. Moreover, the leverage effect also causes the asymmetric effect of dynamic variance and shows the weakness of the GARCH models due to its symmetrical effect on conditional variance. Asymmetric GJR-GARCH models are used to filter the margins while the Copulas are used to link them together into a multivariate distribution. Then, we use copulas to construct flexible multivariate distributions with different marginal and dependence structure, which is led to portfolio joint distribution does not depend on the assumptions of normality and linear correlation. VaR obtained by the analysis with confidence level 95% is 0.005586. This VaR derived from the best Copula model, t-student Copula with marginal distribution of t distribution.

Being First Matters: Topographical Representational Similarity Analysis of ERP Signals Reveals Separate Networks for Audiovisual Temporal Binding Depending on the Leading Sense.

PubMed

Cecere, Roberto; Gross, Joachim; Willis, Ashleigh; Thut, Gregor

2017-05-24

In multisensory integration, processing in one sensory modality is enhanced by complementary information from other modalities. Intersensory timing is crucial in this process because only inputs reaching the brain within a restricted temporal window are perceptually bound. Previous research in the audiovisual field has investigated various features of the temporal binding window, revealing asymmetries in its size and plasticity depending on the leading input: auditory-visual (AV) or visual-auditory (VA). Here, we tested whether separate neuronal mechanisms underlie this AV-VA dichotomy in humans. We recorded high-density EEG while participants performed an audiovisual simultaneity judgment task including various AV-VA asynchronies and unisensory control conditions (visual-only, auditory-only) and tested whether AV and VA processing generate different patterns of brain activity. After isolating the multisensory components of AV-VA event-related potentials (ERPs) from the sum of their unisensory constituents, we ran a time-resolved topographical representational similarity analysis (tRSA) comparing the AV and VA ERP maps. Spatial cross-correlation matrices were built from real data to index the similarity between the AV and VA maps at each time point (500 ms window after stimulus) and then correlated with two alternative similarity model matrices: AV maps = VA maps versus AV maps ≠ VA maps The tRSA results favored the AV maps ≠ VA maps model across all time points, suggesting that audiovisual temporal binding (indexed by synchrony perception) engages different neural pathways depending on the leading sense. The existence of such dual route supports recent theoretical accounts proposing that multiple binding mechanisms are implemented in the brain to accommodate different information parsing strategies in auditory and visual sensory systems. SIGNIFICANCE STATEMENT Intersensory timing is a crucial aspect of multisensory integration, determining whether and how inputs in one modality enhance stimulus processing in another modality. Our research demonstrates that evaluating synchrony of auditory-leading (AV) versus visual-leading (VA) audiovisual stimulus pairs is characterized by two distinct patterns of brain activity. This suggests that audiovisual integration is not a unitary process and that different binding mechanisms are recruited in the brain based on the leading sense. These mechanisms may be relevant for supporting different classes of multisensory operations, for example, auditory enhancement of visual attention (AV) and visual enhancement of auditory speech (VA). Copyright © 2017 Cecere et al.

Reference values for pulmonary diffusing capacity for adult native Finns.

PubMed

Kainu, Annette; Toikka, Jyri; Vanninen, Esko; Timonen, Kirsi L

2017-04-01

Measurement standards for pulmonary diffusing capacity were updated in 2005 by the ATS/ERS Task Force. However, in Finland reference values published in 1982 by Viljanen et al. have been used to date. The main aim of this study was to produce updated reference models for single-breath diffusing capacity for carbon monoxide for Finnish adults. Single-breath diffusing capacity for carbon monoxide was measured in 631 healthy non-smoking volunteers (41.5% male). Reference values for diffusing capacity (DLCO), alveolar volume (VA), diffusing capacity per unit of lung volume (DLCO/VA), and lung volumes were calculated using a linear regression model. Previously used Finnish reference values were found to produce too low predicted values, with mean predicted DLCO 111.0 and 104.4%, and DLCO/VA of 103.5 and 102.7% in males and females, respectively. With the European Coalition for Steel and Coal (ECSC) reference values there was a significant sex difference in DLCO/VA with mean predicted 105.4% in males and 92.8% in females (p < .001). New reference values for DLCO, DLCO/VA, VA, vital capacity (VC), inspiratory vital capacity (IVC), and inspiratory capacity (IC) are suggested for clinical use to replace technically outdated reference values for clinical applications.

Bond-based linear indices in QSAR: computational discovery of novel anti-trichomonal compounds

NASA Astrophysics Data System (ADS)

Marrero-Ponce, Yovani; Meneses-Marcel, Alfredo; Rivera-Borroto, Oscar M.; García-Domenech, Ramón; De Julián-Ortiz, Jesus Vicente; Montero, Alina; Escario, José Antonio; Barrio, Alicia Gómez; Pereira, David Montero; Nogal, Juan José; Grau, Ricardo; Torrens, Francisco; Vogel, Christian; Arán, Vicente J.

2008-08-01

Trichomonas vaginalis ( Tv) is the causative agent of the most common, non-viral, sexually transmitted disease in women and men worldwide. Since 1959, metronidazole (MTZ) has been the drug of choice in the systemic treatment of trichomoniasis. However, resistance to MTZ in some patients and the great cost associated with the development of new trichomonacidals make necessary the development of computational methods that shorten the drug discovery pipeline. Toward this end, bond-based linear indices, new TOMOCOMD-CARDD molecular descriptors, and linear discriminant analysis were used to discover novel trichomonacidal chemicals. The obtained models, using non-stochastic and stochastic indices, are able to classify correctly 89.01% (87.50%) and 82.42% (84.38%) of the chemicals in the training (test) sets, respectively. These results validate the models for their use in the ligand-based virtual screening. In addition, they show large Matthews' correlation coefficients ( C) of 0.78 (0.71) and 0.65 (0.65) for the training (test) sets, correspondingly. The result of predictions on the 10% full-out cross-validation test also evidences the robustness of the obtained models. Later, both models are applied to the virtual screening of 12 compounds already proved against Tv. As a result, they correctly classify 10 out of 12 (83.33%) and 9 out of 12 (75.00%) of the chemicals, respectively; which is the most important criterion for validating the models. Besides, these classification functions are applied to a library of seven chemicals in order to find novel antitrichomonal agents. These compounds are synthesized and tested for in vitro activity against Tv. As a result, experimental observations approached to theoretical predictions, since it was obtained a correct classification of 85.71% (6 out of 7) of the chemicals. Moreover, out of the seven compounds that are screened, synthesized and biologically assayed, six compounds (VA7-34, VA7-35, VA7-37, VA7-38, VA7-68, VA7-70) show pronounced cytocidal activity at the concentration of 100 μg/ml at 24 h (48 h) within the range of 98.66%-100% (99.40%-100%), while only two molecules (chemicals VA7-37 and VA7-38) show high cytocidal activity at the concentration of 10 μg/ml at 24 h (48 h): 98.38% (94.23%) and 97.59% (98.10%), correspondingly. The LDA-assisted QSAR models presented here could significantly reduce the number of synthesized and tested compounds and could increase the chance of finding new chemical entities with anti-trichomonal activity.

Bond-based linear indices in QSAR: computational discovery of novel anti-trichomonal compounds.

PubMed

Marrero-Ponce, Yovani; Meneses-Marcel, Alfredo; Rivera-Borroto, Oscar M; García-Domenech, Ramón; De Julián-Ortiz, Jesus Vicente; Montero, Alina; Escario, José Antonio; Barrio, Alicia Gómez; Pereira, David Montero; Nogal, Juan José; Grau, Ricardo; Torrens, Francisco; Vogel, Christian; Arán, Vicente J

2008-08-01

Trichomonas vaginalis (Tv) is the causative agent of the most common, non-viral, sexually transmitted disease in women and men worldwide. Since 1959, metronidazole (MTZ) has been the drug of choice in the systemic treatment of trichomoniasis. However, resistance to MTZ in some patients and the great cost associated with the development of new trichomonacidals make necessary the development of computational methods that shorten the drug discovery pipeline. Toward this end, bond-based linear indices, new TOMOCOMD-CARDD molecular descriptors, and linear discriminant analysis were used to discover novel trichomonacidal chemicals. The obtained models, using non-stochastic and stochastic indices, are able to classify correctly 89.01% (87.50%) and 82.42% (84.38%) of the chemicals in the training (test) sets, respectively. These results validate the models for their use in the ligand-based virtual screening. In addition, they show large Matthews' correlation coefficients (C) of 0.78 (0.71) and 0.65 (0.65) for the training (test) sets, correspondingly. The result of predictions on the 10% full-out cross-validation test also evidences the robustness of the obtained models. Later, both models are applied to the virtual screening of 12 compounds already proved against Tv. As a result, they correctly classify 10 out of 12 (83.33%) and 9 out of 12 (75.00%) of the chemicals, respectively; which is the most important criterion for validating the models. Besides, these classification functions are applied to a library of seven chemicals in order to find novel antitrichomonal agents. These compounds are synthesized and tested for in vitro activity against Tv. As a result, experimental observations approached to theoretical predictions, since it was obtained a correct classification of 85.71% (6 out of 7) of the chemicals. Moreover, out of the seven compounds that are screened, synthesized and biologically assayed, six compounds (VA7-34, VA7-35, VA7-37, VA7-38, VA7-68, VA7-70) show pronounced cytocidal activity at the concentration of 100 mug/ml at 24 h (48 h) within the range of 98.66%-100% (99.40%-100%), while only two molecules (chemicals VA7-37 and VA7-38) show high cytocidal activity at the concentration of 10 mug/ml at 24 h (48 h): 98.38% (94.23%) and 97.59% (98.10%), correspondingly. The LDA-assisted QSAR models presented here could significantly reduce the number of synthesized and tested compounds and could increase the chance of finding new chemical entities with anti-trichomonal activity.

The NO vA simulation chain

DOE PAGES

Aurisano, A.; Backhouse, C.; Hatcher, R.; ...

2015-12-23

The NO vA experiment is a two-detector, long-baseline neutrino experiment operating in the recently upgraded NuMI muon neutrino beam. Simulating neutrino interactions and backgrounds requires many steps including: the simulation of the neutrino beam flux using FLUKA and the FLUGG interface, cosmic ray generation using CRY, neutrino interaction modeling using GENIE, and a simulation of the energy deposited in the detector using GEANT4. To shorten generation time, the modeling of detector-specific aspects, such as photon transport, detector and electronics noise, and readout electronics, employs custom, parameterized simulation applications. We will describe the NO vA simulation chain, and present details onmore » the techniques used in modeling photon transport near the ends of cells, and in developing a novel data-driven noise simulation. Due to the high intensity of the NuMI beam, the Near Detector samples a high rate of muons originating in the surrounding rock. In addition, due to its location on the surface at Ash River, MN, the Far Detector collects a large rate ((˜) 140 kHz) of cosmic muons. Furthermore, we will discuss the methods used in NO vA for overlaying rock muons and cosmic ray muons with simulated neutrino interactions and show how realistically the final simulation reproduces the preliminary NO vA data.« less

Semi-nonparametric VaR forecasts for hedge funds during the recent crisis

NASA Astrophysics Data System (ADS)

Del Brio, Esther B.; Mora-Valencia, Andrés; Perote, Javier

2014-05-01

The need to provide accurate value-at-risk (VaR) forecasting measures has triggered an important literature in econophysics. Although these accurate VaR models and methodologies are particularly demanded for hedge fund managers, there exist few articles specifically devoted to implement new techniques in hedge fund returns VaR forecasting. This article advances in these issues by comparing the performance of risk measures based on parametric distributions (the normal, Student’s t and skewed-t), semi-nonparametric (SNP) methodologies based on Gram-Charlier (GC) series and the extreme value theory (EVT) approach. Our results show that normal-, Student’s t- and Skewed t- based methodologies fail to forecast hedge fund VaR, whilst SNP and EVT approaches accurately success on it. We extend these results to the multivariate framework by providing an explicit formula for the GC copula and its density that encompasses the Gaussian copula and accounts for non-linear dependences. We show that the VaR obtained by the meta GC accurately captures portfolio risk and outperforms regulatory VaR estimates obtained through the meta Gaussian and Student’s t distributions.

Veterans’ Preferences for Exchanging Information Using Veterans Affairs Health Information Technologies: Focus Group Results and Modeling Simulations

PubMed Central

Chavez, Margeaux; Nazi, Kim; Antinori, Nicole; Melillo, Christine; Cotner, Bridget A; Hathaway, Wendy; Cook, Ashley; Wilck, Nancy; Noonan, Abigail

2017-01-01

Background The Department of Veterans Affairs (VA) has multiple health information technology (HIT) resources for veterans to support their health care management. These include a patient portal, VetLink Kiosks, mobile apps, and telehealth services. The veteran patient population has a variety of needs and preferences that can inform current VA HIT redesign efforts to meet consumer needs. Objective This study aimed to describe veterans’ experiences using the current VA HIT and identify their vision for the future of an integrated VA HIT system. Methods Two rounds of focus group interviews were conducted with a single cohort of 47 veterans and one female caregiver recruited from Bedford, Massachusetts, and Tampa, Florida. Focus group interviews included simulation modeling activities and a self-administered survey. This study also used an expert panel group to provide data and input throughout the study process. High-fidelity, interactive simulations were created and used to facilitate collection of qualitative data. The simulations were developed based on system requirements, data collected through operational efforts, and participants' reported preferences for using VA HIT. Pairwise comparison activities of HIT resources were conducted with both focus groups and the expert panel. Rapid iterative content analysis was used to analyze qualitative data. Descriptive statistics summarized quantitative data. Results Data themes included (1) current use of VA HIT, (2) non-VA HIT use, and (3) preferences for future use of VA HIT. Data indicated that, although the Secure Messaging feature was often preferred, a full range of HIT options are needed. These data were then used to develop veteran-driven simulations that illustrate user needs and expectations when using a HIT system and services to access VA health care services. Conclusions Patient participant redesign processes present critical opportunities for creating a human-centered design. Veterans value virtual health care options and prefer standardized, integrated, and synchronized user-friendly interface designs. PMID:29061553

Exchangeability, extreme returns and Value-at-Risk forecasts

NASA Astrophysics Data System (ADS)

Huang, Chun-Kai; North, Delia; Zewotir, Temesgen

2017-07-01

In this paper, we propose a new approach to extreme value modelling for the forecasting of Value-at-Risk (VaR). In particular, the block maxima and the peaks-over-threshold methods are generalised to exchangeable random sequences. This caters for the dependencies, such as serial autocorrelation, of financial returns observed empirically. In addition, this approach allows for parameter variations within each VaR estimation window. Empirical prior distributions of the extreme value parameters are attained by using resampling procedures. We compare the results of our VaR forecasts to that of the unconditional extreme value theory (EVT) approach and the conditional GARCH-EVT model for robust conclusions.

Measuring daily Value-at-Risk of SSEC index: A new approach based on multifractal analysis and extreme value theory

NASA Astrophysics Data System (ADS)

Wei, Yu; Chen, Wang; Lin, Yu

2013-05-01

Recent studies in the econophysics literature reveal that price variability has fractal and multifractal characteristics not only in developed financial markets, but also in emerging markets. Taking high-frequency intraday quotes of the Shanghai Stock Exchange Component (SSEC) Index as example, this paper proposes a new method to measure daily Value-at-Risk (VaR) by combining the newly introduced multifractal volatility (MFV) model and the extreme value theory (EVT) method. Two VaR backtesting techniques are then employed to compare the performance of the model with that of a group of linear and nonlinear generalized autoregressive conditional heteroskedasticity (GARCH) models. The empirical results show the multifractal nature of price volatility in Chinese stock market. VaR measures based on the multifractal volatility model and EVT method outperform many GARCH-type models at high-risk levels.

Participation of Myosin Va and Pka Type I in the Regeneration of Neuromuscular Junctions

PubMed Central

Röder, Ira Verena; Strack, Siegfried; Reischl, Markus; Dahley, Oliver; Khan, Muzamil Majid; Kassel, Olivier; Zaccolo, Manuela; Rudolf, Rüdiger

2012-01-01

Background The unconventional motor protein, myosin Va, is crucial for the development of the mouse neuromuscular junction (NMJ) in the early postnatal phase. Furthermore, the cooperative action of protein kinase A (PKA) and myosin Va is essential to maintain the adult NMJ. We here assessed the involvement of myosin Va and PKA in NMJ recovery during muscle regeneration. Methodology/Principal Findings To address a putative role of myosin Va and PKA in the process of muscle regeneration, we used two experimental models the dystrophic mdx mouse and Notexin-induced muscle degeneration/regeneration. We found that in both systems myosin Va and PKA type I accumulate beneath the NMJs in a fiber maturation-dependent manner. Morphologically intact NMJs were found to express stable nicotinic acetylcholine receptors and to accumulate myosin Va and PKA type I in the subsynaptic region. Subsynaptic cAMP signaling was strongly altered in dystrophic muscle, particularly in fibers with severely subverted NMJ morphology. Conclusions/Significance Our data show a correlation between the subsynaptic accumulation of myosin Va and PKA type I on the one hand and NMJ regeneration status and morphology, AChR stability and specificity of subsynaptic cAMP handling on the other hand. This suggests an important role of myosin Va and PKA type I for the maturation of NMJs in regenerating muscle. PMID:22815846

Harnessing Protocolized Adaptation in Dissemination: Successful Implementation and Sustainment of the Veterans Affairs Coordinated-Transitional Care Program in a Non-Veterans Affairs Hospital.

PubMed

Kind, Amy J H; Brenny-Fitzpatrick, Maria; Leahy-Gross, Kris; Mirr, Jacquelyn; Chapman, Elizabeth; Frey, Brooke; Houlahan, Beth

2016-02-01

The Department of Veterans Affairs (VA) Coordinated-Transitional Care (C-TraC) program is a low-cost transitional care program that uses hospital-based nurse case managers, inpatient team integration, and in-depth posthospital telephone contacts to support high-risk patients and their caregivers as they transition from hospital to community. The low-cost, primarily telephone-based C-TraC program reduced 30-day rehospitalizations by one-third, leading to significant cost savings at one VA hospital. Non-VA hospitals have expressed interest in launching C-TraC, but non-VA hospitals differ in important ways from VA hospitals, particularly in terms of context, culture, and resources. The objective of this project was to adapt C-TraC to the specific context of one non-VA setting using a modified Replicating Effective Programs (REP) implementation theory model and to test the feasibility of this protocolized implementation approach. The modified REP model uses a mentored phased-based implementation with intensive preimplementation activities and harnesses key local stakeholders to adapt processes and goals to local context. Using this protocolized implementation approach, an adapted C-TraC protocol was created and launched at the non-VA hospital in July 2013. In its first 16 months, C-TraC successfully enrolled 1,247 individuals with 3.2 full-time nurse case managers, achieving good fidelity for core protocol steps. C-TraC participants experienced a 30-day rehospitalization rate of 10.8%, compared with 16.6% for a contemporary comparison group of similar individuals for whom C-TraC was not available (n = 1,307) (P < .001). The new C-TraC program continues in operation. Use of a modified REP model to guide protocolized adaptation to local context resulted in a C-TraC program that was feasible and sustained in a real-world non-VA setting. A modified REP implementation framework may be an appropriate foundational step for other clinical programs seeking to harness protocolized adaptation in mentored dissemination activities. © 2016, Copyright the Authors Journal compilation © 2016, The American Geriatrics Society.

KiVa Anti-Bullying Program in Italy: Evidence of Effectiveness in a Randomized Control Trial.

PubMed

Nocentini, Annalaura; Menesini, Ersilia

2016-11-01

The present study aims to evaluate the effectiveness of the KiVa anti-bullying program in Italy through a randomized control trial of students in grades 4 and 6. The sample involved 2042 students (51 % female; grade 4, mean age = 8.85; ds = 0.43; grade 6, mean age = 10.93; ds = 0.50); 13 comprehensive schools were randomly assigned into intervention (KiVa) or control (usual school provision) conditions. Different outcomes (bullying, victimization, pro-bullying attitudes, pro-victim attitudes, empathy toward victims), analyses (longitudinal mixed model with multiple-item scales; longitudinal prevalence of bullies and victims using Olweus' single question), and estimates of effectiveness (Cohen's d; odds ratios) were considered in order to compare the Italian results with those from other countries. Multilevel models showed that KiVa reduced bullying and victimization and increased pro-victim attitudes and empathy toward the victim in grade 4, with effect sizes from 0.24 to 0.40. In grade 6, KiVa reduced bullying, victimization, and pro-bullying attitudes; the effects were smaller as compared to grade 4, yet significant (d ≥ 0.20). Finally, using Olweus dichotomous definition of bullies and victims, results showed that the odds of being a victim were 1.93 times higher for a control student than for a KiVa student in grade 4. Overall, the findings provide evidence of the effectiveness of the program in Italy; the discussion will focus on factors that influenced successfully the transportability of the KiVa program in Italy.

Advance Appropriations for Veteran’s Health Care: Issues and Options for Congress

DTIC Science & Technology

2009-04-28

care system. Utilization Projection Model (UPM) The UPM is based on the Milliman Health Cost Guidelines ( HCGs ), a proprietary set of utilization-rate...benchmarks derived from commercial data.31 The HCGs contain data on utilization for 37 of the 58 EHCPM health service categories. Milliman applies a...complex set of adjustments to the HCG data to reflect the health status of VA enrollees, their reliance on VA, and the relative efficiency of VA

Factors Related to Attrition from VA Healthcare Use: Findings from the National Survey of Women Veterans

DTIC Science & Technology

2013-01-01

present analysis we draw on aspects of the Andersen Behavioral Model,21 particularly need characteristics (e.g., mental health), as determinants of...converted to number of years ago. Number of years since last VA use was grouped into five-year increments. Statistical Analysis The analytic sample was...healthcare several decades ago. A limitation of our study is that recollections about the decision to discontinue VA care are subject to recall bias

Implementation of the Geriatric Patient-Aligned Care Team Model in the Veterans Health Administration (VA).

PubMed

Sullivan, Jennifer L; Eisenstein, Rina; Price, Thomas; Solimeo, Samantha; Shay, Kenneth

2018-01-01

Here, we describe the implementation of a specialty primary care medical home (PCMH) model called Geriatric Patient-Aligned Care Teams (GeriPACT) in the Veterans' Health Administration (VA) that is focused on serving older complex patients. In particular, our aims in this article are to describe how the GeriPACT model was developed and implemented in VA sites, provide a closer look at how GeriPACT functions by presenting a case study, and highlight data showing national variation in the implementation of GeriPACT staffing models and PCMH practices. Stakeholder feedback regarding the GeriPACT model was obtained from a GeriPACT team and the director of GeriPACT in VA. Here, we present national data regarding variations in GeriPACT staffing and PCMH practices. Following the adoption and implementation of the GeriPACT model and release of the GeriPACT handbook, sites were able to adopt the model's principles. The VA's adoption of PCMH reinforced the mission of patient-centered primary care by integrating psychosocial and environmental determinants of health. This was accomplished with enhancements to staff support through new full-time employment equivalents, but also by optimizing staff productivity through improved team function and interpersonal care. The GeriPACT model was implemented in a bottom-up fashion that has led to variation in how GeriPACTs are structured and staffed, as well as how they conform to various PCMH principles. GeriPACT is one approach for bringing an interdisciplinary, patient-centric perspective to primary care in a manner that can likely support the higher staffing costs with economies realized from diminished reliance on institutional placement and highly technologic health care. It is a model which can provide training for the next generation of providers and clinicians. © Copyright 2018 by the American Board of Family Medicine.

Controlling a multi-degree of freedom upper limb prosthesis using foot controls: user experience.

PubMed

Resnik, Linda; Klinger, Shana Lieberman; Etter, Katherine; Fantini, Christopher

2014-07-01

The DEKA Arm, a pre-commercial upper limb prosthesis, funded by the DARPA Revolutionizing Prosthetics Program, offers increased degrees of freedom while requiring a large number of user control inputs to operate. To address this challenge, DEKA developed prototype foot controls. Although the concept of utilizing foot controls to operate an upper limb prosthesis has been discussed for decades, only small-sized studies have been performed and no commercial product exists. The purpose of this paper is to report amputee user perspectives on using three different iterations of foot controls to operate the DEKA Arm. Qualitative data was collected from 36 subjects as part of the Department of Veterans Affairs (VA) Study to Optimize the DEKA Arm through surveys, interviews, audio memos, and videotaped sessions. Three major, interrelated themes were identified using the constant comparative method: attitudes towards foot controls, psychomotor learning and physical experience of using foot controls. Feedback about foot controls was generally positive for all iterations. The final version of foot controls was viewed most favorably. Our findings indicate that foot controls are a viable control option that can enable control of a multifunction upper limb prosthesis (the DEKA Arm). Multifunction upper limb prostheses require many user control inputs to operate. Foot controls offer additional control input options for such advanced devices, yet have had minimal study. This study found that foot controls were a viable option for controlling multifunction upper limb prostheses. Most of the 36 subjects in this study were willing to adopt foot controls to control the multiple degrees of freedom of the DEKA Arm. With training and practice, all users were able to develop the psychomotor skills needed to successfully operate food controls. Some had initial difficulty, but acclimated over time.

Case-mix groups for VA hospital-based home care.

PubMed

Smith, M E; Baker, C R; Branch, L G; Walls, R C; Grimes, R M; Karklins, J M; Kashner, M; Burrage, R; Parks, A; Rogers, P

1992-01-01

The purpose of this study is to group hospital-based home care (HBHC) patients homogeneously by their characteristics with respect to cost of care to develop alternative case mix methods for management and reimbursement (allocation) purposes. Six Veterans Affairs (VA) HBHC programs in Fiscal Year (FY) 1986 that maximized patient, program, and regional variation were selected, all of which agreed to participate. All HBHC patients active in each program on October 1, 1987, in addition to all new admissions through September 30, 1988 (FY88), comprised the sample of 874 unique patients. Statistical methods include the use of classification and regression trees (CART software: Statistical Software; Lafayette, CA), analysis of variance, and multiple linear regression techniques. The resulting algorithm is a three-factor model that explains 20% of the cost variance (R2 = 20%, with a cross validation R2 of 12%). Similar classifications such as the RUG-II, which is utilized for VA nursing home and intermediate care, the VA outpatient resource allocation model, and the RUG-HHC, utilized in some states for reimbursing home health care in the private sector, explained less of the cost variance and, therefore, are less adequate for VA home care resource allocation.

Cortical Spiking Network Interfaced with Virtual Musculoskeletal Arm and Robotic Arm.

PubMed

Dura-Bernal, Salvador; Zhou, Xianlian; Neymotin, Samuel A; Przekwas, Andrzej; Francis, Joseph T; Lytton, William W

2015-01-01

Embedding computational models in the physical world is a critical step towards constraining their behavior and building practical applications. Here we aim to drive a realistic musculoskeletal arm model using a biomimetic cortical spiking model, and make a robot arm reproduce the same trajectories in real time. Our cortical model consisted of a 3-layered cortex, composed of several hundred spiking model-neurons, which display physiologically realistic dynamics. We interconnected the cortical model to a two-joint musculoskeletal model of a human arm, with realistic anatomical and biomechanical properties. The virtual arm received muscle excitations from the neuronal model, and fed back proprioceptive information, forming a closed-loop system. The cortical model was trained using spike timing-dependent reinforcement learning to drive the virtual arm in a 2D reaching task. Limb position was used to simultaneously control a robot arm using an improved network interface. Virtual arm muscle activations responded to motoneuron firing rates, with virtual arm muscles lengths encoded via population coding in the proprioceptive population. After training, the virtual arm performed reaching movements which were smoother and more realistic than those obtained using a simplistic arm model. This system provided access to both spiking network properties and to arm biophysical properties, including muscle forces. The use of a musculoskeletal virtual arm and the improved control system allowed the robot arm to perform movements which were smoother than those reported in our previous paper using a simplistic arm. This work provides a novel approach consisting of bidirectionally connecting a cortical model to a realistic virtual arm, and using the system output to drive a robotic arm in real time. Our techniques are applicable to the future development of brain neuroprosthetic control systems, and may enable enhanced brain-machine interfaces with the possibility for finer control of limb prosthetics.

23. Photocopy of photograph (original in the Langley Research Center ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

23. Photocopy of photograph (original in the Langley Research Center Archives, Hampton, VA LaRC) (L73-5028) MODEL OF SUPERSONIC TRANSPORT IN FULL-SCALE WIND TUNNEL. - NASA Langley Research Center, Full-Scale Wind Tunnel, 224 Hunting Avenue, Hampton, Hampton, VA

77 FR 51850 - Agency Information Collection: Emergency Submission for OMB Review (PACT: Clinical Innovation...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-08-27

..., et al., 1993), VA Form 10-0532g. i. The Brief COPE (Carver, 1997), VA Form 10-0532h. j. Depression... PCM on depression and anxiety relative to usual care. This data collection's model has been designed...

Comparative Logic Modeling for Policy Analysis: The Case of HIV Testing Policy Change at the Department of Veterans Affairs

PubMed Central

Langer, Erika M; Gifford, Allen L; Chan, Kee

2011-01-01

Objective Logic models have been used to evaluate policy programs, plan projects, and allocate resources. Logic Modeling for policy analysis has been used rarely in health services research but can be helpful in evaluating the content and rationale of health policies. Comparative Logic Modeling is used here on human immunodeficiency virus (HIV) policy statements from the Department of Veterans Affairs (VA) and Centers for Disease Control and Prevention (CDC). We created visual representations of proposed HIV screening policy components in order to evaluate their structural logic and research-based justifications. Data Sources and Study Design We performed content analysis of VA and CDC HIV testing policy documents in a retrospective case study. Data Collection Using comparative Logic Modeling, we examined the content and primary sources of policy statements by the VA and CDC. We then quantified evidence-based causal inferences within each statement. Principal Findings VA HIV testing policy structure largely replicated that of the CDC guidelines. Despite similar design choices, chosen research citations did not overlap. The agencies used evidence to emphasize different components of the policies. Conclusion Comparative Logic Modeling can be used by health services researchers and policy analysts more generally to evaluate structural differences in health policies and to analyze research-based rationales used by policy makers. PMID:21689094

Prospective post traumatic stress disorder symptom trajectories in active duty and separated military personnel

DTIC Science & Technology

2017-01-30

the proportion of active duty service members receiving VA care was restricted to zero. This model included all the covariates of the fully adjusted...assessed remained consistent across participants and timepoints. VA care was assessed from self -report, but could not be verified with VA medical...utility of a self -report version of PRIME-MD: the PHQ primary care study. JAMA J. Am. Med. Assoc. 282, 1737e1744. Spitzer, R.L., Williams, J.B

What the VA can teach us about geriatric care.

PubMed

Ratner, Edward R; West, Melissa; Hartwig, Kristopher N; Meyer, Bruce C

2013-01-01

The innovation now being demanded by Medicare is creating new opportunities for health care organizations to redesign how they deliver care for elderly people. For many years, the VA Health System has experimented with ways to deliver care more effectively and efficiently. Hospital-based postacute and palliative care and home-based primary care are two examples of successful approaches that non-VA providers should be looking at as they move away from fee-for-service reimbursement and invent new care-delivery models.

Measuring physicians' productivity in a Veterans' Affairs Medical Center.

PubMed

Coleman, David L; Moran, Eileen; Serfilippi, Delchi; Mulinski, Paul; Rosenthal, Ronnie; Gordon, Bruce; Mogielnicki, R Peter

2003-07-01

The mission of the Department of Veterans Affairs includes patient care, education, research, and backup to the Department of Defense. Because the measurement of physicians' productivity must reflect both institutional goals and market forces, the authors designed a productivity model that uses measures of clinical workload and academic activities commensurate with the VA's investments in these activities. The productivity model evaluates four domains of physicians' activity: clinical work, education, research, and administration. Examples of the application of the productivity model in the evaluation of VA-paid physician-staff and in the composition of contracts for clinical services are provided. The proposed model is a relatively simple strategy for measuring a broad range of the work of academic physicians in VA medical centers. The model provides incentives for documentation of resident supervision and participation in administrative activities required for effective and efficient clinical care. In addition, the model can aid in determining resource distribution among clinical services and permits comparison with non-VA health care systems. A strategy for modifying the model to incorporate measures of quality of clinical care, research, education, and administration is proposed. The model has been a useful part of the process to ensure the optimum use of resources and to meet clinical and academic institutional goals. The activities and accomplishments used to define physician productivity will have a substantial influence on the character of the medical profession, the vitality of medical education and research, and the cost and quality of health care.

VA health service utilization for homeless and low-income Veterans: a spotlight on the VA Supportive Housing (VASH) program in greater Los Angeles.

PubMed

Gabrielian, Sonya; Yuan, Anita H; Andersen, Ronald M; Rubenstein, Lisa V; Gelberg, Lillian

2014-05-01

The US Department of Housing and Urban Development (HUD)-VA Supportive Housing (VASH) program-the VA's Housing First effort-is central to efforts to end Veteran homelessness. Yet, little is known about health care utilization patterns associated with achieving HUD-VASH housing. We compare health service utilization at the VA Greater Los Angeles among: (1) formerly homeless Veterans housed through HUD-VASH (HUD-VASH Veterans); (2) currently homeless Veterans; (3) housed, low-income Veterans not in HUD-VASH; and (4) housed, not low-income Veterans. We performed a secondary database analysis of Veterans (n=62,459) who received VA Greater Los Angeles care between October 1, 2010 and September 30, 2011. We described medical/surgical and mental health utilization [inpatient, outpatient, and emergency department (ED)]. We controlled for demographics, need, and primary care use in regression analyses of utilization data by housing and income status. HUD-VASH Veterans had more inpatient, outpatient, and ED use than currently homeless Veterans. Adjusting for demographics and need, HUD-VASH Veterans and the low-income housed Veterans had similar likelihoods of medical/surgical inpatient and outpatient utilization, compared with the housed, not low-income group. Adjusting first for demographics and need (model 1), then also for primary care use (model 2), HUD-VASH Veterans had the greatest decrease in incident rates of specialty medical/surgical, mental health, and ED care from models 1 to 2, becoming similar to the currently homeless, compared with the housed, not low-income group. Our findings suggest that currently homeless Veterans underuse health care relative to housed Veterans. HUD-VASH may address this disparity by providing housing and linkages to primary care.

ESRD care within the US Department of Veterans Affairs: a forward-looking program with an illuminating past.

PubMed

Watnick, Suzanne; Crowley, Susan T

2014-03-01

The first governmental agency to provide maintenance hemodialysis to patients with end-stage renal disease (ESRD) was the Veterans Administration (VA; now the US Department of Veterans Affairs). Many historical VA policies and programs set the stage for the later care of both veteran and civilian patients with ESRD. More recent VA initiatives that target restructuring of care models based on quality management, system-wide payment policies to promote cost-effective dialysis, and innovation grants aim to improve contemporary care. The VA currently supports an expanded and diversified nationwide treatment program for patients with ESRD using an integrated patient-centered care paradigm. This narrative review of ESRD care by the VA explores not only the medical advances, but also the historical, socioeconomic, ethical, and political forces related to the care of veterans with ESRD. Published by Elsevier Inc.

23. Photocopy of photograph (original in the Langley Research Center ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

23. Photocopy of photograph (original in the Langley Research Center Archives, Hampton, VA LaRC) (L43584) VIEW OF CHANNEL WITH SEAPLANE MODEL HULL IN POSITION FOR TESTING UNDER CARRIAGE. - NASA Langley Research Center, Seaplane Towing Channel, 108 Andrews Street, Hampton, Hampton, VA

Estimation of value at risk and conditional value at risk using normal mixture distributions model

NASA Astrophysics Data System (ADS)

Kamaruzzaman, Zetty Ain; Isa, Zaidi

2013-04-01

Normal mixture distributions model has been successfully applied in financial time series analysis. In this paper, we estimate the return distribution, value at risk (VaR) and conditional value at risk (CVaR) for monthly and weekly rates of returns for FTSE Bursa Malaysia Kuala Lumpur Composite Index (FBMKLCI) from July 1990 until July 2010 using the two component univariate normal mixture distributions model. First, we present the application of normal mixture distributions model in empirical finance where we fit our real data. Second, we present the application of normal mixture distributions model in risk analysis where we apply the normal mixture distributions model to evaluate the value at risk (VaR) and conditional value at risk (CVaR) with model validation for both risk measures. The empirical results provide evidence that using the two components normal mixture distributions model can fit the data well and can perform better in estimating value at risk (VaR) and conditional value at risk (CVaR) where it can capture the stylized facts of non-normality and leptokurtosis in returns distribution.

Visual acuity with simulated and real astigmatic defocus.

PubMed

Ohlendorf, Arne; Tabernero, Juan; Schaeffel, Frank

2011-05-01

To compare the effects of "simulated" and "real" spherical and astigmatic defocus on visual acuity (VA). VA was determined with letter charts that were blurred by calculated spherical or astigmatic defocus (simulated defocus) or were seen through spherical or astigmatic trial lenses (real defocus). Defocus was simulated using ZEMAX and the Liou-Brennan eye model. Nine subjects participated [mean age, 27.2 ± 1.8 years; logarithm of the minimum angle of resolution (logMAR), -0.1]. Three different experiments were conducted in which VA was reduced by 20% (logMAR 0.0), 50% (logMAR 0.2), or 75% (logMAR 0.5) by either (1) imposing positive spherical defocus, (2) imposing positive and negative astigmatic defocus in three axes (0, 45, and 90°), and (3) imposing cross-cylinder defocus in the same three axes as in (2). Experiment (1): there were only minor differences in VA with simulated and real positive spherical defocus. Experiment (2): simulated astigmatic defocus reduced VA twice as much as real astigmatic defocus in all tested axes (p < 0.01 in all cases). Experiment (3): simulated cross-cylinder defocus reduced VA much more than real cross-cylinder defocus (p < 0.01 in all cases), similarly for all three tested axes. The visual system appears more tolerant against "real" spherical, astigmatic, and cross-cylinder defocus than against "simulated" blur. Possible reasons could be (1) limitations in the modeling procedures to simulate defocus, (2) higher ocular aberrations, and (3) fluctuations of accommodation. However, the two optical explanations (2) and (3) cannot account for the magnitude of the effect, and (1) was carefully analyzed. It is proposed that something may be special about the visual processing of real astigmatic and cross-cylinder defocus-because they have less effect on VA than simulations predict.

Valerenic Acid Protects Against Physical and Psychological Stress by Reducing the Turnover of Serotonin and Norepinephrine in Mouse Hippocampus-Amygdala Region

PubMed Central

Jung, Hyo Young; Yoo, Dae Young; Nam, Sung Min; Kim, Jong Whi; Choi, Jung Hoon; Yoo, Miyoung; Lee, Sanghee; Yoon, Yeo Sung

2015-01-01

Abstract In a previous study, we demonstrated that a Valeriana officinalis extract could attenuate increases in serum corticosterone levels in a mouse model of physical and psychological stress. In addition, our results showed that the extract could modulate serotonin (5-HT) and norepinephrine (NE) turnover in the hippocampus and amygdala region. In this study, we intended to investigate the effects of valerenic acid (VA), the main component of V. officinalis extract, on corticosterone levels in serum in normal mice and monoamine turnover in hippocampus-amygdala homogenates in a mouse model of physical and psychological stress. To determine the minimum dose of VA for antianxiety effect, eight-week-old ICR mice were orally administered VA (0.2, 0.5, and 1.0 mg/kg/0.3 mL) once daily for 3 weeks to probe for immobility time and serum corticosterone levels. At a VA dose of 0.5 and 1.0 mg/kg, animals showed a decrease in the duration of immobility time and serum corticosterone levels. To confirm the antianxiety effect of VA, eight-week-old ICR mice received VA at a dose of 0.5 mg/kg, orally, once daily for 3 weeks, before being subjected to physical or psychological stress for 3 days, in a specially designed communication box, followed by estimation of levels of monoamines and their metabolites in the hippocampus-amygdala region. In conclusion, VA administration at 0.5 mg/kg can mitigate the physical and psychological stress response by decreasing the turnover of 5-HT to 5-hydroxyindoleacetic acid and NE to 3-methoxy-4-hydroxyphenylethyleneglycol sulfate in the hippocampus and amygdala. PMID:26177123

Vertebral Artery Diameter and Flow: Nature or Nurture.

PubMed

Tarnoki, Adam Domonkos; Fejer, Bence; Tarnoki, David Laszlo; Littvay, Levente; Lucatelli, Pierleone; Cirelli, Carlo; Fanelli, Fabrizio; Sacconi, Beatrice; Fagnani, Corrado; Medda, Emanuela; Farina, Filippo; Meneghetti, Giorgio; Horvath, Tamas; Pucci, Giacomo; Schillaci, Giuseppe; Stazi, Maria Antonietta; Baracchini, Claudio

2017-09-01

In contrast with the carotid arteries, the vertebral arteries (VAs) show considerable variation in length, caliber, and vessel course. This study investigated whether the variation in diameter and flow characteristics of the VAs might be inherited. A total of 172 Italian twins from Padua, Perugia, and Terni (54 monozygotic, 32 dizygotic) recruited from the Italian Twin Registry underwent B-mode and pulsed-wave Doppler ultrasound assessment of their VAs. VA diameters, peak systolic velocity (PSV) and end diastolic velocity (EDV) were assessed at the level of a horizontal V2 segment. Univariate quantitative genetic modeling was performed. Fourteen percent of the sample had VA hypoplasia. Within pair correlation in monozygotic twins was higher than in dizygotics (.552 vs. .229) for VA diameter. Age- and sex-adjusted genetic effect, under the most parsimonious model, accounted for 54.7% (95% CI: 42.2-69.1%) of the variance of VA diameter, and unshared environmental effect for 45.3% (95% CI: 30.9-57.8%). No heritability was found for the PSV of VA, but shared (34.1%; 95% CI: 16.7-53.7%) and unshared (65.9%; 95% CI: 45.9-83.1%) environmental factors determined the variance. EDV of VA is moderately genetically influenced (42.4%; 95% CI: 16.1-64.9%) and also determined by the unshared environment (57.6%; 95% CI: 34.7-83.7%). The diameter of the VAs is moderately genetically determined. Different factors influence the PSV and EDV of VAs, which may highlight the complex hemodynamic background of VA flow and help to understand the vertebral flow anomalies found by ultrasound. Copyright © 2017 by the American Society of Neuroimaging.

Veterans' Preferences for Exchanging Information Using Veterans Affairs Health Information Technologies: Focus Group Results and Modeling Simulations.

PubMed

Haun, Jolie N; Chavez, Margeaux; Nazi, Kim; Antinori, Nicole; Melillo, Christine; Cotner, Bridget A; Hathaway, Wendy; Cook, Ashley; Wilck, Nancy; Noonan, Abigail

2017-10-23

The Department of Veterans Affairs (VA) has multiple health information technology (HIT) resources for veterans to support their health care management. These include a patient portal, VetLink Kiosks, mobile apps, and telehealth services. The veteran patient population has a variety of needs and preferences that can inform current VA HIT redesign efforts to meet consumer needs. This study aimed to describe veterans' experiences using the current VA HIT and identify their vision for the future of an integrated VA HIT system. Two rounds of focus group interviews were conducted with a single cohort of 47 veterans and one female caregiver recruited from Bedford, Massachusetts, and Tampa, Florida. Focus group interviews included simulation modeling activities and a self-administered survey. This study also used an expert panel group to provide data and input throughout the study process. High-fidelity, interactive simulations were created and used to facilitate collection of qualitative data. The simulations were developed based on system requirements, data collected through operational efforts, and participants' reported preferences for using VA HIT. Pairwise comparison activities of HIT resources were conducted with both focus groups and the expert panel. Rapid iterative content analysis was used to analyze qualitative data. Descriptive statistics summarized quantitative data. Data themes included (1) current use of VA HIT, (2) non-VA HIT use, and (3) preferences for future use of VA HIT. Data indicated that, although the Secure Messaging feature was often preferred, a full range of HIT options are needed. These data were then used to develop veteran-driven simulations that illustrate user needs and expectations when using a HIT system and services to access VA health care services. Patient participant redesign processes present critical opportunities for creating a human-centered design. Veterans value virtual health care options and prefer standardized, integrated, and synchronized user-friendly interface designs. ©Jolie N. Haun, Margeaux Chavez, Kim Nazi, Nicole Antinori, Christine Melillo, Bridget A Cotner, Wendy Hathaway, Ashley Cook, Nancy Wilck, Abigail Noonan. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 23.10.2017.

Clinical Practice Guideline Implementation Strategy Patterns in Veterans Affairs Primary Care Clinics

PubMed Central

Hysong, Sylvia J; Best, Richard G; Pugh, Jacqueline A

2007-01-01

Background The Department of Veterans Affairs (VA) mandated the system-wide implementation of clinical practice guidelines (CPGs) in the mid-1990s, arming all facilities with basic resources to facilitate implementation; despite this resource allocation, significant variability still exists across VA facilities in implementation success. Objective This study compares CPG implementation strategy patterns used by high and low performing primary care clinics in the VA. Research Design Descriptive, cross-sectional study of a purposeful sample of six Veterans Affairs Medical Centers (VAMCs) with high and low performance on six CPGs. Subjects One hundred and two employees (management, quality improvement, clinic personnel) involved with guideline implementation at each VAMC primary care clinic. Measures Participants reported specific strategies used by their facility to implement guidelines in 1-hour semi-structured interviews. Facilities were classified as high or low performers based on their guideline adherence scores calculated through independently conducted chart reviews. Findings High performing facilities (HPFs) (a) invested significantly in the implementation of the electronic medical record and locally adapting it to provider needs, (b) invested dedicated resources to guideline-related initiatives, and (c) exhibited a clear direction in their strategy choices. Low performing facilities exhibited (a) earlier stages of development for their electronic medical record, (b) reliance on preexisting resources for guideline implementation, with little local adaptation, and (c) no clear direction in their strategy choices. Conclusion A multifaceted, yet targeted, strategic approach to guideline implementation emphasizing dedicated resources and local adaptation may result in more successful implementation and higher guideline adherence than relying on standardized resources and taxing preexisting channels. PMID:17355583

Ventilation/perfusion ratios measured by multiple inert gas elimination during experimental cardiopulmonary resuscitation.

PubMed

Hartmann, E K; Duenges, B; Boehme, S; Szczyrba, M; Liu, T; Klein, K U; Baumgardner, J E; Markstaller, K; David, M

2014-09-01

During cardiopulmonary resuscitation (CPR) the ventilation/perfusion distribution (VA /Q) within the lung is difficult to assess. This experimental study examines the capability of multiple inert gas elimination (MIGET) to determine VA /Q under CPR conditions in a pig model. Twenty-one anaesthetised pigs were randomised to three fractions of inspired oxygen (1.0, 0.7 or 0.21). VA/ Q by micropore membrane inlet mass spectrometry-derived MIGET was determined at baseline and during CPR following induction of ventricular fibrillation. Haemodynamics, blood gases, ventilation distribution by electrical impedance tomography and return of spontaneous circulation were assessed. Intergroup differences were analysed by non-parametric testing. MIGET measurements were feasible in all animals with an excellent correlation of measured and predicted arterial oxygen partial pressure (R(2)  = 0.96, n = 21 for baseline; R(2)  = 0.82, n = 21 for CPR). CPR induces a significant shift from normal VA /Q ratios to the high VA /Q range. Electrical impedance tomography indicates a dorsal to ventral shift of the ventilation distribution. Diverging pulmonary shunt fractions induced by the three inspired oxygen levels considerably increased during CPR and were traceable by MIGET, while 100% oxygen most negatively influenced the VA /Q. Return of spontaneous circulation were achieved in 52% of the animals. VA /Q assessment by MIGET is feasible during CPR and provides a novel tool for experimental purposes. Changes in VA /Q caused by different oxygen fractions are traceable during CPR. Beyond pulmonary perfusion deficits, these data imply an influence of the inspired oxygen level on VA /Q. Higher oxygen levels significantly increase shunt fractions and impair the normal VA /Q ratio. © 2014 The Acta Anaesthesiologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.

Mariner Jupiter/Saturn LCSSE thruster/valve assembly and injection propulsion unit rocket engine assemblies: 0.2-lbf T/VA development and margin limit test report

NASA Technical Reports Server (NTRS)

Clark, E. C.

1975-01-01

Thruster valve assemblies (T/VA's) were subjected to the development test program for the combined JPL Low-Cost Standardized Spacecraft Equipment (LCSSE) and Mariner Jupiter/Saturn '77 spacecraft (MJS) programs. The development test program was designed to achieve the following program goals: (1) demonstrate T/VA design compliance with JPL Specifications, (2) to conduct a complete performance Cf map of the T/VA over the full operating range of environment, (3) demonstrate T/VA life capability and characteristics of life margin for steady-state limit cycle and momentum wheel desaturation duty cycles, (4) verification of structural design capability, and (5) generate a computerized performance model capable of predicting T/VA operation over pressures ranging from 420 to 70 psia, propellant temperatures ranging from 140 F to 40 F, pulse widths of 0.008 to steady-state operation with unlimited duty cycle capability, and finally predict the transient performance associated with reactor heatup during any given duty cycle, start temperature, feed pressure, and propellant temperature conditions.

Review of Quantum Electromagnetic States

DTIC Science & Technology

1999-10-01

product space. 227 The wave functions used in the Jaynes - Cummings ’ model reside in a direct product space Va ɠ> Vf where Va and Vf are the Hubert...Dependent Probability 215 5.1.3 The Relaxation Term 217 5.2 Jaynes - Cummings ’ Model for Matter-Field Interactions 218 5.2.1 The Atomic Hamiltonian 218...5.3 The Interaction Representation for the Jaynes - Cummings ’ Model 224 5.3.1 Atomic Creation and Annihilation Operators 224 5.3.2 The Boson Creation

Cortical Spiking Network Interfaced with Virtual Musculoskeletal Arm and Robotic Arm

PubMed Central

Dura-Bernal, Salvador; Zhou, Xianlian; Neymotin, Samuel A.; Przekwas, Andrzej; Francis, Joseph T.; Lytton, William W.

2015-01-01

Embedding computational models in the physical world is a critical step towards constraining their behavior and building practical applications. Here we aim to drive a realistic musculoskeletal arm model using a biomimetic cortical spiking model, and make a robot arm reproduce the same trajectories in real time. Our cortical model consisted of a 3-layered cortex, composed of several hundred spiking model-neurons, which display physiologically realistic dynamics. We interconnected the cortical model to a two-joint musculoskeletal model of a human arm, with realistic anatomical and biomechanical properties. The virtual arm received muscle excitations from the neuronal model, and fed back proprioceptive information, forming a closed-loop system. The cortical model was trained using spike timing-dependent reinforcement learning to drive the virtual arm in a 2D reaching task. Limb position was used to simultaneously control a robot arm using an improved network interface. Virtual arm muscle activations responded to motoneuron firing rates, with virtual arm muscles lengths encoded via population coding in the proprioceptive population. After training, the virtual arm performed reaching movements which were smoother and more realistic than those obtained using a simplistic arm model. This system provided access to both spiking network properties and to arm biophysical properties, including muscle forces. The use of a musculoskeletal virtual arm and the improved control system allowed the robot arm to perform movements which were smoother than those reported in our previous paper using a simplistic arm. This work provides a novel approach consisting of bidirectionally connecting a cortical model to a realistic virtual arm, and using the system output to drive a robotic arm in real time. Our techniques are applicable to the future development of brain neuroprosthetic control systems, and may enable enhanced brain-machine interfaces with the possibility for finer control of limb prosthetics. PMID:26635598

24. Photocopy of photograph (original in the Langley Research Center ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

24. Photocopy of photograph (original in the Langley Research Center Archives, Hampton, VA LaRC) (L75-734) MODEL OF SUPERSONIC TRANSPORT IN FULL-SCALE WIND TUNNEL FROM ENTRANCE CONE. - NASA Langley Research Center, Full-Scale Wind Tunnel, 224 Hunting Avenue, Hampton, Hampton, VA

A study of facial wrinkles improvement effect of veratric acid from cauliflower mushroom through photo-protective mechanisms against UVB irradiation.

PubMed

Lee, Kyung-Eun; Park, Ji-Eun; Jung, Eunsun; Ryu, Jahyun; Kim, Youn Joon; Youm, Jong-Kyung; Kang, Seunghyun

2016-04-01

Solar ultraviolet (UV) irradiation is a primary cause of premature skin aging that is closely associated with the degradation of collagens caused by up-regulation of matrix metalloproteinases (MMPs) or a decrease in collagen synthesis. The phenolic veratric acid (VA, 3,4-dimethoxybenzoic acid) is one of the major benzoic acid derivatives from fruits, vegetables and medicinal mushrooms. VA has been reported to have anti-inflammatory, anti-oxidant and photo-protective effects. In this study, anti-photoaging effects were investigated through the photo-protective mechanisms of VA against UV irradiation in human dermal fibroblasts and the reconstructed human epidermal model. We used reverse transcription-polymerase chain reaction, Western blot analysis, hematoxylin and eosin staining (H&E) and immunohistochemistry assays. Finally, we further investigated the clinical effects of VA on facial wrinkle improvements in humans. Our results demonstrate that VA attenuated the expression of MMPs, increased cell proliferation, type Ι procollagen, tissue inhibitors of metalloproteinases, and filaggrin against UV radiation; however, has no effect on improvement expressions of elastic fiber. In addition, treatment with cream containing VA improved facial wrinkles in a clinical trial. These findings indicate that VA improves wrinkle formation by modulating MMPs, collagens and epidermal layer integrity, suggesting its potential use in UV-induced premature skin aging.

Filling Open Screw Holes in the Area of Metaphyseal Comminution Does Not Affect Fatigue Life of the Synthes Variable Angle Distal Femoral Locking Plate in the AO/OTA 33-A3 Fracture Model.

PubMed

Grau, Luis; Collon, Kevin; Alhandi, Ali; Kaimrajh, David; Varon, Maria; Latta, Loren; Vilella, Fernando

2018-06-01

The aim of this study is to evaluate the biomechanical effect of filling locking variable angle (VA) screw holes at the area of metaphyseal fracture comminution in a Sawbones® (Sawbones USA, Vashon, Washington) model (AO/OTA 33A-3 fracture) using a Synthes VA locking compression plate (LCP) (Depuy Synthes, Warsaw, Indiana). Seven Sawbones® femur models had a Synthes VA-LCP placed as indicated by the manufacturers technique. A 4cm osteotomy was then created to simulate an AO/OTA 33-A3 femoral fracture pattern with metaphyseal comminution. The control group consisted of four constructs in which the open screw holes at the area of comminution were left unfilled; the experimental group consisted of three constructs in which the VA screw holes were filled with locking screws. One of the control constructs was statically loaded to failure at a rate of 5mm/min. A value equal to 75% of the ultimate load to failure was used as the loading force for fatigue testing of 250,000 cycles at 3Hz. Cycles to failure was recorded for each construct and averages were compared between groups. The average number of cycles to failure in the control and experimental groups were 37524±8187 and 43304±23835, respectively (p=0.72). No significant difference was observed with respect to cycles to failure or mechanism of failure between groups. In all constructs in both the control and experimental groups, plate failure reproducibly occurred with cracks through the variable angle holes in the area of bridged comminution. The Synthes VA-LCP in a simulated AO/OTA 33-A3 comminuted metaphyseal femoral fracture fails in a reproducible manner at the area of comminution through the "honeycomb" VA screw holes. Filling open VA screw holes at the site of comminution with locking screws does not increase fatigue life of the Synthes VA-LCP in a simulated AO/OTA 33-A3 distal femoral fracture. Further studies are necessary to determine whether use of this particular plate is contraindicated when bridging distal femoral fractures with metaphyseal comminution.

Lightcurve Analysis for Two Near-Earth Asteroids Eclipsed by the Earth's Shadow

NASA Astrophysics Data System (ADS)

Birtwhistle, Peter

2018-07-01

Photometry was obtained from Great Shefford Observatory of near-Earth asteroids 2012 XE54 in 2012 and 2016 VA in 2016 during close approaches. A superfast rotation period has been determined for 2012 XE54 and H-G magnitude system coefficients have been estimated for 2016 VA. While under observation, 2012 XE54 underwent a deep penumbral eclipse by the Earth's shadow and 2016 VA also experienced a total eclipse by the Earth's shadow. The dimming due to the eclipses is modeled taking into account solar limb darkening.

ViVaMBC: estimating viral sequence variation in complex populations from illumina deep-sequencing data using model-based clustering.

PubMed

Verbist, Bie; Clement, Lieven; Reumers, Joke; Thys, Kim; Vapirev, Alexander; Talloen, Willem; Wetzels, Yves; Meys, Joris; Aerssens, Jeroen; Bijnens, Luc; Thas, Olivier

2015-02-22

Deep-sequencing allows for an in-depth characterization of sequence variation in complex populations. However, technology associated errors may impede a powerful assessment of low-frequency mutations. Fortunately, base calls are complemented with quality scores which are derived from a quadruplet of intensities, one channel for each nucleotide type for Illumina sequencing. The highest intensity of the four channels determines the base that is called. Mismatch bases can often be corrected by the second best base, i.e. the base with the second highest intensity in the quadruplet. A virus variant model-based clustering method, ViVaMBC, is presented that explores quality scores and second best base calls for identifying and quantifying viral variants. ViVaMBC is optimized to call variants at the codon level (nucleotide triplets) which enables immediate biological interpretation of the variants with respect to their antiviral drug responses. Using mixtures of HCV plasmids we show that our method accurately estimates frequencies down to 0.5%. The estimates are unbiased when average coverages of 25,000 are reached. A comparison with the SNP-callers V-Phaser2, ShoRAH, and LoFreq shows that ViVaMBC has a superb sensitivity and specificity for variants with frequencies above 0.4%. Unlike the competitors, ViVaMBC reports a higher number of false-positive findings with frequencies below 0.4% which might partially originate from picking up artificial variants introduced by errors in the sample and library preparation step. ViVaMBC is the first method to call viral variants directly at the codon level. The strength of the approach lies in modeling the error probabilities based on the quality scores. Although the use of second best base calls appeared very promising in our data exploration phase, their utility was limited. They provided a slight increase in sensitivity, which however does not warrant the additional computational cost of running the offline base caller. Apparently a lot of information is already contained in the quality scores enabling the model based clustering procedure to adjust the majority of the sequencing errors. Overall the sensitivity of ViVaMBC is such that technical constraints like PCR errors start to form the bottleneck for low frequency variant detection.

Effects of spiral arms on star formation in nuclear rings of barred-spiral galaxies

DOE Office of Scientific and Technical Information (OSTI.GOV)

Seo, Woo-Young; Kim, Woong-Tae, E-mail: seowy@astro.snu.ac.kr, E-mail: wkim@astro.snu.ac.kr

2014-09-01

We use hydrodynamic simulations to study the effect of spiral arms on the star formation rate (SFR) in nuclear rings of barred-spiral galaxies. We find that spiral arms can be an efficient means of gas transport from the outskirts to the central parts, provided that the arms are rotating slower than the bar. While the ring star formation in models with no arms or corotating arms is active only during around the bar growth phase, arm-driven gas accretion both significantly enhances and prolongs the ring star formation in models with slow-rotating arms. The arm-enhanced SFR is larger by a factormore » of ∼3-20 than in the no-arm model, with larger values corresponding to stronger and slower arms. Arm-induced mass inflows also make dust lanes stronger. Nuclear rings in slow-arm models are ∼45% larger than in the no-arm counterparts. Star clusters that form in a nuclear ring exhibit an age gradient in the azimuthal direction only when the SFR is small, whereas no notable age gradient is found in the radial direction for models with arm-induced star formation.« less

SNMP is a signaling component required for pheromone sensitivity in Drosophila.

PubMed

Jin, Xin; Ha, Tal Soo; Smith, Dean P

2008-08-05

The only known volatile pheromone in Drosophila, 11-cis-vaccenyl acetate (cVA), mediates a variety of behaviors including aggregation, mate recognition, and sexual behavior. cVA is detected by a small set of olfactory neurons located in T1 trichoid sensilla on the antennae of males and females. Two components known to be required for cVA reception are the odorant receptor Or67d and the extracellular pheromone-binding protein LUSH. Using a genetic screen for cVA-insensitive mutants, we have identified a third component required for cVA reception: sensory neuron membrane protein (SNMP). SNMP is a homolog of CD36, a scavenger receptor important for lipoprotein binding and uptake of cholesterol and lipids in vertebrates. In humans, loss of CD36 is linked to a wide range of disorders including insulin resistance, dyslipidemia, and atherosclerosis, but how CD36 functions in lipid transport and signal transduction is poorly understood. We show that SNMP is required in pheromone-sensitive neurons for cVA sensitivity but is not required for sensitivity to general odorants. Using antiserum to SNMP infused directly into the sensillum lymph, we show that SNMP function is required on the dendrites of cVA-sensitive neurons; this finding is consistent with a direct role in cVA signal transduction. Therefore, pheromone perception in Drosophila should serve as an excellent model to elucidate the role of CD36 members in transmembrane signaling.

A hemodynamics model to study the collective behavior of the ventricular-arterial system

NASA Astrophysics Data System (ADS)

Lin Wang, Yuh-Ying; Wang, Wei-Kung

2013-01-01

Applying principles from complex systems to study the efficacy of integrative therapies has become a new interest in medical research. We aimed to construct a concise model for the ventricular-arterial (VA) system and to provide a systematic method for exploring its overall behavior. The transportation of blood from the heart to the peripheral arterioles via hydraulic pressure forces was described by a multi-rank model. Parts of the VA system that have strong mutual interactions were combined into a single sub system. Sub systems of four different ranks were characterized. We then applied the multi-rank model to analyze the aortic pressure wave generated by the periodic ventricular blood ejection, the renal pressure in response to the input from the VA system, and the blood flowing from the renal artery to its arterioles. Maintaining the pressure distribution along the main arteries and in all of the organs with the lowest possible ventricular input turned out to be the first principle for the operation of an efficient VA system. By this principle, we pointed out the benefit of some arterial structures in mammals, derived specific regulation rules and deduced some fundamental concepts for healing. The justification of the biomechanics in our model that differed greatly from those in the prevailing models was given. We concluded that the oscillatory motion and the pressure pulse of the arterial system can be analyzed as steady states with resonance behaviors and suggested utilizing this model to construct integrative therapies for diseases correlated with abnormality in blood circulation.

Federally funded comprehensive women's health centers: leading innovation in women's healthcare delivery.

PubMed

Bean-Mayberry, Bevanne; Yano, Elizabeth M; Bayliss, Nichole; Navratil, Judith; Weisman, Carol S; Scholle, Sarah Hudson

2007-11-01

Women's healthcare has historically been fragmented, given the artificial separation of reproductive care from general medical care. Aiming to advance new care models for delivery of comprehensive, integrated clinical care for women, two federal agencies-the U.S. Department of Health and Human Services (DHHS) and Department of Veterans Affairs (VA)-launched specialized women's health centers (WHCs). Exemplars of comprehensive service delivery, these originally federally funded centers have served as foundations for innovations in delivering comprehensive care to women in diverse practice settings. Little is known, however, about details of their organization, staffing, practice arrangements, and service availability that might inform adoption of similar models in the community. Using comparable key informant surveys, we collected organizational data from the DHHS National Centers of Excellence (CoE) (n = 13) and the original VA comprehensive WHC's (n = 8). We abstracted supplemental data (e.g., academic affiliation) from the 2001 American Hospital Association (AHA) survey. All DHHS and VA women's health programs served urban areas, and nearly all had academic partnerships. DHHS centers had three times the average caseload as did VA centers. Preventive cancer screening and general reproductive services were uniformly available at all centers, although DHHS centers offered extensive reproductive services on-site more frequently, and VA centers more often had on-site mental healthcare. The DHHS and VA comprehensive WHCs share similar missions and comparable organization, education, and clinical services, demonstrating their commitment to reducing fragmented service delivery. Their common structural components present opportunities for further advancing women's quality of care across other systems of care.

Formation of a tyrosine adduct involved in lignin degradation by Trametopsis cervina lignin peroxidase: a novel peroxidase activation mechanism.

PubMed

Miki, Yuta; Pogni, Rebecca; Acebes, Sandra; Lucas, Fátima; Fernández-Fueyo, Elena; Baratto, Maria Camilla; Fernández, María I; de los Ríos, Vivian; Ruiz-Dueñas, Francisco J; Sinicropi, Adalgisa; Basosi, Riccardo; Hammel, Kenneth E; Guallar, Victor; Martínez, Angel T

2013-06-15

LiP (lignin peroxidase) from Trametopsis cervina has an exposed catalytic tyrosine residue (Tyr181) instead of the tryptophan conserved in other lignin-degrading peroxidases. Pristine LiP showed a lag period in VA (veratryl alcohol) oxidation. However, VA-LiP (LiP after treatment with H2O2 and VA) lacked this lag, and H2O2-LiP (H2O2-treated LiP) was inactive. MS analyses revealed that VA-LiP includes one VA molecule covalently bound to the side chain of Tyr181, whereas H2O2-LiP contains a hydroxylated Tyr181. No adduct is formed in the Y171N variant. Molecular docking showed that VA binding is favoured by sandwich π stacking with Tyr181 and Phe89. EPR spectroscopy after peroxide activation of the pre-treated LiPs showed protein radicals other than the tyrosine radical found in pristine LiP, which were assigned to a tyrosine-VA adduct radical in VA-LiP and a dihydroxyphenyalanine radical in H2O2-LiP. Both radicals are able to oxidize large low-redox-potential substrates, but H2O2-LiP is unable to oxidize high-redox-potential substrates. Transient-state kinetics showed that the tyrosine-VA adduct strongly promotes (>100-fold) substrate oxidation by compound II, the rate-limiting step in catalysis. The novel activation mechanism is involved in ligninolysis, as demonstrated using lignin model substrates. The present paper is the first report on autocatalytic modification, resulting in functional alteration, among class II peroxidases.

Academic Affiliations with the Department of Veterans Affairs: Characteristics of the Ohio State University Model.

ERIC Educational Resources Information Center

Newcomb, Robert D.; Hill, Richard M.

1993-01-01

The Ohio State University School of Optometry affiliation with four Veterans Administration (VA) health care facilities is characterized by a central governing committee, regular faculty appointments for all participating VA staff, substantial interaction with each site, strong orientation for rotating senior optometry students, and joint…

A Survey of Physicians' Attitudes toward Decision-Making Authority for Initiating and Withdrawing VA-ECMO: Results and Ethical Implications for Shared Decision Making.

PubMed

Meltzer, Ellen C; Ivascu, Natalia S; Stark, Meredith; Orfanos, Alexander V; Acres, Cathleen A; Christos, Paul J; Mangione, Thomas; Fins, Joseph J

2016-01-01

Although patients exercise greater autonomy than in the past, and shared decision making is promoted as the preferred model for doctor-patient engagement, tensions still exist in clinical practice about the primary locus of decision-making authority for complex, scarce, and resource-intensive medical therapies: patients and their surrogates, or physicians. We assessed physicians' attitudes toward decisional authority for adult venoarterial extracorporeal membrane oxygenation (VA-ECMO), hypothesizing they would favor a medical locus. A survey of resident/fellow physicians and internal medicine attendings at an academic medical center, May to August 2013. We used a 24-item, internet-based survey assessing physician-respondents' demographic characteristics, knowledge, and attitudes regarding decisional authority for adult VA-ECMO. Qualitative narratives were also collected. A total of 179 physicians completed the survey (15 percent response rate); 48 percent attendings and 52 percent residents/fellows. Only 32 percent of the respondents indicated that a surrogate's consent should be required to discontinue VA-ECMO; 56 percent felt that physicians should have the right to discontinue VA-ECMO over a surrogate's objection. Those who self-reported as "knowledgeable" about VA-ECMO, compared to those who did not, more frequently replied that there should not be presumed consent for VA-ECMO (47.6 percent versus 33.3 percent, p = 0.007), that physicians should have the right to discontinue VA-ECMO over a surrogate's objection (76.2 percent versus 50 percent, p = 0.02) and that, given its cost, the use of VA-ECMO should be restricted (81.0 percent versus 54.4 percent, p = 0.005). Surveyed physicians, especially those who self-reported as knowledgeable about VA-ECMO and/or were specialists in pulmonary/critical care, favored a medical locus of decisional authority for VA-ECMO. VA-ECMO is complex, and the data may (1) reflect physicians' hesitance to cede authority to presumably less knowledgeable patients and surrogates, (2) stem from a stewardship of resources perspective, and/or (3) point to practical efforts to avoid futility and utility disputes. Whether these results indicate a more widespread reversion to paternalism or a more circumscribed usurping of decisional authority occasioned by VA-ECMO necessitates further study. Copyright 2016 The Journal of Clinical Ethics. All rights reserved.

Being First Matters: Topographical Representational Similarity Analysis of ERP Signals Reveals Separate Networks for Audiovisual Temporal Binding Depending on the Leading Sense

PubMed Central

2017-01-01

In multisensory integration, processing in one sensory modality is enhanced by complementary information from other modalities. Intersensory timing is crucial in this process because only inputs reaching the brain within a restricted temporal window are perceptually bound. Previous research in the audiovisual field has investigated various features of the temporal binding window, revealing asymmetries in its size and plasticity depending on the leading input: auditory–visual (AV) or visual–auditory (VA). Here, we tested whether separate neuronal mechanisms underlie this AV–VA dichotomy in humans. We recorded high-density EEG while participants performed an audiovisual simultaneity judgment task including various AV–VA asynchronies and unisensory control conditions (visual-only, auditory-only) and tested whether AV and VA processing generate different patterns of brain activity. After isolating the multisensory components of AV–VA event-related potentials (ERPs) from the sum of their unisensory constituents, we ran a time-resolved topographical representational similarity analysis (tRSA) comparing the AV and VA ERP maps. Spatial cross-correlation matrices were built from real data to index the similarity between the AV and VA maps at each time point (500 ms window after stimulus) and then correlated with two alternative similarity model matrices: AVmaps = VAmaps versus AVmaps ≠ VAmaps. The tRSA results favored the AVmaps ≠ VAmaps model across all time points, suggesting that audiovisual temporal binding (indexed by synchrony perception) engages different neural pathways depending on the leading sense. The existence of such dual route supports recent theoretical accounts proposing that multiple binding mechanisms are implemented in the brain to accommodate different information parsing strategies in auditory and visual sensory systems. SIGNIFICANCE STATEMENT Intersensory timing is a crucial aspect of multisensory integration, determining whether and how inputs in one modality enhance stimulus processing in another modality. Our research demonstrates that evaluating synchrony of auditory-leading (AV) versus visual-leading (VA) audiovisual stimulus pairs is characterized by two distinct patterns of brain activity. This suggests that audiovisual integration is not a unitary process and that different binding mechanisms are recruited in the brain based on the leading sense. These mechanisms may be relevant for supporting different classes of multisensory operations, for example, auditory enhancement of visual attention (AV) and visual enhancement of auditory speech (VA). PMID:28450537

Teacher factors contributing to dosage of the KiVa anti-bullying program.

PubMed

Swift, Lauren E; Hubbard, Julie A; Bookhout, Megan K; Grassetti, Stevie N; Smith, Marissa A; Morrow, Michael T

2017-12-01

The KiVa Anti-Bullying Program (KiVa) seeks to meet the growing need for anti-bullying programming through a school-based, teacher-led intervention for elementary school children. The goals of this study were to examine how intervention dosage impacts outcomes of KiVa and how teacher factors influence dosage. Participants included 74 teachers and 1409 4th- and 5th-grade students in nine elementary schools. Teachers and students completed data collection at the beginning and end of the school year, including measures of bullying and victimization, correlates of victimization (depression, anxiety, peer rejection, withdrawal, and school avoidance), intervention cognitions/emotions (anti-bullying attitudes, and empathy toward victims), bystander behaviors, and teacher factors thought to relate to dosage (self-efficacy for teaching, professional burnout, perceived principal support, expected effectiveness of KiVa, perceived feasibility of KiVa). The dosage of KiVa delivered to classrooms was measured throughout the school year. Results highlight dosage as an important predictor of change in bullying, victimization, correlates of victimization, bystander behavior, and intervention cognitions/emotions. Of the teacher factors, professional burnout uniquely predicted intervention dosage. A comprehensive structural equation model linking professional burnout to dosage and then to child-level outcomes demonstrated good fit. Implications for intervention design and implementation are discussed. Copyright © 2017 Society for the Study of School Psychology. Published by Elsevier Ltd. All rights reserved.

Evaluation of visual acuity measurements after autorefraction vs manual refraction in eyes with and without diabetic macular edema.

PubMed

Sun, Jennifer K; Qin, Haijing; Aiello, Lloyd Paul; Melia, Michele; Beck, Roy W; Andreoli, Christopher M; Edwards, Paul A; Glassman, Adam R; Pavlica, Michael R

2012-04-01

To compare visual acuity (VA) scores after autorefraction vs manual refraction in eyes of patients with diabetes mellitus and a wide range of VAs. The letter score from the Electronic Visual Acuity (EVA) test from the electronic Early Treatment Diabetic Retinopathy Study was measured after autorefraction (AR-EVA score) and after manual refraction (MR-EVA score), which is the research protocol of the Diabetic Retinopathy Clinical Research Network. Testing order was randomized, study participants and VA examiners were masked to refraction source, and a second EVA test using an identical supplemental manual refraction (MR-EVAsuppl score) was performed to determine test-retest variability. In 878 eyes of 456 study participants, the median MR-EVA score was 74 (Snellen equivalent, approximately 20/32). The spherical equivalent was often similar for manual refraction and autorefraction (median difference, 0.00; 5th-95th percentile range, -1.75 to 1.13 diopters). However, on average, the MR-EVA scores were slightly better than the AR-EVA scores, across the entire VA range. Furthermore, the variability between the AR-EVA scores and the MR-EVA scores was substantially greater than the test-retest variability of the MR-EVA scores (P < .001). The variability of differences was highly dependent on the autorefractor model. Across a wide range of VAs at multiple sites using a variety of autorefractors, VA measurements tend to be worse with autorefraction than manual refraction. Differences between individual autorefractor models were identified. However, even among autorefractor models that compare most favorably with manual refraction, VA variability between autorefraction and manual refraction is higher than the test-retest variability of manual refraction. The results suggest that, with current instruments, autorefraction is not an acceptable substitute for manual refraction for most clinical trials with primary outcomes dependent on best-corrected VA.

Understanding collaborative care implementation in the Department of Veterans Affairs: core functions and implementation challenges.

PubMed

Lipschitz, Jessica M; Benzer, Justin K; Miller, Christopher; Easley, Siena R; Leyson, Jenniffer; Post, Edward P; Burgess, James F

2017-10-10

The collaborative care model is an evidence-based practice for treatment of depression in which designated care managers provide clinical services, often by telephone. However, the collaborative care model is infrequently adopted in the Department of Veterans Affairs (VA). Almost all VA medical centers have adopted a co-located or embedded approach to integrating mental health care for primary care patients. Some VA medical centers have also adopted a telephone-based collaborative care model where depression care managers support patient education, patient activation, and monitoring of adherence and progress over time. This study evaluated two research questions: (1) What does a dedicated care manager offer in addition to an embedded-only model? (2) What are the barriers to implementing a dedicated depression care manager? This study involved 15 qualitative, multi-disciplinary, key informant interviews at two VA medical centers where reimbursement options were the same- both with embedded mental health staff, but one with a depression care manager. Participant interviews were recorded and transcribed. Thematic analysis was used to identify descriptive and analytical themes. Findings suggested that some of the core functions of depression care management are provided as part of embedded-only mental health care. However, formal structural attention to care management may improve the reliability of care management functions, in particular monitoring of progress over time. Barriers to optimal implementation were identified at both sites. Themes from the care management site included finding assertive care managers to hire, cross-discipline integration and collaboration, and primary care provider burden. Themes from interviews at the embedded site included difficulty getting care management on leaders' agendas amidst competing priorities and logistics (staffing and space). Providers and administrators see depression care management as a valuable healthcare service that improves patient care. Barriers to implementation may be addressed by team-building interventions to improve cross-discipline integration and communication. Findings from this study are limited in scope to the VA healthcare system. Future investigation of whether alternative barriers exist in implementation of depression care management programs in non-VA hospital systems, where reimbursement rates may be a more prominent concern, would be valuable.

Kollidon VA64, a membrane-resealing agent, reduces histopathology and improves functional outcome after controlled cortical impact in mice.

PubMed

Mbye, Lamin H; Keles, Eyup; Tao, Luyang; Zhang, Jimmy; Chung, Joonyong; Larvie, Mykol; Koppula, Rajani; Lo, Eng H; Whalen, Michael J

2012-03-01

Loss of plasma membrane integrity is a feature of acute cellular injury/death in vitro and in vivo. Plasmalemma-resealing agents are protective in acute central nervous system injury models, but their ability to reseal cell membranes in vivo has not been reported. Using a mouse controlled cortical impact (CCI) model, we found that propidium iodide-positive (PI+) cells pulse labeled at 6, 24, or 48 hours maintained a degenerative phenotype and disappeared from the injured brain by 7 days, suggesting that plasmalemma permeability is a biomarker of fatal cellular injury after CCI. Intravenous or intracerebroventricular administration of Kollidon VA64, poloxamer P188, or polyethylene glycol 8000 resealed injured cell membranes in vivo (P<0.05 versus vehicle or poloxamer P407). Kollidon VA64 (1 mmol/L, 500 μL) administered intravenously to mice 1  hour after CCI significantly reduced acute cellular degeneration, chronic brain tissue damage, brain edema, blood-brain barrier damage, and postinjury motor deficits (all P<0.05 versus vehicle). However, VA64 did not rescue pulse-labeled PI+ cells from eventual demise. We conclude that PI permeability within 48 hours of CCI is a biomarker of eventual cell death/loss. Kollidon VA64 reduces secondary damage after CCI by mechanisms other than or in addition to resealing permeable cells.

Solution behavior of PVP-VA and HPMC-AS-based amorphous solid dispersions and their bioavailability implications.

PubMed

Qian, Feng; Wang, Jennifer; Hartley, Ruiling; Tao, Jing; Haddadin, Raja; Mathias, Neil; Hussain, Munir

2012-10-01

To identify the mechanism behind the unexpected bio-performance of two amorphous solid dispersions: BMS-A/PVP-VA and BMS-A/HPMC-AS. Solubility of crystalline BMS-A in PVP-VA and HPMC-AS was measured by DSC. Drug-polymer interaction parameters were obtained by Flory-Huggins model fitting. Drug dissolution kinetics of spray-dried dispersions were studied under sink and non-sink conditions. BMS-A supersaturation was studied in the presence of pre-dissolved PVP-VA and HPMC-AS. Potency and crystallinity of undissolved solid dispersions were determined by HPLC and DSC. Polymer dissolution kinetics were obtained by mass balance calculation. Bioavailability of solid dispersions was assessed in dogs. In solid state, both polymers are miscible with BMS-A, while PVP-VA solublizes the drug better. BMS-A dissolves similarly from both solid dispersions in vitro regardless of dissolution method, while the HPMC-AS dispersion performed much better in vivo. At the same concentration, HPMC-AS is more effective in prolonging BMS-A supersaturation; this effect was negated by the slow dissolution rate of HPMC-AS. Further study revealed that fast PVP-VA dissolution resulted in elevated drug loading in undissolved dispersions and facilitated drug recrystallization before complete release. In contrast, the hydrophobicity and slower HPMC-AS dissolution prevented BMS-A recrystallization within the HPMC-AS matrix for >24 h. The lower bioavailability of PVP-VA dispersion was attributed to BMS-A recrystallization within the undissolved dispersion, due to hydrophilicity and fast PVP-VA dissolution rate. Polymer selection for solid dispersion development has significant impact on in vivo performance besides physical stability.

Insights into the complex association of bovine factor Va with acidic-lipid-containing synthetic membranes.

PubMed Central

Cutsforth, G A; Koppaka, V; Krishnaswamy, S; Wu, J R; Mann, K G; Lentz, B R

1996-01-01

The mechanism of binding of blood coagulation cofactor factor Va to acidic-lipid-containing membranes has been addressed. Binding isotherms were generated at room temperature using the change in fluorescence anisotropy of pyrene-labeled bovine factor Va to detect binding to sonicated membrane vesicles containing either bovine brain phosphatidylserine (PS) or 1,2-dioleoyl-3-sn-phosphatidylglycerol (DOPG) in combination with 1-palmitoyl-2-oleoyl-3-sn-phosphatidylcholine (POPC). The composition of the membranes was varied from 0 to 40 mol% for PS/POPC and from 0 to 65 mol % for DOPG/POPC membranes. Fitting the data to a classical Langmuir adsorption model yielded estimates of the dissociation constant (Kd) and the stoichiometry of binding. The values of Kd defined in this way displayed a maximum at low acidic lipid content but were nearly constant at intermediate to high fractions of acidic lipid. Fitting the binding isotherms to a two-process binding model (nonspecific adsorption in addition to binding of acidic lipids to sites on the protein) suggested a significant acidic-lipid-independent binding affinity in addition to occupancy of three protein sites that bind PS in preference to DOPG. Both analyses indicated that interaction of factor Va with an acidic-lipid-containing membrane is much more complex than those of factor Xa or prothrombin. Furthermore, a change in the conformation of bound pyrene-labeled factor Va with surface concentration of acidic lipid was implied by variation of both the saturating fluorescence anisotropy and the binding parameters with the acidic lipid content of the membrane. Finally, the results cannot support the contention that binding occurs through nonspecific adsorption to a patch or domain of acidic lipids in the membrane. Factor Va is suggested to associate with membranes by a complex process that includes both acidic-lipid-specific and acidic-lipid-independent sites and a protein structure change induced by occupancy of acidic-lipid-specific sites on the factor Va molecule. Images FIGURE 5 PMID:8744332

Vitamin supplementation of HIV-infected women improves postnatal child growth.

PubMed

Villamor, Eduardo; Saathoff, Elmar; Bosch, Ronald J; Hertzmark, Ellen; Baylin, Ana; Manji, Karim; Msamanga, Gernard; Hunter, David J; Fawzi, Wafaie W

2005-04-01

Linear growth retardation and wasting are common in children born to HIV-infected women. Inexpensive interventions that could improve the postnatal growth pattern of such children are needed. The objective was to examine the effect of supplementing HIV-infected women with multivitamins or vitamin A and beta-carotene, during and after pregnancy, on the growth of their children during the first 2 y of life. We conducted a randomized placebo-controlled trial in 886 mother-infant pairs in Tanzania. At the first prenatal visit, HIV-infected women were randomly assigned to 1 of 4 daily oral regimens in a 2 x 2 factorial fashion: multivitamins (MV: thiamine, riboflavin, vitamin B-6, niacin, vitamin B-12, vitamin C, vitamin E, and folic acid), preformed vitamin A + beta-carotene (VA/BC), MV including VA/BC, or placebo. Supplementation continued during the first 2 y postpartum and thereafter. Children were weighed and measured monthly, and all received vitamin A supplements after 6 mo of age per the standard of care. Multivitamins had a significant positive effect on attained weight (459 g; 95% CI: 35, 882; P = 0.03) and on weight-for-age (0.42; 95% CI: 0.07, 0.77; P = 0.02) and weight-for-length (0.38; 95% CI: 0.07, 0.68; P = 0.01) z scores at 24 mo. VA/BC seemed to reduce the benefits of MV on these outcomes. No significant effects were observed on length, midupper arm circumference, or head circumference. Supplementation of HIV-infected women with multivitamins (vitamin B complex, vitamin C, and vitamin E) during pregnancy and lactation is an effective intervention for improving ponderal growth in children.

Pilot randomised clinical trial of Pascal TargETEd Retinal versus variable fluence PANretinal 20 ms laser in diabetic retinopathy: PETER PAN study.

PubMed

Muqit, Mahiul M K; Young, Lorna B; McKenzie, Rod; John, Binu; Marcellino, George R; Henson, David B; Turner, George S; Stanga, Paulo E

2013-02-01

To investigate the short-term effects of high-density 20-ms laser on macular thickness using Pascal-targeted retinal photocoagulation (TRP) and reduced fluence/minimally-traumatic panretinal photocoagulation (MT-PRP) compared to standard-intensity PRP (SI-PRP) in proliferative diabetic retinopathy (PDR). Prospective randomised clinical trial. Treatment-naive PDR was treated with single-session 20-ms Pascal 2500 burns photocoagulation randomised to one of three treatment arms (TRP:MT-PRP:SI-PRP). Primary outcome measure was change in central retinal thickness (CRT) on OCT. Secondary outcomes at 4 and 12 weeks post-laser included: OCT peripapillary nerve fibre layer (NFL) thickness; PDR disease regression on Optos angiography; SITA-Std visual fields (VF); and, visual acuity (VA). 30 eyes of 24 patients were studied, ten eyes/arm. At 12 weeks, there were significant reductions in CRT after TRP (9.6 µm; 95% CI, 1.84 to 17.36; p=0.021) and MT-PRP (17.1 µm; 95% CI, 11 to 23.2; p=0.001), versus SI-PRP (+5.9 µm; 95% CI, -6.75 to 18.55; p=0.32). PDR regression was similar between groups (TRP 70%; MT-PRP 70%; SI-PRP 90%; κ=0.76). No significant changes in VA and NFL thickness developed between groups. The VF mean deviation scores increased significantly in all groups at 12 weeks ([TRP, +0.70dB; 95% CI, 0.07 to 1.48; p=0.07], [MT-PRP, +0.63dB; 95% CI, 0.12 to 1.15; p=0.02], [SI-PRP, +1.0dB; 95% CI, 0.19 to 1.74; p=0.02]). There were no laser-related ocular complications. This pilot study reports that high-density 20-ms Pascal TRP and MT-PRP using 2500 burns did not produce increased macular thickness or any ocular adverse events during the short-term.

The Influence of International Law Upon Military Operation on Urbanized Terrain (MOUT) During Romanian Revolution, December 1989

DTIC Science & Technology

2001-01-01

The Use of Military Force in Combating Urban Crime Using British Royal Marines in Northern Ireland as a Model .” MMS Thesis. Quantico, VA: USMC...to capture armaments and to destabilize command and control functions. Solid intelligence networks were required to operate efficiently in the urban ...Force in Combating Urban Crime Using British Royal Marines in Northern Ireland as a Model .” MMS Thesis. Quantico, VA: USMC Command and Staff College

Numerical Modelling of Electromagnetic Wave Propagation and Scattering: High-Order Schemes, Impedance Boundary Conditions and Cole-Cole Dielectrics

DTIC Science & Technology

2004-09-12

Time-Domain Reflectometry (TDR) experiment could serve as a means to determine the most appropriate frequency-domain model for the data at hand. Time...CO. Title: "A review of the perfectly matched layer ABC and some new results." August 2002: NASA Langley Research Center (ICASE), Hampton, VA. Title...ICASE, NASA Langley Research Center, Hamp- ton, VA. July-August 2002. 4. Organized a mini-symposium at the May 2004 Frontiers in Applied and Computational

Multifractal Value at Risk model

NASA Astrophysics Data System (ADS)

Lee, Hojin; Song, Jae Wook; Chang, Woojin

2016-06-01

In this paper new Value at Risk (VaR) model is proposed and investigated. We consider the multifractal property of financial time series and develop a multifractal Value at Risk (MFVaR). MFVaR introduced in this paper is analytically tractable and not based on simulation. Empirical study showed that MFVaR can provide the more stable and accurate forecasting performance in volatile financial markets where large loss can be incurred. This implies that our multifractal VaR works well for the risk measurement of extreme credit events.

A parametric model of muscle moment arm as a function of joint angle: application to the dorsiflexor muscle group in mice.

PubMed

Miller, S W; Dennis, R G

1996-12-01

A parametric model was developed to describe the relationship between muscle moment arm and joint angle. The model was applied to the dorsiflexor muscle group in mice, for which the moment arm was determined as a function of ankle angle. The moment arm was calculated from the torque measured about the ankle upon application of a known force along the line of action of the dorsiflexor muscle group. The dependence of the dorsiflexor moment arm on ankle angle was modeled as r = R sin(a + delta), where r is the moment arm calculated from the measured torque and a is the joint angle. A least-squares curve fit yielded values for R, the maximum moment arm, and delta, the angle at which the maximum moment arm occurs as offset from 90 degrees. Parametric models were developed for two strains of mice, and no differences were found between the moment arms determined for each strain. Values for the maximum moment arm, R, for the two different strains were 0.99 and 1.14 mm, in agreement with the limited data available from the literature. While in some cases moment arm data may be better fitted by a polynomial, use of the parametric model provides a moment arm relationship with meaningful anatomical constants, allowing for the direct comparison of moment arm characteristics between different strains and species.

Geropsychology Post-Doctoral Training in Public Sector Service Delivery: The USF/Tampa VA Fellowship Model

ERIC Educational Resources Information Center

Molinari, Victor; Chiriboga, David A.; Schonfeld, Lawrence; Haley, William E.; Schinka, John A.; Hyer, Kathy; Dupree, Larry W.

2005-01-01

There is a growing need for geropsychologists who are specialists in practice, research, education, and advocacy for older adults. The combined USF/Tampa VA geropsychology fellowship program focuses on the training of three post-doctoral Fellows each year in public sector service delivery across diverse long term care (LTC) and primary care…

Nondestructive quantification of the soluble-solids content and the available acidity of apples by Fourier-transform near-infrared spectroscopy

NASA Astrophysics Data System (ADS)

Ying, Yibin; Liu, Yande; Tao, Yang

2005-09-01

This research evaluated the feasibility of using Fourier-transform near-infrared (FT-NIR) spectroscopy to quantify the soluble-solids content (SSC) and the available acidity (VA) in intact apples. Partial least-squares calibration models, obtained from several preprocessing techniques (smoothing, derivative, etc.) in several wave-number ranges were compared. The best models were obtained with the high coefficient determination (r) 0.940 for the SSC and a moderate r of 0.801 for the VA, root-mean-square errors of prediction of 0.272% and 0.053%, and root-mean-square errors of calibration of 0.261% and 0.046%, respectively. The results indicate that the FT-NIR spectroscopy yields good predictions of the SSC and also showed the feasibility of using it to predict the VA of apples.

Economic Analysis of Veterans Affairs Initiative to Prevent Methicillin-Resistant Staphylococcus aureus Infections.

PubMed

Nelson, Richard E; Stevens, Vanessa W; Khader, Karim; Jones, Makoto; Samore, Matthew H; Evans, Martin E; Douglas Scott, R; Slayton, Rachel B; Schweizer, Marin L; Perencevich, Eli L; Rubin, Michael A

2016-05-01

In an effort to reduce methicillin-resistant Staphylococcus aureus (MRSA) transmission through universal screening and isolation, the Department of Veterans Affairs (VA) launched the National MRSA Prevention Initiative in October 2007. The objective of this analysis was to quantify the budget impact and cost effectiveness of this initiative. An economic model was developed using published data on MRSA hospital-acquired infection (HAI) rates in the VA from October 2007 to September 2010; estimates of the costs of MRSA HAIs in the VA; and estimates of the intervention costs, including salaries of staff members hired to support the initiative at each VA facility. To estimate the rate of MRSA HAIs that would have occurred if the initiative had not been implemented, two different assumptions were made: no change and a downward temporal trend. Effectiveness was measured in life-years gained. The initiative resulted in an estimated 1,466-2,176 fewer MRSA HAIs. The initiative itself was estimated to cost $207 million during this 3-year period, while the cost savings from prevented MRSA HAIs ranged from $27 million to $75 million. The incremental cost-effectiveness ratios ranged from $28,048 to $56,944/life-years. The overall impact on the VA's budget was $131-$179 million. Wide-scale implementation of a national MRSA surveillance and prevention strategy in VA inpatient settings may have prevented a substantial number of MRSA HAIs. Although the savings associated with prevented infections helped offset some but not all of the cost of the initiative, this model indicated that the initiative would be considered cost effective. Copyright © 2016 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

13C Natural Abundance of Serum Retinol Is a Novel Biomarker for Evaluating Provitamin A Carotenoid-Biofortified Maize Consumption in Male Mongolian Gerbils.

PubMed

Gannon, Bryan M; Pungarcher, India; Mourao, Luciana; Davis, Christopher R; Simon, Philipp; Pixley, Kevin V; Tanumihardjo, Sherry A

2016-07-01

Crops such as maize, sorghum, and millet are being biofortified with provitamin A carotenoids to ensure adequate vitamin A (VA) intakes. VA assessment can be challenging because serum retinol concentrations are homeostatically controlled and more sensitive techniques are resource-intensive. We investigated changes in serum retinol relative differences of isotope amount ratios of (13)C/(12)C (δ(13)C) caused by natural (13)C fractionation in C3 compared with C4 plants as a biomarker to detect provitamin A efficacy from biofortified (orange) maize and high-carotene carrots. The design was a 2 × 2 × 2 maize (orange compared with white) by carrot (orange compared with white) by a VA fortificant (VA+ compared with VA-) in weanling male Mongolian gerbils (n = 55), which included a 14-d VA depletion period and a 62-d treatment period (1 baseline and 8 treatment groups; n = 5-7/group). Liver VA and serum retinol were quantified, purified by HPLC, and analyzed by GC combustion isotope ratio mass spectrometry for (13)C. Treatments affected liver VA concentrations (0.048 ± 0.039 to 0.79 ± 0.24 μmol/g; P < 0.0001) but not overall serum retinol concentrations (1.38 ± 0.22 μmol/L). Serum retinol and liver VA δ(13)C were significantly correlated (R(2) = 0.92; P < 0.0001). Serum retinol δ(13)C differentiated control groups that consumed white maize and white carrots (-27.1 ± 1.2 δ(13)C‰) from treated groups that consumed orange maize and white carrots (-21.6 ± 1.4 δ(13)C‰ P < 0.0001) and white maize and orange carrots (-30.6 ± 0.7 δ(13)C‰ P < 0.0001). A prediction model demonstrated the relative contribution of orange maize to total dietary VA for groups that consumed VA from mixed sources. Provitamin A efficacy and quantitative estimation of the relative contribution to dietary VA were demonstrated with the use of serum retinol δ(13)C. This method could be used for maize efficacy or effectiveness studies and with other C4 crops biofortified with provitamin A carotenoids (e.g., millet, sorghum). Advantages include no extrinsic tracer dose, 1 blood sample, and higher sensitivity than serum retinol concentrations alone.

Prevalence and the risk factors for visual impairment in age-related macular degeneration.

PubMed

Srinivasan, S; Swaminathan, G; Kulothungan, V; Raman, R; Sharma, T

2017-06-01

PurposeTo characterize the type, and the causes of visual impairment (VI) in various stages of early and late age-related macular degeneration (AMD) and the factors associated with visual impairment in subjects with AMDMethods6617 subjects ≥60 years were enumerated; 5495 (83.04%) participated in eye examination. Of which, 4791 subjects had gradable fundus images. AMD was graded per International ARM Epidemiological Study Group. Subjects underwent detailed ophthalmic exam. VI was defined per the WHO classification. Mild VI was defined as VA less than 6/12 to 6/18, moderate VI-VA less than 6/18 but up to 6/60, severe VI-VA less than 6/60 but up to 3/60 and legal blindness-VA worse than 3/60. Factors associated with VI in AMD was analyzed with univariate and logistic regression analysis.ResultsNine hundred and eighty-eight subjects were identified as having AMD (893 with early AMD and 95 with late AMD); 85% of the subjects (95% CI: 82.7-87.1) had no VI, 13.1% had mild VI (95% CI: 11.1-15.3), 0.8% had severe VI (95% CI: 0.4-1.6), 1.1% had legal blindness (95% CI: 0.6-1.9). Prevalence of any VI was 13.7% in early AMD and 27.4% in late AMD, P=0.0004; age group 65-70 years (OR=1.89, 95% CI: 1.16-3.08, P=0.011), and those ≥75 years (OR=3.67, 95% CI: 1.95-6.91, P=0.0001) had greater odds of VI compared with age group 60-64 years. Male gender was a protective factor for VI (OR=0.57, CI: 0.36-0.90, P=0.016). Cataract (31.8%) and refractive error (28.4%) accounted for a majority of the VI.ConclusionsCataract and refractive error account for a significant proportion of VI in the south Indian population with AMD. Early AMD is the third leading cause of VI. Greater age and female gender are associated with VI in subjects with AMD.

Clearing margin system in the futures markets—Applying the value-at-risk model to Taiwanese data

NASA Astrophysics Data System (ADS)

Chiu, Chien-Liang; Chiang, Shu-Mei; Hung, Jui-Cheng; Chen, Yu-Lung

2006-07-01

This article sets out to investigate if the TAIFEX has adequate clearing margin adjustment system via unconditional coverage, conditional coverage test and mean relative scaled bias to assess the performance of three value-at-risk (VaR) models (i.e., the TAIFEX, RiskMetrics and GARCH-t). For the same model, original and absolute returns are compared to explore which can accurately capture the true risk. For the same return, daily and tiered adjustment methods are examined to evaluate which corresponds to risk best. The results indicate that the clearing margin adjustment of the TAIFEX cannot reflect true risks. The adjustment rules, including the use of absolute return and tiered adjustment of the clearing margin, have distorted VaR-based margin requirements. Besides, the results suggest that the TAIFEX should use original return to compute VaR and daily adjustment system to set clearing margin. This approach would improve the funds operation efficiency and the liquidity of the futures markets.

Multifractality and value-at-risk forecasting of exchange rates

NASA Astrophysics Data System (ADS)

Batten, Jonathan A.; Kinateder, Harald; Wagner, Niklas

2014-05-01

This paper addresses market risk prediction for high frequency foreign exchange rates under nonlinear risk scaling behaviour. We use a modified version of the multifractal model of asset returns (MMAR) where trading time is represented by the series of volume ticks. Our dataset consists of 138,418 5-min round-the-clock observations of EUR/USD spot quotes and trading ticks during the period January 5, 2006 to December 31, 2007. Considering fat-tails, long-range dependence as well as scale inconsistency with the MMAR, we derive out-of-sample value-at-risk (VaR) forecasts and compare our approach to historical simulation as well as a benchmark GARCH(1,1) location-scale VaR model. Our findings underline that the multifractal properties in EUR/USD returns in fact have notable risk management implications. The MMAR approach is a parsimonious model which produces admissible VaR forecasts at the 12-h forecast horizon. For the daily horizon, the MMAR outperforms both alternatives based on conditional as well as unconditional coverage statistics.

Veratric acid removal from water by electrochemical oxidation on BDD anode

NASA Astrophysics Data System (ADS)

Jum'h, Inshad; Abdelhay, Arwa; Telfah, Ahmad; Al-Akhras, M.-Ali; Al-Kazwini, Akeel; Rosiwal, Stefan

2018-02-01

The efficiency of boron doped diamond (BDD) in the electrochemical treatment of synthetically contaminated water with veratric acid (VA), one kind of polyphenolic type compounds, is investigated in this work. A BDD electrode was practically fabricated using hot filament chemical vapor deposition (HFCVD). Later on, the BDD electrode was implemented as an anode in a batch electrolytic reactor. The effect of operating factors such as the initial concentration of VA, NaCl addition, and supporting electrolyte type (H2SO4, H3PO4 and Na2SO4) was studied. The chemical oxygen demand (COD) measurements were conducted to study the VA electrolysis kinetics. The experimental data suggested that sodium sulfate was the best supporting electrolyte as the COD removal reached a percentage of 100% using 1 mmol/dm3 as VA concentration. The kinetics of the COD decay of the VA electrolysis were found to obey the pseudo-first order model. Remarkably, the electrolysis process is significantly speeded up once chloride is added to the reaction. The complete COD removal was achieved in 60 minutes of treatment.

Formulation of 3D Printed Tablet for Rapid Drug Release by Fused Deposition Modeling: Screening Polymers for Drug Release, Drug-Polymer Miscibility and Printability.

PubMed

Solanki, Nayan G; Tahsin, Md; Shah, Ankita V; Serajuddin, Abu T M

2018-01-01

The primary aim of this study was to identify pharmaceutically acceptable amorphous polymers for producing 3D printed tablets of a model drug, haloperidol, for rapid release by fused deposition modeling. Filaments for 3D printing were prepared by hot melt extrusion at 150°C with 10% and 20% w/w of haloperidol using Kollidon ® VA64, Kollicoat ® IR, Affinsiol ™ 15 cP, and HPMCAS either individually or as binary blends (Kollidon ® VA64 + Affinisol ™ 15 cP, 1:1; Kollidon ® VA64 + HPMCAS, 1:1). Dissolution of crushed extrudates was studied at pH 2 and 6.8, and formulations demonstrating rapid dissolution rates were then analyzed for drug-polymer, polymer-polymer and drug-polymer-polymer miscibility by film casting. Polymer-polymer (1:1) and drug-polymer-polymer (1:5:5 and 2:5:5) mixtures were found to be miscible. Tablets with 100% and 60% infill were printed using MakerBot printer at 210°C, and dissolution tests of tablets were conducted at pH 2 and 6.8. Extruded filaments of Kollidon ® VA64-Affinisol ™ 15 cP mixtures were flexible and had optimum mechanical strength for 3D printing. Tablets containing 10% drug with 60% and 100% infill showed complete drug release at pH 2 in 45 and 120 min, respectively. Relatively high dissolution rates were also observed at pH 6.8. The 1:1-mixture of Kollidon ® VA64 and Affinisol ™ 15 cP was thus identified as a suitable polymer system for 3D printing and rapid drug release. Copyright © 2018 American Pharmacists Association®. Published by Elsevier Inc. All rights reserved.

Primary care-mental health integration and treatment retention among Iraq and Afghanistan war veterans.

PubMed

Tsan, Jack Y; Zeber, John E; Stock, Eileen M; Sun, Fangfang; Copeland, Laurel A

2012-11-01

Despite the high prevalence of posttraumatic stress disorder (PTSD) and medical comorbidity among veterans from Iraq/Afghanistan (OEF/OIF), keeping these patients engaged in health care is challenging. Primary Care-Mental Health Integration (PC-MHI), an initiative in the Veterans Health Administration (VA), sought to improve access to mental health care from within primary care. This study examined the lag between first PC-MHI visit and next mental/medical care visit, if any, and the relationship of PC-MHI with short-term (subsequent year) and long-term (4 years later) use of VA. We identified 2,470 OEF/OIF veterans receiving care during fiscal year 2006 (FY06) in a regional VA health care system. Unconditional survival analysis modeled time to next mental/medical visit and logistic regression modeled short- and long-term care as a function of PC-MHI, demographics, and clinical covariates. Of 181 patients in the PC-MHI program, 60%/18% returned for mental/medical care within 1 month, and 82%/74% within 1 year. Sixty-one percent (1,503) were still using the VA in FY09. Short-term mental care was related to prior-year PC-MHI. Consistent correlates of short- and long-term mental/medical care included physical comorbidity and Priority 1 status. Most patients attended mental health appointments subsequent to PC-MHI, and PC-MHI was correlated with mental health treatment retention in adjusted models for our cohort. Need for treatment, notably VA Priority 1 status and physical comorbidity, were the primary correlates of care-seeking. Developing innovative approaches to engaging new veterans in care remains imperative as multiple options will be necessary to meet the needs of these complex patients.

Real-time Volcanic Cloud Products and Predictions for Aviation Alerts

NASA Astrophysics Data System (ADS)

Krotkov, N. A.; Hughes, E. J.; da Silva, A. M., Jr.; Seftor, C. J.; Brentzel, K. W.; Hassinen, S.; Heinrichs, T. A.; Schneider, D. J.; Hoffman, R.; Myers, T.; Flynn, L. E.; Niu, J.; Theys, N.; Brenot, H. H.

2016-12-01

We will discuss progress of the NASA ASP project, which promotes the use of satellite volcanic SO2 (VSO2) and Ash (VA) data, and forecasting tools that enhance VA Decision Support Systems (DSS) at the VA Advisory Centers (VAACs) for prompt aviation warnings. The goals are: (1) transition NASA algorithms to NOAA for global NRT processing and integration into DSS at Washington VAAC for operational users and public dissemination; (2) Utilize Direct Broadcast capability of the Aura and SNPP satellites to process Direct Readout (DR) data at two high latitude locations in Finland and Fairbanks, Alaska to enhance VA DSS in Europe and at USGS's Alaska Volcano Observatory (AVO) and Alaska-VAAC; (3) Improve global Eulerian model-based VA/VSO2 forecasting and risk/cost assessments with Metron Aviation. Our global NRT OMI and OMPS data have been fully integrated into European Support to Aviation Control Service and NOAA operational web sites. We are transitioning OMPS processing to our partners at NOAA/NESDIS to integrate into operational processing environment. NASA's Suomi NPP Ozone Science Team, in conjunction with GSFC's Direct Readout Laboratory (DRL), have implemented Version 2 of the OMPS real-time DR processing package to generate VSO2 and VA products at the Geographic Information Network of Alaska (GINA) and the Finnish Meteorological Institute (FMI). The system provides real-time coverage over some of the most congested airspace and over many of the most active volcanoes in the world. The OMPS real time capability is now publicly available via DRL's IPOPP package. We use satellite observations to define volcanic source term estimates in the NASA GOES-5 model, which was updated allowing for the simulation of VA and VSO2 clouds. Column SO2 observations from SNPP/OMPS provide an initial estimate of the total cloud SO2 mass, and are used with backward transport analysis to make an initial cloud height estimate. Later VSO2 observations are used to "nudge" the SO2 mass within the model. The GEOS-5 simulations provide qualitative forecasts, which locate the extent of regions hazardous to aviation. Air traffic flow algorithms have been developed by Metron Aviation to use GEOS-5 volcanic simulations to determine the most cost-effective rerouting paths around hazardous volcanic clouds.

Impact of airway gas exchange on the multiple inert gas elimination technique: theory.

PubMed

Anderson, Joseph C; Hlastala, Michael P

2010-03-01

The multiple inert gas elimination technique (MIGET) provides a method for estimating alveolar gas exchange efficiency. Six soluble inert gases are infused into a peripheral vein. Measurements of these gases in breath, arterial blood, and venous blood are interpreted using a mathematical model of alveolar gas exchange (MIGET model) that neglects airway gas exchange. A mathematical model describing airway and alveolar gas exchange predicts that two of these gases, ether and acetone, exchange primarily within the airways. To determine the effect of airway gas exchange on the MIGET, we selected two additional gases, toluene and m-dichlorobenzene, that have the same blood solubility as ether and acetone and minimize airway gas exchange via their low water solubility. The airway-alveolar gas exchange model simulated the exchange of toluene, m-dichlorobenzene, and the six MIGET gases under multiple conditions of alveolar ventilation-to-perfusion, VA/Q, heterogeneity. We increased the importance of airway gas exchange by changing bronchial blood flow, Qbr. From these simulations, we calculated the excretion and retention of the eight inert gases and divided the results into two groups: (1) the standard MIGET gases which included acetone and ether and (2) the modified MIGET gases which included toluene and m-dichlorobenzene. The MIGET mathematical model predicted distributions of ventilation and perfusion for each grouping of gases and multiple perturbations of VA/Q and Qbr. Using the modified MIGET gases, MIGET predicted a smaller dead space fraction, greater mean VA, greater log(SDVA), and more closely matched the imposed VA distribution than that using the standard MIGET gases. Perfusion distributions were relatively unaffected.

Estimating liver cancer deaths in Thailand based on verbal autopsy study.

PubMed

Waeto, Salwa; Pipatjaturon, Nattakit; Tongkumchum, Phattrawan; Choonpradub, Chamnein; Saelim, Rattikan; Makaje, Nifatamah

2014-01-01

Liver cancer mortality is high in Thailand but utility of related vital statistics is limited due to national vital registration (VR) data being under reported for specific causes of deaths. Accurate methodologies and reliable supplementary data are needed to provide worthy national vital statistics. This study aimed to model liver cancer deaths based on verbal autopsy (VA) study in 2005 to provide more accurate estimates of liver cancer deaths than those reported. The results were used to estimate number of liver cancer deaths during 2000-2009. A verbal autopsy (VA) was carried out in 2005 based on a sample of 9,644 deaths from nine provinces and it provided reliable information on causes of deaths by gender, age group, location of deaths in or outside hospital, and causes of deaths of the VR database. Logistic regression was used to model liver cancer deaths and other variables. The estimated probabilities from the model were applied to liver cancer deaths in the VR database, 2000-2009. Thus, the more accurately VA-estimated numbers of liver cancer deaths were obtained. The model fits the data quite well with sensitivity 0.64. The confidence intervals from statistical model provide the estimates and their precisions. The VA-estimated numbers of liver cancer deaths were higher than the corresponding VR database with inflation factors 1.56 for males and 1.64 for females. The statistical methods used in this study can be applied to available mortality data in developing countries where their national vital registration data are of low quality and supplementary reliable data are available.

An empirical study on information spillover effects between the Chinese copper futures market and spot market

NASA Astrophysics Data System (ADS)

Liu, Xiangli; Cheng, Siwei; Wang, Shouyang; Hong, Yongmiao; Li, Yi

2008-02-01

This study employs a parametric approach based on TGARCH and GARCH models to estimate the VaR of the copper futures market and spot market in China. Considering the short selling mechanism in the futures market, the paper introduces two new notions: upside VaR and extreme upside risk spillover. And downside VaR and upside VaR are examined by using the above approach. Also, we use Kupiec’s [P.H. Kupiec, Techniques for verifying the accuracy of risk measurement models, Journal of Derivatives 3 (1995) 73-84] backtest to test the power of our approaches. In addition, we investigate information spillover effects between the futures market and the spot market by employing a linear Granger causality test, and Granger causality tests in mean, volatility and risk respectively. Moreover, we also investigate the relationship between the futures market and the spot market by using a test based on a kernel function. Empirical results indicate that there exist significant two-way spillovers between the futures market and the spot market, and the spillovers from the futures market to the spot market are much more striking.

Business intelligence from social media: a study from the VAST Box Office Challenge.

PubMed

Lu, Yafeng; Wang, Feng; Maciejewski, Ross

2014-01-01

With over 16 million tweets per hour, 600 new blog posts per minute, and 400 million active users on Facebook, businesses have begun searching for ways to turn real-time consumer-based posts into actionable intelligence. The goal is to extract information from this noisy, unstructured data and use it for trend analysis and prediction. Current practices support the idea that visual analytics (VA) can help enable the effective analysis of such data. However, empirical evidence demonstrating the effectiveness of a VA solution is still lacking. A proposed VA toolkit extracts data from Bitly and Twitter to predict movie revenue and ratings. Results from the 2013 VAST Box Office Challenge demonstrate the benefit of an interactive environment for predictive analysis, compared to a purely statistical modeling approach. The VA approach used by the toolkit is generalizable to other domains involving social media data, such as sales forecasting and advertisement analysis.

Full ocular biometry through dual-depth whole-eye optical coherence tomography

PubMed Central

Kim, Hyung-Jin; Kim, Minji; Hyeon, Min Gyu; Choi, Youngwoon; Kim, Beop-Min

2018-01-01

We propose a new method of determining the optical axis (OA), pupillary axis (PA), and visual axis (VA) of the human eye by using dual-depth whole-eye optical coherence tomography (OCT). These axes, as well as the angles “α” between the OA and VA and “κ” between PA and VA, are important in many ophthalmologic applications, especially in refractive surgery. Whole-eye images are reconstructed based on simultaneously acquired images of the anterior segment and retina. The light from a light source is split into two orthogonal polarization components for imaging the anterior segment and retina, respectively. The OA and PA are identified based on their geometric definitions by using the anterior segment image only, while the VA is detected through accurate correlation between the two images. The feasibility of our approach was tested using a model eye and human subjects. PMID:29552378

Varicella infection modeling.

DOE Office of Scientific and Technical Information (OSTI.GOV)

Jones, Katherine A.; Finley, Patrick D.; Moore, Thomas W.

2013-09-01

Infectious diseases can spread rapidly through healthcare facilities, resulting in widespread illness among vulnerable patients. Computational models of disease spread are useful for evaluating mitigation strategies under different scenarios. This report describes two infectious disease models built for the US Department of Veteran Affairs (VA) motivated by a Varicella outbreak in a VA facility. The first model simulates disease spread within a notional contact network representing staff and patients. Several interventions, along with initial infection counts and intervention delay, were evaluated for effectiveness at preventing disease spread. The second model adds staff categories, location, scheduling, and variable contact rates tomore » improve resolution. This model achieved more accurate infection counts and enabled a more rigorous evaluation of comparative effectiveness of interventions.« less

The effect of Scutellaria baicalensis stem-leaf flavonoids on spatial learning and memory in chronic cerebral ischemia-induced vascular dementia of rats.

PubMed

Cao, Yanjing; Liang, Lizhen; Xu, Jian; Wu, Jiali; Yan, Yongxing; Lin, Ping; Chen, Qiang; Zheng, Fengming; Wang, Qin; Ren, Qian; Gou, Zengmei; Du, Yifeng

2016-05-01

Flavonoids have been shown to improve cognitive function and delay the dementia progression. However, the underlying mechanisms remain elusive. In the present study, we examined the effect of Scutellaria baicalensis stem-leaf total flavonoids (SSTFs) extracted from S. baicalensis Georgi on spatial learning and memory in a vascular dementia (VaD) rat model and explored its molecular mechanisms. The VaD rats were developed by permanent bilateral occlusion of the common carotid artery. Seven days after recovery, the VaD rats were treated with either 50 or 100 mg/kg of SSTF for 60 days. The spatial learning and memory was evaluated in the Morris water maze (MWM) test. The tau hyperphosphorylation and the levels of the related protein kinases or phosphatases were examined by western blot analysis. In VaD rats, SSTF treatment at 100 mg/kg significantly reduced the escape latency in training trial in MWM test. In the probe trial, SSTF treatment increased the searching time and travel distance in the target quadrant. SSTF treatment inhibited the tau phosphorylation in both cortex and hippocampus in VaD rats. Meanwhile, SSTF reduced the activity of glycogen synthase kinase 3β and cyclin-dependent kinase 5 in VaD rats. In contrast, SSTF treatment increased the level of the protein phosphatase 2A subunit B in VaD rats. SSTF treatment significantly improved the spatial cognition in VaD rats. Our results suggest that SSTF may alleviate tau-hyperphosphorylation-induced neurotoxicity through coordinating the activity of kinases and phosphatase after a stroke. SSTF may be developed into promising novel therapeutics for VaD. © The Author 2016. Published by ABBS Editorial Office in association with Oxford University Press on behalf of the Institute of Biochemistry and Cell Biology, Shanghai Institutes for Biological Sciences, Chinese Academy of Sciences.

Alzheimer disease with cerebrovascular disease and vascular dementia: clinical features and course compared with Alzheimer disease.

PubMed

Bruandet, A; Richard, F; Bombois, S; Maurage, C A; Deramecourt, V; Lebert, F; Amouyel, P; Pasquier, F

2009-02-01

Vascular dementia (VaD) and Alzheimer disease with cerebrovascular disease (AD+CVD) are the leading causes of dementia after Alzheimer disease alone (AD). Little is known about the progression of either VaD or AD+CVD. The aim of this study was to compare demographic features, cognitive decline and survival of patients with VaD, AD+CVD and AD alone attending a memory clinic. This study included 970 patients who were followed at the Lille-Bailleul memory clinic, France. Cognitive functions were measured with the Mini Mental State Examination (MMSE) and the Dementia Rating Scale (DRS). Survival rate was analysed with a left-truncated Cox model. Analyses were adjusted for age, sex, education, hypertension, diabetes and baseline MMSE and DRS. Of 970 patients, 141 had VaD, 663 AD alone and 166 AD+CVD. The latter were significantly older than AD or VaD patients at onset (71 (SD 7) vs 69 (9) and 68 (9) years, p = 0.01) and at first visit (75 (6) vs 73 (8) and 72 (8) years, p = 0.0002). Baseline MMSE and DRS evaluations were highest for VaD compared with AD alone or AD+CVD patients (p<0.006). Cognitive decline during follow-up was slowest for VaD, intermediate for AD+CVD and fastest for AD alone (p = 0.03). After adjustment, compared with AD patients, mortality risk was similar for those with VaD (relative mortality risk (RR) = 0.7 (0.5 to 1.1)) and tended to be lower for AD+CVD (RR = 0.7 (0.5 to 1.0)). The shorter the delay between first symptoms and first visit, the longer patients survived. This clinical cohort study shows that patients with VaD, AD+CVD and AD present different characteristics at baseline and during follow-up, and underlines the need to distinguish between them.

Valproic acid ameliorates C. elegans dopaminergic neurodegeneration with implications for ERK-MAPK signaling.

PubMed

Kautu, Bwarenaba B; Carrasquilla, Alejandro; Hicks, Matthew L; Caldwell, Kim A; Caldwell, Guy A

2013-04-29

Parkinson's disease (PD) is a currently incurable neurodegenerative disorder that affects the aging population. The loss of dopaminergic neurons in the substantia nigra is one of the pathological features of PD. The precise causes of PD remain unresolved but evidence supports both environmental and genetic contributions. Current efforts for the treatment of PD are directed toward the discovery of compounds that show promise in impeding age-dependent neurodegeneration in PD patients. Alpha-synuclein (α-Syn) is a human protein that is mutated in specific populations of patients with familial PD. Overexpression of α-Syn in animal models of PD replicates key symptoms of PD, including neurodegeneration. Here, we use the nematode Caenorhabditis elegans as a model system, whereby α-Syn toxicity causes dopaminergic neurodegeneration, to test the capacity of valproic acid (VA) to protect neurons. The results of our study showed that treatment of nematodes with moderate concentrations of VA significantly protects dopaminergic neurons against α-Syn toxicity. Consistent with previously established knowledge related to the mechanistic action of VA in the cell, we showed through genetic analysis that the neuroprotection conferred by VA is inhibited by cell-specific depletion of the C. elegans ortholog of the MAP extracellular signal-regulated kinase (ERK), MPK-1, in the dopaminergic neurons. These findings suggest that VA may exert its neuroprotective effect via ERK-MAPK, or alternately could act with MAPK signaling to additively provide dopaminergic neuroprotection. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

Implementation and validation of the extended Hill-type muscle model with robust routing capabilities in LS-DYNA for active human body models.

PubMed

Kleinbach, Christian; Martynenko, Oleksandr; Promies, Janik; Haeufle, Daniel F B; Fehr, Jörg; Schmitt, Syn

2017-09-02

In the state of the art finite element AHBMs for car crash analysis in the LS-DYNA software material named *MAT_MUSCLE (*MAT_156) is used for active muscles modeling. It has three elements in parallel configuration, which has several major drawbacks: restraint approximation of the physical reality, complicated parameterization and absence of the integrated activation dynamics. This study presents implementation of the extended four element Hill-type muscle model with serial damping and eccentric force-velocity relation including [Formula: see text] dependent activation dynamics and internal method for physiological muscle routing. Proposed model was implemented into the general-purpose finite element (FE) simulation software LSDYNA as a user material for truss elements. This material model is verified and validated with three different sets of mammalian experimental data, taken from the literature. It is compared to the *MAT_MUSCLE (*MAT_156) Hill-type muscle model already existing in LS-DYNA, which is currently used in finite element human body models (HBMs). An application example with an arm model extracted from the FE ViVA OpenHBM is given, taking into account physiological muscle paths. The simulation results show better material model accuracy, calculation robustness and improved muscle routing capability compared to *MAT_156. The FORTRAN source code for the user material subroutine dyn21.f and the muscle parameters for all simulations, conducted in the study, are given at https://zenodo.org/record/826209 under an open source license. This enables a quick application of the proposed material model in LS-DYNA, especially in active human body models (AHBMs) for applications in automotive safety.

C-arm rotation encoding with accelerometers.

PubMed

Grzeda, Victor; Fichtinger, Gabor

2010-07-01

Fluoroscopic C-arms are being incorporated in computer-assisted interventions in increasing number. For these applications to work, the relative poses of imaging must be known. To find the pose, tracking methods such as optical cameras, electromagnetic trackers, and radiographic fiducials have been used-all hampered by significant shortcomings. We propose to recover the rotational pose of the C-arm using the angle-sensing ability of accelerometers, by exploiting the capability of the accelerometer to measure tilt angles. By affixing the accelerometer to a C-arm, the accelerometer tracks the C-arm pose during rotations of the C-arm. To demonstrate this concept, a C-arm analogue was constructed with a webcam device affixed to the C-arm model to mimic X-ray imaging. Then, measuring the offset between the accelerometer angle readings to the webcam pose angle, an angle correction equation (ACE) was created to properly tracking the C-arm rotational pose. Several tests were performed on the webcam C-arm model using the ACEs to tracking the primary and secondary angle rotations of the model. We evaluated the capability of linear and polynomial ACEs to tracking the webcam C-arm pose angle for different rotational scenarios. The test results showed that the accelerometer could track the pose of the webcam C-arm model with an accuracy of less than 1.0 degree. The accelerometer was successful in sensing the C-arm's rotation with clinically adequate accuracy in the C-arm webcam model.

β2 adrenergic receptor activation governs cardiac repolarization and arrhythmogenesis in a guinea pig model of heart failure.

PubMed

Wang, Yao; Yuan, Jiamin; Qian, Zhiyong; Zhang, Xiwen; Chen, Yanhong; Hou, Xiaofeng; Zou, Jiangang

2015-01-08

β2-AR activation increases the risk of sudden cardiac death (SCD) in heart failure (HF) patients. Non-selective β-AR blockers have greater benefits on survival than selective β1-AR blockers in chronic HF patients, indicating that β2-AR activation contributes to SCD in HF. This study investigated the role of β2-AR activation on repolarization and ventricular arrhythmia (VA) in the experimental HF model. The guinea pig HF was induced by descending aortic banding. The effective refractoriness period (ERP), corrected QT (QTc) and the incidence of VA were examined using Langendorff and programmed electrical stimulation. Ikr and APD were recorded by the whole cell patch clamp. Selective β2-AR agonist salbutamol significantly increased the incidence of VA, prolonged QTc and shortened ERP. These effects could be prevented by the selective β2-AR antagonist, ICI118551. Salbutamol prolonged APD90 and reduced Ikr in guinea pig HF myocytes. The antagonists of cAMP (Rp-cAMP) and PKA (KT5720) attenuated Ikr inhibition and APD prolongation induced by salbutamol. However, the antagonists of Gi protein (PTX) and PDE III (amrinone) showed opposite effects. This study indicates that β2-AR activation increases the incidence of VA in the experimental HF model via activation of Gs/cAMP/PKA and/or inhibition of Gi/PDE pathways.

Care coordination in epilepsy: Measuring neurologists' connectivity using social network analysis.

PubMed

Altalib, Hamada Hamid; Fenton, Brenda T; Cheung, Kei-Hoi; Pugh, Mary Jo V; Bates, Jonathan; Valente, Thomas W; Kerns, Robert D; Brandt, Cynthia A

2017-08-01

The study sought to quantify coordination of epilepsy care, over time, between neurologists and other health care providers using social network analysis (SNA). The Veterans Health Administration (VA) instituted an Epilepsy Center of Excellence (ECOE) model in 2008 to enhance care coordination between neurologists and other health care providers. Provider networks in the 16 VA ECOE facilities (hub sites) were compared to a subset of 33 VA facilities formally affiliated (consortium sites) and 14 unaffiliated VA facilities. The number of connections between neurologists and each provider (node degree) was measured by shared epilepsy patients and tallied to generate estimates at the facility level separately within and across facilities. Mixed models were used to compare change of facility-level node degree over time across the three facility types, adjusted for number of providers per facility. Over the time period 2000-2013, epilepsy care coordination both within and across facilities significantly increased. These increases were seen in all three types of facilities namely hub, consortium, and unaffiliated site, relatively equally. The increase in connectivity was more dramatic with providers across facilities compared to providers within the same facilities. Establishment of the ECOE hub and spoke model contributed to an increase in epilepsy care coordination both within and across facilities from 2000 to 2013, but there was substantial variation across different facilities. SNA is a tool that may help measure coordination of specialty care. Published by Elsevier Inc.

Identifying viscoelastic parameters of tissue specimens using Hertz contact mechanics

NASA Astrophysics Data System (ADS)

Namiri, Nikan K.; Maccabi, Ashkan; Bajwa, Neha; Badran, Karam W.; St. John, Maie A.; Taylor, Zachary D.; Grundfest, Warren S.; Saddik, George N.

2018-02-01

The unique viscoelastic properties of tissues throughout the human body can be utilized in a variety of clinical applications. Palpation techniques, for instance, enable surgeons to distinguish malignancies in tissue composition during surgical procedures. Additionally, imaging devices have begun utilizing the viscoelastic properties of tissue to delineate tumor margins. Vibroacoustography (VA), a non-invasive, high resolution imaging modality, has the ability to detect sub-millimeter differences in tissue composition. VA images tissue using a low frequency acoustic radiation force, which perturbs the target and causes an acoustic response that is dependent on the target's viscoelastic properties. Given the unique properties specific to human and animal tissues, there are far-reaching clinical applications of VA. To date, however, a comprehensive model that relates viscoelasticity to VA tissue response has yet to be developed. Utilizing tissue-mimicking phantoms (TMPs) and fresh ex vivo tissues, a mechanical stress relaxation model was developed to compare the viscoelastic properties of known and unknown specimens. This approach was conducted using the Hertz theory of contact mechanics. Fresh hepatic tissue was obtained from porcine subjects (n=10), while gelatin and agar TMPs (n=12) were fabricated from organic extracts. Each specimen's elastic modulus (E), long term shear modulus (η), and time constant (τ) were found to be unique. Additionally, each specimen's stress relaxation profiles were analyzed using Weichert-Maxwell viscoelastic modeling, and retained high precision (R2>0.9) among all samples.

β2 adrenergic receptor activation governs cardiac repolarization and arrhythmogenesis in a guinea pig model of heart failure

PubMed Central

Wang, Yao; Yuan, Jiamin; Qian, Zhiyong; Zhang, Xiwen; Chen, Yanhong; Hou, Xiaofeng; Zou, Jiangang

2015-01-01

β2-AR activation increases the risk of sudden cardiac death (SCD) in heart failure (HF) patients. Non-selective β-AR blockers have greater benefits on survival than selective β1-AR blockers in chronic HF patients, indicating that β2-AR activation contributes to SCD in HF. This study investigated the role of β2-AR activation on repolarization and ventricular arrhythmia (VA) in the experimental HF model. The guinea pig HF was induced by descending aortic banding. The effective refractoriness period (ERP), corrected QT (QTc) and the incidence of VA were examined using Langendorff and programmed electrical stimulation. Ikr and APD were recorded by the whole cell patch clamp. Selective β2-AR agonist salbutamol significantly increased the incidence of VA, prolonged QTc and shortened ERP. These effects could be prevented by the selective β2-AR antagonist, ICI118551. Salbutamol prolonged APD90 and reduced Ikr in guinea pig HF myocytes. The antagonists of cAMP (Rp-cAMP) and PKA (KT5720) attenuated Ikr inhibition and APD prolongation induced by salbutamol. However, the antagonists of Gi protein (PTX) and PDE III (amrinone) showed opposite effects. This study indicates that β2-AR activation increases the incidence of VA in the experimental HF model via activation of Gs/cAMP/PKA and/or inhibition of Gi/PDE pathways. PMID:25567365

Systems innovation model: an integrated interdisciplinary team approach pre- and post-bariatric surgery at a veterans affairs (VA) medical center.

PubMed

Eisenberg, Dan; Lohnberg, Jessica A; Kubat, Eric P; Bates, Cheryl C; Greenberg, Lauren M; Frayne, Susan M

2017-04-01

Provision of bariatric surgery in the Veterans Health Administration must account for obese veterans' co-morbidity burden and the geographically dispersed location of patients relative to Veterans Affairs (VA) bariatric centers. To evaluate a collaborative, integrated, interdisciplinary bariatric team of surgeons, bariatricians, psychologists, dieticians, and physical therapists working in a hub-and-spokes care model, for pre- and post-bariatric surgery assessment and management. This is a description of an interdisciplinary clinic and bariatric program at a VA healthcare system and a report on program evaluation findings. Retrospective data of a prospective database was abstracted. For program evaluation, we abstracted charts to characterize patient data and conducted a patient survey. Since 2009, 181 veterans have undergone bariatric surgery. Referrals came from 7 western U.S. states. Mean preoperative body mass index was 46 kg/m 2 (maximum 71). Mean age was 53 years, with 33% aged>60 years; 79% were male. Medical co-morbidity included diabetes (70%), hypertension (85%), and lower back or extremity joint pain (84%). A psychiatric diagnosis was present in 58%. At 12 months, follow-up was 81% and percent excess body mass index loss was 50.5%. Among 54 sequential clinic patients completing anonymous surveys, overall satisfaction with the interdisciplinary team approach and improved quality of life were high (98% and 94%, respectively). The integrated, interdisciplinary team approach using a hub-and-spokes model is well suited to the VA bariatric surgery population, with its heavy burden of medical and mental health co-morbidity and its system of geographically dispersed patients receiving treatment at specialty centers. As the VA seeks to expand the use of bariatric surgery as an option for obese veterans, interdisciplinary models crafted to address case complexity, care coordination, and long-term outcomes should be part of policy planning efforts. Published by Elsevier Inc.

Real-World Vision in Age-Related Macular Degeneration Patients Treated with Single Anti-VEGF Drug Type for 1 Year in the IRIS Registry.

PubMed

Rao, Prethy; Lum, Flora; Wood, Kevin; Salman, Craig; Burugapalli, Bhavya; Hall, Rebecca; Singh, Sukhminder; Parke, David W; Williams, George A

2018-04-01

The purpose of this study is to compare real-world visual acuity (VA) in patients with neovascular age-related macular degeneration (nAMD) treated with a single anti-vascular endothelial growth factor (VEGF) drug monotherapy for 1 year from the American Academy of Ophthalmology (AAO) Intelligent Research in Sight (IRIS) Registry. Retrospective, nonrandomized, comparative study. IRIS Registry patients with nAMD who received bevacizumab, ranibizumab, or aflibercept only for 1 year between 2013-2016. Participants were divided into 3 groups based on monotherapy type. Multivariate analysis of covariance models (ANCOVA) was constructed in a stepwise fashion. The logarithm of the minimum angle of resolution (logMAR) VA at 1 year and mean change in logMAR VA between baseline and 1 year were compared between drug types. Of 13 859 patients, 6723 received bevacizumab, 2749 received ranibizumab, and 4387 received aflibercept only for 1 year. A total of 84 828 injections were performed. The mean number of injections (standard deviation) at 1 year was higher in the ranibizumab (6.4 [±2.4]) and aflibercept groups (6.2 [±2.4]) compared to bevacizumab group (5.9 [±2.4]; P < 0.0001). In the age-adjusted model, both ranibizumab and aflibercept achieved better logMAR VA at 1 year compared with bevacizumab (0.50 [±0.49], 0.49 [±0.44], 0.55 [±0.57]; P < 0.0001). However, this difference was not significant after multivariate adjustment (age, baseline VA, diabetes, posterior vitreous detachment, number of injections, race, insurance). There was no statistical difference in the age-adjusted or multivariate-adjusted mean logMAR VA change (standard deviation) at 1 year among treatment groups (-0.048 [0.44] bevacizumab, -0.053 [0.46] ranibizumab, -0.040 [0.39] aflibercept; P = 0.46). A higher percentage of patients achieved a ≥3-line VA improvement at 1 year in the bevacizumab group (22.7%) compared with ranibizumab (20.1%; P = 0.0093) and aflibercept (17.8%; P < 0.0001). However, after multivariate adjustment, aflibercept exhibited a greater log odds of a ≥3-line VA loss compared with bevacizumab only (1.25 log odds ratio; P < 0.0016). This study suggests that all 3 drugs improve VA similarly over 1 year of monotherapy. Copyright © 2017 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.

Oxygen transfer rate estimation in oxidation ditches from clean water measurements.

PubMed

Abusam, A; Keesman, K J; Meinema, K; Van Straten, G

2001-06-01

Standard methods for the determination of oxygen transfer rate are based on assumptions that are not valid for oxidation ditches. This paper presents a realistic and simple new method to be used in the estimation of oxygen transfer rate in oxidation ditches from clean water measurements. The new method uses a loop-of-CSTRs model, which can be easily incorporated within control algorithms, for modelling oxidation ditches. Further, this method assumes zero oxygen transfer rates (KLa) in the unaerated CSTRs. Application of a formal estimation procedure to real data revealed that the aeration constant (k = KLaVA, where VA is the volume of the aerated CSTR) can be determined significantly more accurately than KLa and VA. Therefore, the new method estimates k instead of KLa. From application to real data, this method proved to be more accurate than the commonly used Dutch standard method (STORA, 1980).

Nondestructive quantification of the soluble-solids content and the available acidity of apples by Fourier-transform near-infrared spectroscopy

DOE Office of Scientific and Technical Information (OSTI.GOV)

Ying Yibin; Liu Yande; Tao Yang

2005-09-01

This research evaluated the feasibility of using Fourier-transform near-infrared (FT-NIR) spectroscopy to quantify the soluble-solids content (SSC) and the available acidity (VA) in intact apples. Partial least-squares calibration models, obtained from several preprocessing techniques (smoothing, derivative, etc.) in several wave-number ranges were compared. The best models were obtained with the high coefficient determination (r{sup 2}) 0.940 for the SSC and a moderate r{sup 2} of 0.801 for the VA, root-mean-square errors of prediction of 0.272% and 0.053%, and root-mean-square errors of calibration of 0.261% and 0.046%, respectively. The results indicate that the FT-NIR spectroscopy yields good predictions of the SSCmore » and also showed the feasibility of using it to predict the VA of apples.« less

75 FR 52437 - IFR Altitudes; Miscellaneous Amendments

Federal Register 2010, 2011, 2012, 2013, 2014

2010-08-26

... Part GORDONSVILLE, VA VORTAC LURAY, VA FIX 6100 LURAY, VA FIX *KERRE, VA FIX **6000 *7000--MRA **5000--MOCA *KERRE, VA FIX MARTINSBURG, WV VORTAC.. **6000 *7000--MRA **5000--MOCA Sec. 95.6005 VOR Federal... GORDONSVILLE, VA VORTAC LURAY, VA FIX 6100 LURAY, VA FIX *KERRE, VA FIX **6000 *7000--MRA **5000--MOCA *KERRE...

Local perceptions of causes of death in rural South Africa: a comparison of perceived and verbal autopsy causes of death.

PubMed

Hussain-Alkhateeb, Laith; Fottrell, Edward; Petzold, Max; Kahn, Kathleen; Byass, Peter

2015-01-01

Understanding how lay people perceive the causes of mortality and their associated risk factors is important for public health. In resource-limited settings, where verbal autopsy (VA) is used as the most expedient method of determining cause of death, it is important to understand how pre-existing concepts of cause of death among VA-informants may influence their VA-responses and the consequential impact on cause of death assessment. This study describes the agreement between VA-derived causes of death and informant-perceived causes and associated influential factors, which also reflects lay health literacy in this setting. Using 20 years of VA data (n=11,228) from the Agincourt Health and Demographic Surveillance System (HDSS) site in rural South Africa, we explored the agreement between the causes of death perceived by the VA-informants and those assigned by the automated Inter-VA tool. Kappa statistics and concordance correlation coefficients were applied to measure agreement at individual and population levels, respectively. Multivariable regression models were used to explore factors associated with recognised lay perceptions of causes of mortality. Agreement between informant-perceived and VA-derived causes of death at the individual level was limited, but varied substantially by cause of death. However, agreement at the population level, comparing cause-specific mortality fractions was higher, with the notable exception of bewitchment as a cause. More recent deaths, those in adults aged 15-49 years, deaths outside the home, and those associated with external causes showed higher concordance with InterVA. Overall, informant perception of causes of death was limited, but depended on informant characteristics and causes of death, and to some extent involved non-biomedical constructs. Understanding discordance between perceived and recognised causes of death is important for public health planning; low community understanding of causes of death may be detrimental to public health. These findings also illustrate the importance of using rigorous and standardised VA methods rather than relying on informants' reported causes of death.

ARM Cloud Radar Simulator Package for Global Climate Models Value-Added Product

DOE Office of Scientific and Technical Information (OSTI.GOV)

Zhang, Yuying; Xie, Shaocheng

It has been challenging to directly compare U.S. Department of Energy (DOE) Atmospheric Radiation Measurement (ARM) Climate Research Facility ground-based cloud radar measurements with climate model output because of limitations or features of the observing processes and the spatial gap between model and the single-point measurements. To facilitate the use of ARM radar data in numerical models, an ARM cloud radar simulator was developed to converts model data into pseudo-ARM cloud radar observations that mimic the instrument view of a narrow atmospheric column (as compared to a large global climate model [GCM] grid-cell), thus allowing meaningful comparison between model outputmore » and ARM cloud observations. The ARM cloud radar simulator value-added product (VAP) was developed based on the CloudSat simulator contained in the community satellite simulator package, the Cloud Feedback Model Intercomparison Project (CFMIP) Observation Simulator Package (COSP) (Bodas-Salcedo et al., 2011), which has been widely used in climate model evaluation with satellite data (Klein et al., 2013, Zhang et al., 2010). The essential part of the CloudSat simulator is the QuickBeam radar simulator that is used to produce CloudSat-like radar reflectivity, but is capable of simulating reflectivity for other radars (Marchand et al., 2009; Haynes et al., 2007). Adapting QuickBeam to the ARM cloud radar simulator within COSP required two primary changes: one was to set the frequency to 35 GHz for the ARM Ka-band cloud radar, as opposed to 94 GHz used for the CloudSat W-band radar, and the second was to invert the view from the ground to space so as to attenuate the beam correctly. In addition, the ARM cloud radar simulator uses a finer vertical resolution (100 m compared to 500 m for CloudSat) to resolve the more detailed structure of clouds captured by the ARM radars. The ARM simulator has been developed following the COSP workflow (Figure 1) and using the capabilities available in COSP wherever possible. The ARM simulator is written in Fortran 90, just as is the COSP. It is incorporated into COSP to facilitate use by the climate modeling community. In order to evaluate simulator output, the observational counterpart of the simulator output, radar reflectivity-height histograms (CFAD) is also generated from the ARM observations. This report includes an overview of the ARM cloud radar simulator VAP and the required simulator-oriented ARM radar data product (radarCFAD) for validating simulator output, as well as a user guide for operating the ARM radar simulator VAP.« less

To Use or Not to Use

PubMed Central

Washington, Donna L; Yano, Elizabeth M; Simon, Barbara; Sun, Su

2006-01-01

BACKGROUND AND OBJECTIVE Effects of advances in Department of Veterans Affairs (VA) women's health care on women veterans' health care decision making are unknown. Our objective was to determine why women veterans use or do not use VA health care. DESIGN AND PARTICIPANTS Cross-sectional survey of 2,174 women veteran VA users and VA-eligible nonusers throughout southern California and southern Nevada. MEASUREMENTS VA utilization, attitudes toward care, and socio-demographics. RESULTS Reasons cited for VA use included affordability (67.9%); women's health clinic (WHC) availability (58.8%); quality of care (54.8%); and convenience (47.9%). Reasons for choosing health care in non-VA settings included having insurance (71.0%); greater convenience of non-VA care (66.9%); lack of knowledge of VA eligibility and services (48.5%); and perceived better non-VA quality (34.5%). After adjustment for socio-demographics, health characteristics, and VA priority group, knowledge deficits about VA eligibility and services and perceived worse VA care quality predicted outside health care use. VA users were less likely than non-VA users to have after-hours access to nonemergency care, but more likely to receive both general and gender-related care from the same clinic or provider, to use a WHC for gender-related care, and to consider WHC availability very important. CONCLUSIONS Lack of information about VA, perceptions of VA quality, and inconvenience of VA care, are deterrents to VA use for many women veterans. VA WHCs may foster VA use. Educational campaigns are needed to fill the knowledge gap regarding women veterans' VA eligibility and advances in VA quality of care, while VA managers consider solutions to after-hours access barriers. PMID:16637939

Visual Acuity Is Correlated with the Area of the Foveal Avascular Zone in Diabetic Retinopathy and Retinal Vein Occlusion.

PubMed

Balaratnasingam, Chandrakumar; Inoue, Maiko; Ahn, Seungjun; McCann, Jesse; Dhrami-Gavazi, Elona; Yannuzzi, Lawrence A; Freund, K Bailey

2016-11-01

To determine if the area of the foveal avascular zone (FAZ) is correlated with visual acuity (VA) in diabetic retinopathy (DR) and retinal vein occlusion (RVO). Cross-sectional study. Ninety-five eyes of 66 subjects with DR (65 eyes), branch retinal vein occlusion (19 eyes), and central retinal vein occlusion (11 eyes). Structural optical coherence tomography (OCT; Spectralis, Heidelberg Engineering) and OCT angiography (OCTA; Avanti, Optovue RTVue XR) data from a single visit were analyzed. FAZ area, point thickness of central fovea, central 1-mm subfield thickness, the occurrence of intraretinal cysts, ellipsoid zone disruption, and disorganization of retinal inner layers (DRIL) length were measured. VA was also recorded. Correlations between FAZ area and VA were explored using regression models. Main outcome measure was VA. Mean age was 62.9±13.2 years. There was no difference in demographic and OCT-derived anatomic measurements between branch retinal vein occlusion and central retinal vein occlusion groups (all P ≥ 0.058); therefore, data from the 2 groups were pooled together to a single RVO group for further statistical comparisons. Univariate and multiple regression analysis showed that the area of the FAZ was significantly correlated with VA in DR and RVO (all P ≤ 0.003). The relationship between FAZ area and VA varied with age (P = 0.026) such that for a constant FAZ area, an increase in patient age was associated with poorer vision (rise in logarithm of the minimum angle of resolution visual acuity). Disruption of the ellipsoid zone was significantly correlated with VA in univariate and multiple regression analysis (both P < 0.001). Occurrence of intraretinal cysts, DRIL length, and lens status were significantly correlated with VA in the univariate regression analysis (P ≤ 0.018) but not the multiple regression analysis (P ≥ 0.210). Remaining variables evaluated in this study were not predictive of VA (all P ≥ 0.225). The area of the FAZ is significantly correlated with VA in DR and RVO and this relationship is modulated by patient age. Further study about FAZ area and VA correlations during the natural course of retinal vascular diseases and following treatment is warranted. Copyright © 2016 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.

AFRRI Annual Research Reports, Fiscal Year 1992

DTIC Science & Technology

1993-01-01

ghwaySt. Suite t204 Arlington. VA 22202 4302. and to the Office of Management and Budget. Pperwwork Rteductionlikofect ,0704-01") Washington DC 20503...VA 22161; telephone (703)487-4650. Contents M essage from the Director ..... . 1 F oreword ............... . . 3 p erformance Management Program...22 Casualty Management Program . . 29 Reconstitution of hemopoiesis and resistance to sepsis and septic shock in preclinical models of radiation

Multiobjective Risk Partitioning: An Application to Dam Safety Risk Analysis

DTIC Science & Technology

1988-04-01

Charlottesville, VA 22901 Fort Belvoir, VA 22060-5586 Ba. NAME OF FUNDING/SPONSORING 8b. OFFICE SYMBOL 9. PROCUREMENT INSTRUMENT IDENTIFICATION NUMBER...Resources. The successful collaboration throughout the study between the two groups is indeed a model ef an effective partnership among government ...catchment response shows good agreement with historical data. Wood and Hebson [19851 also developed a dimensionless geomorphologic unit hydrograph (DGUH

Anti-Inflammatory and Neuroprotective Effects of Co-UltraPEALut in a Mouse Model of Vascular Dementia

PubMed Central

Siracusa, Rosalba; Impellizzeri, Daniela; Cordaro, Marika; Crupi, Rosalia; Esposito, Emanuela; Petrosino, Stefania; Cuzzocrea, Salvatore

2017-01-01

Vascular dementia (VaD), the second most common cause of cognitive impairment in the population, is a disease that results from reduction in regional cerebral blood flow and involves oxidative stress and inflammation. Co-ultramicronized PEALut (co-ultra PEALut) is a new compound with beneficial effects, which include anti-inflammatory and antioxidant properties. Recently, co-ultraPEALut has been shown to exhibit neuroprotective effects in models of Parkinson’s disease, cerebral ischemia and Alzheimer’s disease. However, its effects on VaD remain unknown. Therefore, the purpose of the present study was to highlight the potential neuroprotective actions of co-ultraPEALut containing N-palmitoylethanolamine (PEA) and the antioxidant flavonoid luteolin (Lut) (10:1 by mass) in a mouse model of VaD induced by bilateral carotid arteries occlusion. At 24 h after VaD induction, mice were orally treated with 1 mg/kg co-ultraPEALut daily for 15 days. On the 15th day, brain tissues were processed for histological, immunohistochemical, Western blot, and immunofluorescent analysis. Our results clearly demonstrate that co-ultraPEALut improved learning, memory ability, locomotor activity, and the reciprocal social interaction. In addition, the mice subjected to VaD and treated with the co-ultraPEALut showed a reorganization of CA1 and CA3 regions of the hippocampus and restored the number of hippocampal neurons as evidenced by NeuN expression, a specific marker of neurons. Furthermore following carotid arteries ligation, mice treated with co-ultraPEALut showed a modification of proinflammatory, proapoptotic proteins and of oxidative stress as evidenced by the expression of IκB-α, NF-κB p65, Bax, Bcl-2, inducible nitric oxide synthase, and cyclooxygenase-2. In order, co-ultraPEALut treatment restored VaD-induced loss of brain-derived neurotrophic factor and neurotrophins 3 (NT-3) expression in mice. These results confirmed that the neuroprotective effects of co-ultraPEALut were associated with its anti-inflammatory and antioxidant properties. PMID:28634464

40 CFR Appendix A to Part 97 - Final Section 126 Rule: EGU Allocations, 2004-2007

Code of Federal Regulations, 2012 CFR

2012-07-01

... VA POSSUM POINT 3804 4 528 VA POSSUM POINT 3804 5 322 VA POTOMAC RIVER 3788 1 203 VA POTOMAC RIVER 3788 2 139 VA POTOMAC RIVER 3788 3 232 VA POTOMAC RIVER 3788 4 223 VA POTOMAC RIVER 3788 5 222 VA SEI...

40 CFR Appendix A to Part 97 - Final Section 126 Rule: EGU Allocations, 2004-2007

Code of Federal Regulations, 2013 CFR

2013-07-01

... VA POSSUM POINT 3804 4 528 VA POSSUM POINT 3804 5 322 VA POTOMAC RIVER 3788 1 203 VA POTOMAC RIVER 3788 2 139 VA POTOMAC RIVER 3788 3 232 VA POTOMAC RIVER 3788 4 223 VA POTOMAC RIVER 3788 5 222 VA SEI...

40 CFR Appendix A to Part 97 - Final Section 126 Rule: EGU Allocations, 2004-2007

Code of Federal Regulations, 2014 CFR

2014-07-01

... VA POSSUM POINT 3804 4 528 VA POSSUM POINT 3804 5 322 VA POTOMAC RIVER 3788 1 203 VA POTOMAC RIVER 3788 2 139 VA POTOMAC RIVER 3788 3 232 VA POTOMAC RIVER 3788 4 223 VA POTOMAC RIVER 3788 5 222 VA SEI...

Aeroelastic instability stoppers for wind tunnel models

NASA Technical Reports Server (NTRS)

Doggett, R. V., Jr.; Ricketts, R. H. (Inventor)

1981-01-01

A mechanism for constraining models or sections thereof, was wind tunnel tested, deployed at the onset of aeroelastic instability, to forestall destructive vibrations in the model is described. The mechanism includes a pair of arms pivoted to the tunnel wall and straddling the model. Rollers on the ends of the arms contact the model, and are pulled together against the model by a spring stretched between the arms. An actuator mechanism swings the arms into place and back as desired.

The prophylactic effect of Viscum album in streptozotocin-induced diabetic rats

PubMed Central

Turkkan, Asuman; Savas, Hasan Basri; Yavuz, Berire; Yigit, Ayse; Uz, Efkan; Bayram, Nezire Asli; Kale, Banu

2016-01-01

OBJECTIVE: Viscum album (VA) is a species of mistletoe in the family Santalaceae that is thought to have therapeutic properties for several diseases, including diabetes. In the present study, conventional experimental rat model was used with diabetes induced with streptozotocin (STZ) to evaluate effect of VA on lipid peroxidation and antioxidant system. METHODS: Total of 32 adult, male Sprague-Dawley rats were divided into 4 groups of 8 rats: Control group, STZ group, VA group, and group administered VA+STZ. VA extract was 100 mg/kg preparation delivered once a day by oral gavage for 10 days. Single dose of 55 mg/kg STZ citrate buffer (0.1 M, pH 4.5) was administered intraperitoneally to induce diabetes. Fasting blood glucose level was measured and recorded. Animals were sacrificed, and catalase (CAT), malondialdehyde (MDA), and protein present in liver and kidney tissue samples were measured. Activity of CAT, an antioxidant enzyme, was studied according to the Aebi method. MDA, a product of lipid peroxidation, was analyzed using Draper and Hadley spectrophotometric procedure. Protein level was determined using supernatant and extract of tissue homogenates according to Lowry method. Data were assessed using one-way analysis of variance and pairwise comparisons between groups. Post-hoc analysis included Dunnet test, Duncan test, and least significant difference test. P<0.05 was considered significant probability value. RESULTS: Oxidative stress is associated with diabetic complications. VA administered to diabetic rats reduced oxidative stress and improved their general condition. CONCLUSION: Further studies are needed to enhance understanding of potential antidiabetic and antioxidant effects of VA. PMID:28058393

REACH VA: Moving from Translation to System Implementation.

PubMed

Nichols, Linda O; Martindale-Adams, Jennifer; Burns, Robert; Zuber, Jeffrey; Graney, Marshall J

2016-02-01

Resources for Enhancing All Caregivers Health in the Department of Veterans Affairs (REACH VA) has been implemented in the VA system as a national program for caregivers. We describe the trajectory of REACH VA from national randomized clinical trial through translation to national implementation. The implementation is examined through the six stages of the Fixsen and Blasé implementation process model: exploration and adoption, program installation, initial implementation, full operation, innovation, and sustainability. Different drivers that move the implementation process forward are important at each stage, including staff selection, staff training, consultation and coaching, staff evaluation, administrative support, program evaluation/fidelity, and systems interventions. Caregivers in the REACH VA 4 session intervention currently implemented in the VA had similar outcomes to longer REACH interventions, including Resources for Enhancing Alzheimer's Caregivers Health (REACH II). Caregivers experienced significant decreases in burden, depression, anxiety, number of troubling patient behaviors reported, caregiving frustrations, stress symptoms (feeling overwhelmed, feeling like crying, being frustrated as a result of caregiving, being lonely), and general stress. Effect sizes (Cohen's d) for these significant variables were between small and medium ranging from .24 to .46. The implementation of REACH VA provides a road map for implementation of other behavioral interventions in health care delivery settings. Lessons learned include the importance of implementing a proven, needed intervention, support from both leadership and clinical staff, willingness to respond to staff and organization needs and modify the intervention while preserving its integrity, and fitting the intervention into ongoing routines and practices. Published by Oxford University Press on behalf of the Gerontological Society of America 2014.

Vitamin D status and vascular dementia due to cerebral small vessel disease in the elderly Asian Indian population.

PubMed

Prabhakar, Puttachandra; Chandra, Sadanandavalli Retnaswami; Supriya, Manjunath; Issac, Thomas Gregor; Prasad, Chandrajit; Christopher, Rita

2015-12-15

Vitamin D plays vital roles in human health and recent studies have shown its beneficial effect on brain functioning. The present study was designed to evaluate the association of vitamin D with vascular dementia (VaD) due to cerebral small vessel disease (SVD) in Asian Indian population. 140 VaD patients aged ≥ 60 years with neuroimaging evidence of SVD, and 132 age and gender-matched controls, were investigated. Vitamin D status was estimated by measuring serum 25-hydroxy vitamin D. Logistic regression model revealed that deficient levels of vitamin D (<12 ng/ml) were associated with 2.2-fold increase in odds of VaD after adjustment with covariates. Hypertension was independently associated with 11.3-fold increased odds of VaD. In hypertensives with vitamin D deficiency and insufficiency (12-20 ng/ml), the odds were increased to 31.6-fold and 14.4-fold, respectively. However, in hypertensives with vitamin D sufficiency (>20 ng/ml), the odds of VaD were increased by 3.8-fold only. Pearson correlation showed that serum vitamin D was inversely associated with systolic and diastolic blood pressure (r=-0.401 and -0.411, p<0.01, respectively) in vitamin D-deficient subjects. Since the combined presence of hypertension and vitamin D deficiency increases the probability of developing VaD, screening for vitamin D status in addition to regular monitoring of blood pressure, could reduce the risk of VaD associated with cerebral SVD in the elderly Asian Indian subjects. Copyright © 2015 Elsevier B.V. All rights reserved.

Empirical-Based Typology of Health Care Utilization by Medicare Eligible Veterans.

PubMed

Vaughan Sarrazin, Mary; Rosenthal, Gary E; Turvey, Carolyn L

2018-06-12

Up to 70 percent of patients who receive care through Veterans Health Administration (VHA) facilities also receive care from non-VA providers. Using applied classification techniques, this study sought to improve understanding of how elderly VA patients use VA services and complementary use of non-VA care. The study included 1,721,900 veterans age 65 and older who were enrolled in VA and Medicare during 2013 with at least one VA encounter during 2013. Outpatient and inpatient encounters and medications received in VA were classified, and mutually exclusive patient subsets distinguished by patterns of VA service use were derived empirically using latent class analysis (LCA). Patient characteristics and complementary use of non-VA care were compared by patient subset. Five patterns of VA service use were identified that were distinguished by quantity of VA medical and specialty services, medication complexity, and mental health services. Low VA Medical users tend to be healthier and rely on non-VA services, while High VA users have multiple high cost illnesses and concentrate their care in the VA. VA patients distinguished by patterns of VA service use differ in illness burden and the use of non-VA services. This information may be useful for framing efforts to optimize access to care and care coordination for elderly VA patients. © Health Research and Educational Trust.

Combined prenatal and postnatal butyl paraben exposure produces autism-like symptoms in offspring: comparison with valproic acid autistic model.

PubMed

Ali, Elham H A; Elgoly, Amany H Mahmoud

2013-10-01

The aim of this work is to evaluate the impact of butyl paraben (BP) in brain of the pups developed for mothers administered BP from early pregnancy till weaning and its effect on studying the behavior, brain neurotransmitters and brain derived neurotrophic factor BDNF via comparing the results with valproic acid (VA) autistic-rat model preparing by a single oral injection dose of VA (800 mg/kg b.wt) at the 12.5 days of gestation. Butyl paraben was orally and subcutaneously administered (200 mg/kg b.wt) to pregnant rats from gestation day 1 to lactation day 21. The offspring male rats were subjected at the last 3 days of lactation to Morris water maze and three chamber sociability test then decapitated and the brain was excised and dissected to the cortex, hippocampus, cerebellum, midbrain and pons for the determination of norepinephrine, dopamine and serotonin (NE, DA and 5-HT) and cortex amino acids and whole brain BDNF. The results showed similar social and learning and memory behavioral deficits in VA rat model and the butyl paraben offspring in comparison with the controls. Also, some similar alterations were observed in monoamine content, amino acids and BDNF factor in the autistic-like model and butyl paraben offspring in comparison with the controls. The alterations were recorded notably in hippocampus and pons NE, midbrain DA, hippocampus and midbrain 5-HT, and frontal cortex GABA and asparagine. These data suggest that prenatal exposure to butyl paraben induced neuro-developmental disorders similar to some of the neurodevelopmental disorders observed in the VA model of autism. © 2013 Elsevier Inc. All rights reserved.

Alveolar ventilation to perfusion heterogeneity and diffusion impairment in a mathematical model of gas exchange

NASA Technical Reports Server (NTRS)

Vidal Melo, M. F.; Loeppky, J. A.; Caprihan, A.; Luft, U. C.

1993-01-01

This study describes a two-compartment model of pulmonary gas exchange in which alveolar ventilation to perfusion (VA/Q) heterogeneity and impairment of pulmonary diffusing capacity (D) are simultaneously taken into account. The mathematical model uses as input data measurements usually obtained in the lung function laboratory. It consists of two compartments and an anatomical shunt. Each compartment receives fractions of alveolar ventilation and blood flow. Mass balance equations and integration of Fick's law of diffusion are used to compute alveolar and blood O2 and CO2 values compatible with input O2 uptake and CO2 elimination. Two applications are presented. The first is a method to partition O2 and CO2 alveolar-arterial gradients into VA/Q and D components. The technique is evaluated in data of patients with chronic obstructive pulmonary disease (COPD). The second is a theoretical analysis of the effects of blood flow variation in alveolar and blood O2 partial pressures. The results show the importance of simultaneous consideration of D to estimate VA/Q heterogeneity in patients with diffusion impairment. This factor plays an increasing role in gas alveolar-arterial gradients as severity of COPD increases. Association of VA/Q heterogeneity and D may produce an increase of O2 arterial pressure with decreasing QT which would not be observed if only D were considered. We conclude that the presented computer model is a useful tool for description and interpretation of data from COPD patients and for performing theoretical analysis of variables involved in the gas exchange process.

Optimizing signal output: effects of viscoelasticity and difference frequency on vibroacoustic radiation of tissue-mimicking phantoms

NASA Astrophysics Data System (ADS)

Namiri, Nikan K.; Maccabi, Ashkan; Bajwa, Neha; Badran, Karam W.; Taylor, Zachary D.; St. John, Maie A.; Grundfest, Warren S.; Saddik, George N.

2018-02-01

Vibroacoustography (VA) is an imaging technology that utilizes the acoustic response of tissues to a localized, low frequency radiation force to generate a spatially resolved, high contrast image. Previous studies have demonstrated the utility of VA for tissue identification and margin delineation in cancer tissues. However, the relationship between specimen viscoelasticity and vibroacoustic emission remains to be fully quantified. This work utilizes the effects of variable acoustic wave profiles on unique tissue-mimicking phantoms (TMPs) to maximize VA signal power according to tissue mechanical properties, particularly elasticity. A micro-indentation method was utilized to provide measurements of the elastic modulus for each biological replica. An inverse relationship was found between elastic modulus (E) and VA signal amplitude among homogeneous TMPs. Additionally, the difference frequency (Δf ) required to reach maximum VA signal correlated with specimen elastic modulus. Peak signal diminished with increasing Δf among the polyvinyl alcohol specimen, suggesting an inefficient vibroacoustic response by the specimen beyond a threshold of resonant Δf. Comparison of these measurements may provide additional information to improve tissue modeling, system characterization, as well as insights into the unique tissue composition of tumors in head and neck cancer patients.

Interprofessional transformation of clinical education: The first six years of the Veterans Affairs Centers of Excellence in Primary Care Education.

PubMed

Harada, Nancy D; Traylor, Laural; Rugen, Kathryn Wirtz; Bowen, Judith L; Smith, C Scott; Felker, Bradford; Ludke, Deborah; Tonnu-Mihara, Ivy; Ruberg, Joshua L; Adler, Jayson; Uhl, Kimberly; Gardner, Annette L; Gilman, Stuart C

2018-02-20

This paper describes the Centers of Excellence in Primary Care Education (CoEPCE), a seven-site collaborative project funded by the Office of Academic Affiliations (OAA) within the Veterans Health Administration of the United States Department of Veterans Affairs (VA). The CoEPCE was established to fulfill OAA's vision of large-scale transformation of the clinical learning environment within VA primary care settings. This was accomplished by funding new Centers within VA facilities to develop models of interprofessional education (IPE) to teach health professions trainees to deliver high quality interprofessional team-based primary care to Veterans. Using reports and data collected and maintained by the National Coordinating Center over the first six years of the project, we describe program inputs, the multicomponent intervention, activities undertaken to develop the intervention, and short-term outcomes. The findings have implications for lessons learned that can be considered by others seeking large-scale transformation of education within the clinical workplace and the development of interprofessional clinical learning environments. Within the VA, the CoEPCE has laid the foundation for IPE and collaborative practice, but much work remains to disseminate this work throughout the national VA system.

Green-Ampt approximations: A comprehensive analysis

NASA Astrophysics Data System (ADS)

Ali, Shakir; Islam, Adlul; Mishra, P. K.; Sikka, Alok K.

2016-04-01

Green-Ampt (GA) model and its modifications are widely used for simulating infiltration process. Several explicit approximate solutions to the implicit GA model have been developed with varying degree of accuracy. In this study, performance of nine explicit approximations to the GA model is compared with the implicit GA model using the published data for broad range of soil classes and infiltration time. The explicit GA models considered are Li et al. (1976) (LI), Stone et al. (1994) (ST), Salvucci and Entekhabi (1994) (SE), Parlange et al. (2002) (PA), Barry et al. (2005) (BA), Swamee et al. (2012) (SW), Ali et al. (2013) (AL), Almedeij and Esen (2014) (AE), and Vatankhah (2015) (VA). Six statistical indicators (e.g., percent relative error, maximum absolute percent relative error, average absolute percent relative errors, percent bias, index of agreement, and Nash-Sutcliffe efficiency) and relative computer computation time are used for assessing the model performance. Models are ranked based on the overall performance index (OPI). The BA model is found to be the most accurate followed by the PA and VA models for variety of soil classes and infiltration periods. The AE, SW, SE, and LI model also performed comparatively better. Based on the overall performance index, the explicit models are ranked as BA > PA > VA > LI > AE > SE > SW > ST > AL. Results of this study will be helpful in selection of accurate and simple explicit approximate GA models for solving variety of hydrological problems.

Generating Variable Wind Profiles and Modeling Their Effects on Small-Arms Trajectories

DTIC Science & Technology

2016-04-01

ARL-TR-7642 ● APR 2016 US Army Research Laboratory Generating Variable Wind Profiles and Modeling Their Effects on Small-Arms... Wind Profiles and Modeling Their Effects on Small-Arms Trajectories by Timothy A Fargus Weapons and Materials Research Directorate, ARL...Generating Variable Wind Profiles and Modeling Their Effects on Small-Arms Trajectories 5a. CONTRACT NUMBER 5b. GRANT NUMBER 5c. PROGRAM

Comparison of outcomes for veterans receiving dialysis care from VA and non-VA providers

PubMed Central

2013-01-01

Background Demand for dialysis treatment exceeds its supply within the Veterans Health Administration (VA), requiring VA to outsource dialysis care by purchasing private sector dialysis for veterans on a fee-for-service basis. It is unclear whether outcomes are similar for veterans receiving dialysis from VA versus non-VA providers. We assessed the extent of chronic dialysis treatment utilization and differences in all-cause hospitalizations and mortality between veterans receiving dialysis from VA versus VA-outsourced providers. Methods We constructed a retrospective cohort of veterans in 2 VA regions who received chronic dialysis treatment financed by VA between January 2007 and December 2008. From VA administrative data, we identified veterans who received outpatient dialysis in (1) VA, (2) VA-outsourced settings, or (3) both (“dual”) settings. In adjusted analyses, we used two-part and logistic regression to examine associations between dialysis setting and all-cause hospitalization and mortality one-year from veterans’ baseline dialysis date. Results Of 1,388 veterans, 27% received dialysis exclusively in VA, 47% in VA-outsourced settings, and 25% in dual settings. Overall, half (48%) were hospitalized and 12% died. In adjusted analysis, veterans in VA-outsourced settings incurred fewer hospitalizations and shorter hospital stays than users of VA due to favorable selection. Dual-system dialysis patients had lower one-year mortality than veterans receiving VA dialysis. Conclusions VA expenditures for “buying” outsourced dialysis are high and increasing relative to “making” dialysis treatment within its own system. Outcomes comparisons inform future make-or-buy decisions and suggest the need for VA to consider veterans’ access to care, long-term VA savings, and optimal patient outcomes in its placement decisions for dialysis services. PMID:23327632

Comparison of outcomes for veterans receiving dialysis care from VA and non-VA providers.

PubMed

Wang, Virginia; Maciejewski, Matthew L; Patel, Uptal D; Stechuchak, Karen M; Hynes, Denise M; Weinberger, Morris

2013-01-18

Demand for dialysis treatment exceeds its supply within the Veterans Health Administration (VA), requiring VA to outsource dialysis care by purchasing private sector dialysis for veterans on a fee-for-service basis. It is unclear whether outcomes are similar for veterans receiving dialysis from VA versus non-VA providers. We assessed the extent of chronic dialysis treatment utilization and differences in all-cause hospitalizations and mortality between veterans receiving dialysis from VA versus VA-outsourced providers. We constructed a retrospective cohort of veterans in 2 VA regions who received chronic dialysis treatment financed by VA between January 2007 and December 2008. From VA administrative data, we identified veterans who received outpatient dialysis in (1) VA, (2) VA-outsourced settings, or (3) both ("dual") settings. In adjusted analyses, we used two-part and logistic regression to examine associations between dialysis setting and all-cause hospitalization and mortality one-year from veterans' baseline dialysis date. Of 1,388 veterans, 27% received dialysis exclusively in VA, 47% in VA-outsourced settings, and 25% in dual settings. Overall, half (48%) were hospitalized and 12% died. In adjusted analysis, veterans in VA-outsourced settings incurred fewer hospitalizations and shorter hospital stays than users of VA due to favorable selection. Dual-system dialysis patients had lower one-year mortality than veterans receiving VA dialysis. VA expenditures for "buying" outsourced dialysis are high and increasing relative to "making" dialysis treatment within its own system. Outcomes comparisons inform future make-or-buy decisions and suggest the need for VA to consider veterans' access to care, long-term VA savings, and optimal patient outcomes in its placement decisions for dialysis services.

Shallow Water Acoustics Workshop, 1983.

DTIC Science & Technology

1983-02-01

WAGSTAFF , Ronald McKISIC, Mike 800 N. Quincy Street NVRDA Office of Naval Research Arlington, VA 22217 NSTL Station, MS 39529 Code 4250A Arlington, VA...Groups were: 1. Environmental Acoustics and Modeling (R. Wagstaff , NORDA, Chairman) 2. Measurements and Survey Techniques (G. Lewis, NAVOCEANO...NORDA’s present program (S. Stanic) and its additional proposed work (W. Kuperman and R. Wagstaff ) were delivered as invited papers. The abstracts of all

"To care for him who shall have borne the battle and for his widow and his orphan" (Abraham Lincoln): the Department of Veterans Affairs polytrauma system of care.

PubMed

Sigford, Barbara J

2008-01-01

The initiation of combat in Iraq and Afghanistan has resulted in a new cohort of active-duty service members and veterans seeking rehabilitation care through the U.S. Department of Veterans Affairs (VA). Service members injured in combat most often sustain multiple injuries (polytrauma) and require a unique service delivery model to meet their needs. The VA recognized this need and responded with the development of the Polytrauma System of Care (PSC). This national system of care balances access and expertise to provide specialized life-long care to the combat injured. The PSC is comprised of: 4 specialized regional rehabilitation centers that are accredited in brain injury by the Commission on Accreditation of Rehabilitation Facilities; 21 specialized outpatient and subacute rehabilitation programs; designated polytrauma teams at smaller, more remote VA facilities; and a point of contact at all other VA facilities. In addition, the PSC has developed a proactive case-management model, a specialized telehealth network, guidelines for long-term follow-up, and services for those individuals who are unable to return home. The following commentary and articles provide additional detail on this new and unique system of care.

Metabolic Effects of Inflammation on Vitamin A and Carotenoids in Humans and Animal Models.

PubMed

Rubin, Lewis P; Ross, A Catharine; Stephensen, Charles B; Bohn, Torsten; Tanumihardjo, Sherry A

2017-03-01

The association between inflammation and vitamin A (VA) metabolism and status assessment has been documented in multiple studies with animals and humans. The relation between inflammation and carotenoid status is less clear. Nonetheless, it is well known that carotenoids are associated with certain health benefits. Understanding these relations is key to improving health outcomes and mortality risk in infants and young children. Hyporetinolemia, i.e., low serum retinol concentrations, occurs during inflammation, and this can lead to the misdiagnosis of VA deficiency. On the other hand, inflammation causes impaired VA absorption and urinary losses that can precipitate VA deficiency in at-risk groups of children. Many epidemiologic studies have suggested that high dietary carotenoid intake and elevated plasma concentrations are correlated with a decreased risk of several chronic diseases; however, large-scale carotenoid supplementation trials have been unable to confirm the health benefits and in some cases resulted in controversial results. However, it has been documented that dietary carotenoids and retinoids play important roles in innate and acquired immunity and in the body's response to inflammation. Although animal models have been useful in investigating retinoid effects on developmental immunity, it is more challenging to tease out the effects of carotenoids because of differences in the absorption, kinetics, and metabolism between humans and animal models. The current understanding of the relations between inflammation and retinoid and carotenoid metabolism and status are the topics of this review. © 2017 American Society for Nutrition.

Metabolic Effects of Inflammation on Vitamin A and Carotenoids in Humans and Animal Models123

PubMed Central

Rubin, Lewis P; Ross, A Catharine; Stephensen, Charles B; Bohn, Torsten; Tanumihardjo, Sherry A

2017-01-01

The association between inflammation and vitamin A (VA) metabolism and status assessment has been documented in multiple studies with animals and humans. The relation between inflammation and carotenoid status is less clear. Nonetheless, it is well known that carotenoids are associated with certain health benefits. Understanding these relations is key to improving health outcomes and mortality risk in infants and young children. Hyporetinolemia, i.e., low serum retinol concentrations, occurs during inflammation, and this can lead to the misdiagnosis of VA deficiency. On the other hand, inflammation causes impaired VA absorption and urinary losses that can precipitate VA deficiency in at-risk groups of children. Many epidemiologic studies have suggested that high dietary carotenoid intake and elevated plasma concentrations are correlated with a decreased risk of several chronic diseases; however, large-scale carotenoid supplementation trials have been unable to confirm the health benefits and in some cases resulted in controversial results. However, it has been documented that dietary carotenoids and retinoids play important roles in innate and acquired immunity and in the body’s response to inflammation. Although animal models have been useful in investigating retinoid effects on developmental immunity, it is more challenging to tease out the effects of carotenoids because of differences in the absorption, kinetics, and metabolism between humans and animal models. The current understanding of the relations between inflammation and retinoid and carotenoid metabolism and status are the topics of this review. PMID:28298266

Multimethod evaluation of the VA's peer-to-peer Toolkit for patient-centered medical home implementation.

PubMed

Luck, Jeff; Bowman, Candice; York, Laura; Midboe, Amanda; Taylor, Thomas; Gale, Randall; Asch, Steven

2014-07-01

Effective implementation of the patient-centered medical home (PCMH) in primary care practices requires training and other resources, such as online toolkits, to share strategies and materials. The Veterans Health Administration (VA) developed an online Toolkit of user-sourced tools to support teams implementing its Patient Aligned Care Team (PACT) medical home model. To present findings from an evaluation of the PACT Toolkit, including use, variation across facilities, effect of social marketing, and factors influencing use. The Toolkit is an online repository of ready-to-use tools created by VA clinic staff that physicians, nurses, and other team members may share, download, and adopt in order to more effectively implement PCMH principles and improve local performance on VA metrics. Multimethod evaluation using: (1) website usage analytics, (2) an online survey of the PACT community of practice's use of the Toolkit, and (3) key informant interviews. Survey respondents were PACT team members and coaches (n = 544) at 136 VA facilities. Interview respondents were Toolkit users and non-users (n = 32). For survey data, multivariable logistic models were used to predict Toolkit awareness and use. Interviews and open-text survey comments were coded using a "common themes" framework. The Consolidated Framework for Implementation Research (CFIR) guided data collection and analyses. The Toolkit was used by 6,745 staff in the first 19 months of availability. Among members of the target audience, 80 % had heard of the Toolkit, and of those, 70 % had visited the website. Tools had been implemented at 65 % of facilities. Qualitative findings revealed a range of user perspectives from enthusiastic support to lack of sufficient time to browse the Toolkit. An online Toolkit to support PCMH implementation was used at VA facilities nationwide. Other complex health care organizations may benefit from adopting similar online peer-to-peer resource libraries.

The Association of Race with Childhood Uveitis

PubMed Central

Angeles-Han, Sheila T; McCracken, Courtney; Yeh, Steven; Jenkins, Kirsten; Stryker, Daneka; Travers, Curtis; Rouster-Stevens, Kelly; Vogler, Larry B.; Lambert, Scott R.; Drews-Botsch, Carolyn; Prahalad, Sampath

2015-01-01

Purpose To identify risk factors for a severe uveitis course among children with non-infectious uveitis. Design Retrospective cohort study Method This was a retrospective analysis of a prospectively collected database. Records of 94 children with uveitis were reviewed at enrollment and every 3-6 months (2011-2015). Severe uveitis was defined as a history of ocular complications or a visual acuity (VA) of ≤20/200. Children were compared by disease, VA, complications and race. Regression models were used to model risk factors for severe disease. When examining race, we focused on non-Hispanic African American and non-Hispanic White children only. Results Of 85 children with uveitis and complete ocular examinations, 27 (32%) had a history of a VA of ≤20/200. A subanalysis of non-Hispanic African American and White children showed an increased prevalence of VA ≤20/200 in non-Hispanic African Americans (18/25 (72%) vs. 4/43 (9%)). Non-Hispanic African Americans were more likely to be diagnosed at an older age (p=0.030), have intermediate uveitis (p=0.026), bilateral disease (p=0.032), a history of VA ≤20/50 (p=0.002), VA ≤20/200 (p<0.001), and a higher rate of complications (p<0.001). On multivariable analysis, non-Hispanic African American race was a significant predictor of blindness (OR=31.6, 95% CI (5.9– 168.5), p<0.001), after controlling for uveitis duration. Non-Hispanic African Americans also developed 2.2 times more unique complications per year of disease than non-Hispanic Whites when controlling for uveitis type and duration. Conclusions There appear to be racial differences in the outcomes of children with uveitis. Non-Hispanic African American children with non-juvenile idiopathic arthritis associated uveitis may have worse visual outcomes with increased vision loss and ocular complications. These findings highlight the need for future studies in minority populations. PMID:26255577

Factors related to attrition from VA healthcare use: findings from the National Survey of Women Veterans.

PubMed

Hamilton, Alison B; Frayne, Susan M; Cordasco, Kristina M; Washington, Donna L

2013-07-01

While prior research characterizes women Veterans' barriers to accessing and using Veterans Health Administration (VA) care, there has been little attention to women who access VA and use services, but then discontinue use. Recent data suggest that among women Veterans, there is a 30 % attrition rate within 3 years of initial VA use. To compare individual characteristics and perceptions about VA care between women Veteran VA attriters (those who discontinue use) and non-attriters (those who continue use), and to compare recent versus remote attriters. Cross-sectional, population-based 2008-2009 national telephone survey. Six hundred twenty-six attriters and 2,065 non-attriters who responded to the National Survey of Women Veterans. Population weighted demographic, military and health characteristics; perceptions about VA healthcare; length of time since last VA use; among attriters, reasons for no longer using VA care. Fifty-four percent of the weighted VA ever user population reported that they no longer use VA. Forty-five percent of attrition was within the past ten years. Attriters had better overall health (p = 0.007), higher income (p < 0.001), and were more likely to have health insurance (p < 0.001) compared with non-attriters. Attriters had less positive perceptions of VA than non-attriters, with attriters having lower ratings of VA quality and of gender-specific features of VA care (p < 0.001). Women Veterans who discontinued VA use since 2001 did not differ from those with more remote VA use on most measures of VA perceptions. Overall, among attriters, distance to VA sites of care and having alternate insurance coverage were the most common reasons for discontinuing VA use. We found high VA attrition despite recent advances in VA care for women Veterans. Women's attrition from VA could reduce the critical mass of women Veterans in VA and affect current system-wide efforts to provide high-quality care for women Veterans. An understanding of reasons for attrition can inform organizational efforts to re-engage women who have attrited, to retain current users, and potentially to attract new VA patients.

US-guided application of Nd:YAG laser in porcine pancreatic tissue: an ex vivo study and numerical simulation.

PubMed

Di Matteo, Francesco; Martino, Margareth; Rea, Roberta; Pandolfi, Monica; Panzera, Francesco; Stigliano, Egidio; Schena, Emiliano; Saccomandi, Paola; Silvestri, Sergio; Pacella, Claudio Maurizio; Breschi, Luca; Perrone, Giuseppe; Coppola, Roberto; Costamagna, Guido

2013-11-01

Laser ablation (LA) with a neodymium-doped yttrium aluminum garnet (Nd:YAG) laser is a minimally invasive approach able to achieve a high rate of complete tissue necrosis. In a previous study we described the feasibility of EUS-guided Nd:YAG pancreas LA performed in vivo in a porcine model. To establish the best laser setting of Nd:YAG lasers for pancreatic tissue ablation. A secondary aim was to investigate the prediction capability of a mathematical model on ablation volume. Ex vivo animal study. Hospital animal laboratory. Explanted pancreatic glands from 60 healthy farm pigs. Laser output powers (OP) of 1.5, 3, 6, 10, 15, and 20 W were supplied. Ten trials for each OP were performed under US guidance on ex vivo healthy porcine pancreatic tissue. Ablation volume (Va) and central carbonization volume (Vc) were measured on histologic specimens as the sum of the lesion areas multiplied by the thickness of each slide. The theoretical model of the laser-tissue interaction was based on the Pennes equation. A circumscribed ablation zone was observed in all histologic specimens. Va values grow with the increase of the OP up to 10 W and reach a plateau between 10 and 20 W. The trend of Vc values rises constantly until 20 W. The theoretical model shows a good agreement with experimental Va and Vc for OP between 1.5 and 10 W. Ex vivo study. Volumes recorded suggest that the best laser OP could be the lowest one to obtain similar Va with smaller Vc in order to avoid the risk of thermal injury to the surrounding tissue. The good agreement between the two models demonstrates the prediction capability of the theoretical model on laser-induced ablation volume in an ex vivo animal model and supports its potential use for estimating the ablation size at different laser OPs. Copyright © 2013 American Society for Gastrointestinal Endoscopy. Published by Mosby, Inc. All rights reserved.

Biosynthesis of actinorhodin and related antibiotics: discovery of alternative routes for quinone formation encoded in the act gene cluster.

PubMed

Okamoto, Susumu; Taguchi, Takaaki; Ochi, Kozo; Ichinose, Koji

2009-02-27

All known benzoisochromanequinone (BIQ) biosynthetic gene clusters carry a set of genes encoding a two-component monooxygenase homologous to the ActVA-ORF5/ActVB system for actinorhodin biosynthesis in Streptomyces coelicolor A3(2). Here, we conducted molecular genetic and biochemical studies of this enzyme system. Inactivation of actVA-ORF5 yielded a shunt product, actinoperylone (ACPL), apparently derived from 6-deoxy-dihydrokalafungin. Similarly, deletion of actVB resulted in accumulation of ACPL, indicating a critical role for the monooxygenase system in C-6 oxygenation, a biosynthetic step common to all BIQ biosyntheses. Furthermore, in vitro, we showed a quinone-forming activity of the ActVA-ORF5/ActVB system in addition to that of a known C-6 monooxygenase, ActVA-ORF6, by using emodinanthrone as a model substrate. Our results demonstrate that the act gene cluster encodes two alternative routes for quinone formation by C-6 oxygenation in BIQ biosynthesis.

Promoting a Strategic Approach to Clinical Nurse Leader Practice Integration.

PubMed

Williams, Marjory; Avolio, Alice E; Ott, Karen M; Miltner, Rebecca S

2016-01-01

The Office of Nursing Services of the Department of Veterans Affairs (VA) piloted implementation of the clinical nurse leader (CNL) into the care delivery model and established a strategic goal in 2011 to implement the CNL role across the VA health care system. The VA Office of Nursing Services CNL Implementation and Evaluation (CNL I&E) Service was created as one mechanism to facilitate that goal in response to a need identified by facility nurse executives for consultative support for CNL practice integration. This article discusses strategies employed by the CNL I&E consultative team to help facility-level nursing leadership integrate CNLs into practice. Measures of success include steady growth in CNL practice capacity as well as positive feedback from nurse executives about the value of consultative engagement. Future steps to better integrate CNL practice into the VA include consolidation of lessons learned, collaboration to strengthen the evidence base for CNL practice, and further exploration of the transformational potential of CNL practice across the care continuum.

Arm motion coupling during locomotion-like actions: An experimental study and a dynamic model

PubMed Central

Shapkova, E.Yu; Terekhov, A.V.; Latash, M.L.

2010-01-01

We studied the coordination of arm movements in standing persons who performed an out-of-phase arm-swinging task while stepping in place or while standing. The subjects were instructed to stop one of the arms in response to an auditory signal while trying to keep the rest of the movement pattern unchanged. A significant increase was observed in the amplitude of the arm that continued swinging under both the stepping and standing conditions. This increase was similar between the right and left arms. A dynamic model was developed including two coupled non-linear van der Pol oscillators. We assumed that stopping an arm did not eliminate the coupling but introduced a new constraint. Within the model, superposition of two factors, a command to stop the ongoing movement of one arm and the coupling between the two oscillators, has been able to account for the observed effects. The model makes predictions for future experiments. PMID:21628725

Productivity of Veterans Health Administration laboratories: a College of American Pathologists Laboratory Management Index Program (LMIP) study.

PubMed

Valenstein, Paul N; Wang, Edward; O'Donohue, Tom

2003-12-01

The Veterans Health Administration (VA) operates the largest integrated laboratory network in the United States. To assess whether the unique characteristics of VA laboratories impact efficiency of operations, we compared the productivity of VA and non-VA facilities. Financial and activity data were prospectively collected from 124 VA and 131 non-VA laboratories enrolled in the College of American Pathologists Laboratory Management Index Program (LMIP) during 2002. In addition, secular trends in 5 productivity ratios were calculated for VA and non-VA laboratories enrolled in LMIP from 1997 through 2002. Veterans Health Administration and non-VA facilities did not differ significantly in size. Inpatients accounted for a lower percentage of testing at VA facilities than non-VA facilities (21.7% vs 37.3%; P <.001). Technical staff at the median VA facility were paid more than at non-VA facilities (28.11/h dollars vs 22.60/h dollars, salaries plus benefits; P <.001), VA laboratories employed a smaller percentage of nontechnical staff (30.0% vs 41.9%; P <.001), and workers at VA laboratories worked less time per hour paid (85.5% vs 88.5%; P <.001). However, labor productivity was significantly higher at VA than at non-VA facilities (30 448 test results/total full-time equivalent (FTE)/y vs 19 260 results/total FTE; P <.001), resulting in lower labor expense per on-site test at VA sites than at non-VA sites (1.79 dollars/result vs 2.08 dollars/result; P <.001). Veterans Health Administration laboratories paid less per test for consumables (P =.003), depreciation, and maintenance than their non-VA counterparts (all P <.001), resulting in lower overall cost per on-site test result (2.64 dollars vs 3.40 dollars; P <.001). Cost per referred (sent-out) test did not differ significantly between the 2 groups. Analysis of 6-year trends showed significant increases in both VA (P <.001) and non-VA (P =.02) labor productivity (on-site tests/total FTE). Expenses at VA laboratories for labor per test, consumables per test, overall expense per test, and overall laboratory expense per discharge decreased significantly during the 6-year period (P <.001), while in non-VA facilities the corresponding ratios showed no significant change. Overall productivity of VA laboratories is superior to that of non-VA facilities enrolled in LMIP. The principal advantages enjoyed by the VA are higher-than-average labor productivity (tests/FTE) and lower-than-average consumable expenses.

Geographic variation in cancer-related imaging: Veterans Affairs health care system versus Medicare.

PubMed

McWilliams, J Michael; Dalton, Jesse B; Landrum, Mary Beth; Frakt, Austin B; Pizer, Steven D; Keating, Nancy L

2014-12-02

Geographic variations in use of medical services have been interpreted as indirect evidence of wasteful care. Less overuse of services, however, may not be reliably associated with less geographic variation. To compare average use and geographic variation in use of cancer-related imaging between fee-for-service Medicare and the Department of Veterans Affairs (VA) health care system. Observational analysis of cancer-related imaging from 2003 to 2005 using Medicare and VA utilization data linked to cancer registry data. Multilevel models, adjusted for sociodemographic and tumor characteristics, were used to estimate mean differences in annual imaging use between cohorts of Medicare and VA patients within geographic areas and variation in use across areas for each cohort. 40 hospital referral regions. Older men with lung, colorectal, or prostate cancer, including 34,475 traditional Medicare beneficiaries (Medicare cohort) and 6835 VA patients (VA cohort). Per-patient count of imaging studies for which lung, colorectal, or prostate cancer was the primary diagnosis (each study weighted by a standardized price), and a direct measure of overuse-advanced imaging for prostate cancer at low risk for metastasis. Adjusted annual use of cancer-related imaging was lower in the VA cohort than in the Medicare cohort (price-weighted count, $197 vs. $379 per patient; P < 0.001), as was annual use of advanced imaging for prostate cancer at low risk for metastasis ($41 vs. $117 per patient; P < 0.001). Geographic variation in cancer-related imaging use was similar in magnitude in the VA and Medicare cohorts. Observational study design. Use of cancer-related imaging was lower in the VA health care system than in fee-for-service Medicare, but lower use was not associated with less geographic variation. Geographic variation in service use may not be a reliable indicator of the extent of overuse. Doris Duke Charitable Foundation and Department of Veterans Affairs Office of Policy and Planning.

Hearing aid patients in private practice and public health (Veterans Affairs) clinics: are they different?

PubMed

Cox, Robyn M; Alexander, Genevieve C; Gray, Ginger A

2005-12-01

In hearing aid research, it is commonplace to combine data across subjects whose hearing aids were provided in different service delivery models. There is reason to question whether these types of patients are always similar enough to justify this practice. To explore this matter, this investigation evaluated similarities and differences in self-report data obtained from hearing aid patients derived from public health (Veterans Affairs, VA) and private practice (PP) settings. The study was a multisite, cross-sectional survey in which 230 hearing aid patients from VA and PP audiology clinic settings provided self-report data on a collection of questionnaires both before and after the hearing aid fitting. Subjects were all older adults with mild to moderately severe hearing loss. About half of them had previous experience wearing hearing aids. All subjects were fitted with wide-dynamic-range-compression instruments and received similar treatment protocols. Numerous statistically significant differences were observed between the VA and PP subject groups. Before the fitting, VA patients reported higher expectations from the hearing aids and more severe unaided problems compared with PP patients with similar audiograms. Three wks after the fitting, VA patients reported more satisfaction with their hearing aids. On some measures VA patients reported more benefit, but different measures of benefit did not give completely consistent results. Both groups reported using the hearing aids an average of approximately 8 hrs per day. VA patients reported age-normal physical and mental health, but PP patients tended to report better than typical health for their age group. These data indicate that hearing aid patients seen in the VA public health hearing services are systematically different in self-report domains from those seen in private practice services. It is therefore risky to casually combine data from these two types of subjects or to generalize research results from one group to the other. Further, compared with PP patients, VA patients consistently reported more favorable hearing aid fitting outcomes. Additional study is indicated to explore the determinants of this result and its generalizability to other public health service delivery systems such as those in other countries. Moreover, efforts should be made to assess the potential for transferring positive elements from the VA system to the PP service delivery system, if possible.

Macular morphology and visual acuity in the comparison of age-related macular degeneration treatments trials.

PubMed

Jaffe, Glenn J; Martin, Daniel F; Toth, Cynthia A; Daniel, Ebenezer; Maguire, Maureen G; Ying, Gui-Shuang; Grunwald, Juan E; Huang, Jiayan

2013-09-01

To describe the effects of treatment for 1 year with ranibizumab or bevacizumab on macular morphology and the association of macular morphology with visual acuity (VA) in eyes with neovascular age-related macular degeneration (AMD). Prospective cohort study within a randomized clinical trial. Participants in the Comparison of Age-related Macular Degeneration Treatments Trials. Participants were assigned randomly to treatment with ranibizumab or bevacizumab on a monthly or as-needed schedule. Optical coherence tomography (OCT), fluorescein angiography (FA), color fundus photography (FP), and VA testing were performed periodically throughout 52 weeks. Masked readers graded images. General linear models were applied to evaluate effects of time and treatment on outcomes. Fluid type and location and thickness by OCT, size, and lesion composition on FP, FA, and VA. Intraretinal fluid (IRF), subretinal fluid (SRF), subretinal pigment epithelium fluid, and retinal, subretinal, and subretinal tissue complex thickness decreased in all treatment groups. A higher proportion of eyes treated monthly with ranibizumab had fluid resolution at 4 weeks, and the difference persisted through 52 weeks. At 52 weeks, there was little association between the presence of fluid of any type (without regard to fluid location) and the mean VA. However, at all time points, eyes with residual IRF, especially foveal IRF, had worse mean VA (9 letters) than those without IRF. Eyes with abnormally thin (<120 μm) or thick (>212 μm) retinas had worse VA than those with normal thickness (120-212 μm). At week 52, eyes with larger neovascular lesions or with foveal scar had worse VA than eyes without these features. Anti-vascular endothelial growth factor (VEGF) therapy reduced lesion activity and improved VA in all treatment groups. At all time points, eyes with residual IRF had worse VA than those without. Eyes with abnormally thin or thick retinas, residual large lesions, and scar also had worse VA. Monthly ranibizumab dosing yielded more eyes with no fluid and an abnormally thin retina, although the long-term significance is unknown. These results have important treatment implications in eyes undergoing anti-VEGF therapy for neovascular AMD. Proprietary or commercial disclosure may be found after the references. Copyright © 2013 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.

Real-time simulation of three-dimensional shoulder girdle and arm dynamics.

PubMed

Chadwick, Edward K; Blana, Dimitra; Kirsch, Robert F; van den Bogert, Antonie J

2014-07-01

Electrical stimulation is a promising technology for the restoration of arm function in paralyzed individuals. Control of the paralyzed arm under electrical stimulation, however, is a challenging problem that requires advanced controllers and command interfaces for the user. A real-time model describing the complex dynamics of the arm would allow user-in-the-loop type experiments where the command interface and controller could be assessed. Real-time models of the arm previously described have not included the ability to model the independently controlled scapula and clavicle, limiting their utility for clinical applications of this nature. The goal of this study therefore was to evaluate the performance and mechanical behavior of a real-time, dynamic model of the arm and shoulder girdle. The model comprises seven segments linked by eleven degrees of freedom and actuated by 138 muscle elements. Polynomials were generated to describe the muscle lines of action to reduce computation time, and an implicit, first-order Rosenbrock formulation of the equations of motion was used to increase simulation step-size. The model simulated flexion of the arm faster than real time, simulation time being 92% of actual movement time on standard desktop hardware. Modeled maximum isometric torque values agreed well with values from the literature, showing that the model simulates the moment-generating behavior of a real human arm. The speed of the model enables experiments where the user controls the virtual arm and receives visual feedback in real time. The ability to optimize potential solutions in simulation greatly reduces the burden on the user during development.

Study of design and control of remote manipulators. Modeling manipulator arms with distributed flexibility for design and control

NASA Technical Reports Server (NTRS)

Book, W. J.

1974-01-01

The interactions of control system and distributed flexible structural dynamics is explored for mechanical arms. A modeling process using 4 x 4 transfer matrices is described which permits the closed loop response of many current arm configurations to be evaluated. Root locus, frequency response, modal shapes, and time impulse response have all been obtained from the digital computer implementation of this model, which is oriented to arm design and allows for easy variation of the arm configuration through data cards. The model corresponds with experimentally observed natural frequencies with an average error of less than 5% in the first three flexible modes in the seven cases considered. The model was used to explore the limits imposed by structural flexibility on a nondimensionalized two link arm with one and two joints for planar motion.

Betaine reverses the memory impairments in a chronic cerebral hypoperfusion rat model.

PubMed

Nie, Chunjie; Nie, Huijuan; Zhao, Yin; Wu, Jianzhao; Zhang, Xiaojian

2016-02-26

Vascular dementia (VaD) is the second reason for the cognitive decline in aged people, but the effective therapy is still missing. The chronic cerebral hypoperfusion (CCH) had been widely found in VaD patients and is thought to be the key reason for cognitive impairment. Betaine is a natural product that had been implicated in many biological processes and had been used for the therapy of some neurodegenerative disease, such as Alzheimer's disease. In this study, we reported that betaine treatment could rescue the memory deficits induced by two-vessel occlusion (2-VO), a widely used CCH rat model. Betaine also restored the expression of PSD93, PSD95 and MAP2 to preserve the synaptic functions. Furthermore, betaine could reduce the oxidative stress by suppressing the MDA and ROS and enhancing the SOD and GSH. Overall, betaine treatment is able to rescue the memory deficits in CCH rats, which provide an experimental basis for the therapy of VaD. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Evaluation of an implementation model: a national investigation of VA residential programs.

PubMed

Cook, Joan M; Dinnen, Stephanie; Coyne, James C; Thompson, Richard; Simiola, Vanessa; Ruzek, Josef; Schnurr, Paula P

2015-03-01

This national investigation utilizes qualitative data to evaluate an implementation model regarding factors influencing provider use of two evidence-based treatments for posttraumatic stress disorder (PTSD). Semi-structured qualitative interviews with 198 mental health providers from 38 Department of Veterans Affairs' (VA) residential treatment programs were used to explore these issues regarding prolonged exposure (PE) and cognitive processing therapy (CPT) in VA residential PTSD programs. Several unique and some overlapping predictors emerged. Leadership was viewed as an influence on implementation for both CPT and PE, while a lack of dedicated time and resources was viewed as a deterrent for both. Compatibility of CPT with providers' existing practices and beliefs, the ability to observe noticeable patient improvement, a perceived relative advantage of CPT over alternative treatments, and the presence of a supportive peer network emerged as influential on CPT implementation. Leadership was associated with PE implementation. Implications for the design and improvement of training and implementation efforts are discussed.

Poorer Visual Acuity Is Associated with Declines in Cognitive Performance Across Multiple Cognitive Domains: The Maine-Syracuse Longitudinal Study.

PubMed

Dearborn, Peter J; Elias, Merrill F; Sullivan, Kevin J; Sullivan, Cara E; Robbins, Michael A

2018-06-21

Prior studies have found associations between visual acuity (VA) and cognitive function. However, these studies used a limited range of cognitive measures and did not control for cardiovascular disease risk factors (CVD-RFs) and baseline function. The primary objective of this study was to analyze the associations of VA and cognitive performance using a thorough neuropsychological test battery. This study used community-dwelling sample data across the sixth (2001-2006) and seventh (2006-2010) waves of the Maine-Syracuse Longitudinal Study (n=655). Wave 6 VA as measured by the Snellen Eye Test was the primary predictor of wave 6 and wave 7 Global cognitive performance, Visual-Spatial Organization and Memory, Verbal Episodic Memory, Working Memory, Scanning and Tracking, and Executive Function. Additionally, VA was used to predict longitudinal changes in wave 7 cognitive performance (wave 6 performance adjusted). We analyzed these relationships with multiple linear and logistic regression models adjusted for age, sex, education, ethnicity, depressive symptoms, physical function deficits in addition to CVD-RFs, chronic kidney disease, homocysteine, continuous systolic blood pressure, and hypertension status. Adjusted for demographic covariates and CVD-RFs, poorer VA was associated with concurrent and approximate 5-year declines in Global cognitive function, Visual-Spatial Organization and Memory, and Verbal Episodic Memory. VA may be used in combination with other screening measures to determine risk for cognitive decline. (JINS, 2018, 24, 1-9).

In-Drift Microbial Communities

DOE Office of Scientific and Technical Information (OSTI.GOV)

D. Jolley

2000-11-09

As directed by written work direction (CRWMS M and O 1999f), Performance Assessment (PA) developed a model for microbial communities in the engineered barrier system (EBS) as documented here. The purpose of this model is to assist Performance Assessment and its Engineered Barrier Performance Section in modeling the geochemical environment within a potential repository drift for TSPA-SR/LA, thus allowing PA to provide a more detailed and complete near-field geochemical model and to answer the key technical issues (KTI) raised in the NRC Issue Resolution Status Report (IRSR) for the Evolution of the Near Field Environment (NFE) Revision 2 (NRC 1999).more » This model and its predecessor (the in-drift microbial communities model as documented in Chapter 4 of the TSPA-VA Technical Basis Document, CRWMS M and O 1998a) was developed to respond to the applicable KTIs. Additionally, because of the previous development of the in-drift microbial communities model as documented in Chapter 4 of the TSPA-VA Technical Basis Document (CRWMS M and O 1998a), the M and O was effectively able to resolve a previous KTI concern regarding the effects of microbial processes on seepage and flow (NRC 1998). This document supercedes the in-drift microbial communities model as documented in Chapter 4 of the TSPA-VA Technical Basis Document (CRWMS M and O 1998a). This document provides the conceptual framework of the revised in-drift microbial communities model to be used in subsequent performance assessment (PA) analyses.« less

75 FR 78806 - Agency Information Collection (Create Payment Request for the VA Funding Fee Payment System (VA...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-12-16

... Payment Request for the VA Funding Fee Payment System (VA FFPS); a Computer Generated Funding Fee Receipt.... 2900-0474.'' SUPPLEMENTARY INFORMATION: Title: Create Payment Request for the VA Funding Fee Payment System (VA FFPS); a Computer Generated Funding Fee Receipt, VA Form 26-8986. OMB Control Number: 2900...

78 FR 59771 - Proposed Information Collection (Create Payment Request for the VA Funding Fee Payment System (VA...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-09-27

... Payment Request for the VA Funding Fee Payment System (VA FFPS); a Computer Generated Funding Fee Receipt.... Title: Create Payment Request for the VA Funding Fee Payment System (VA FFPS); A Computer Generated Funding Fee Receipt, VA Form 26-8986. OMB Control Number: 2900-0474. Type of Review: Revision of a...

VA Health Care: Further Action Needed to Address Weaknesses in Management and Oversight of Non-VA Medical Care

DTIC Science & Technology

2014-06-18

medical centers. VA also provides care to veterans in VA-operated community-based outpatient clinics, community living centers ( nursing homes...facility or nursing home up to the point that the veteran can be safely returned to the VA facility following the emergency care treatment at the non-VA... nursing home care, compensation and pension exams, and most pharmacy expenses paid for through the Non-VA Medical Care Program. (See fig. 1.) 8VA

Neck Muscle Moment Arms Obtained In-Vivo from MRI: Effect of Curved and Straight Modeled Paths.

PubMed

Suderman, Bethany L; Vasavada, Anita N

2017-08-01

Musculoskeletal models of the cervical spine commonly represent neck muscles with straight paths. However, straight lines do not best represent the natural curvature of muscle paths in the neck, because the paths are constrained by bone and soft tissue. The purpose of this study was to estimate moment arms of curved and straight neck muscle paths using different moment arm calculation methods: tendon excursion, geometric, and effective torque. Curved and straight muscle paths were defined for two subject-specific cervical spine models derived from in vivo magnetic resonance images (MRI). Modeling neck muscle paths with curvature provides significantly different moment arm estimates than straight paths for 10 of 15 neck muscles (p < 0.05, repeated measures two-way ANOVA). Moment arm estimates were also found to be significantly different among moment arm calculation methods for 11 of 15 neck muscles (p < 0.05, repeated measures two-way ANOVA). In particular, using straight lines to model muscle paths can lead to overestimating neck extension moment. However, moment arm methods for curved paths should be investigated further, as different methods of calculating moment arm can provide different estimates.

Development and Properties of Valine-Alanine based Antibody-Drug Conjugates with Monomethyl Auristatin E as the Potent Payload

PubMed Central

Fan, Shiyong; Zhong, Wu; Zhou, Xinbo; Li, Song

2017-01-01

Antibody-drug conjugates (ADCs), designed to selectively deliver cytotoxic agents to antigen-bearing cells, are poised to become an important class of cancer therapeutics. Human epithelial growth factor receptor (HER2) is considered an effective target for cancer treatment, and a HER2-targeting ADC has shown promising results. Most ADCs undergoing clinical evaluation contain linkers that have a lysosomal protease-cleavable dipeptide, of which the most common is valine-citrulline (VC). However, valine-alanine (VA), another dipeptide comprising two human essential amino acids, has been used in next generation ADCs loading new toxins, but the druggable properties of ADCs loaded the most popular monomethyl auristatin E (MMAE) remain to be further explored. In this study, we generated VA-based ADCs that connected MMAE to an anti-HER2 antibody. We studied the differences in the preparation process, in vitro stability, cathepsin B activity and in vitro cytotoxicity of VA-based ADC compared to the ADC of VC. VA had comparable performance to VC, which preliminarily displays its practicability. Additional efficacy and safety studies in a xenograft model indicate this novel ADC exerted potent anti-tumor activity and negligible toxicity. The results of this study show the application potential of VA-based ADC with MMAE as the payload. PMID:28841157

Proposed comprehensive ototoxicity monitoring program for VA healthcare (COMP-VA)

PubMed Central

Konrad-Martin, Dawn; Reavis, Kelly M.; McMillan, Garnett; Helt, Wendy J.; Dille, Marilyn

2015-01-01

Prevention and rehabilitation of hearing loss and tinnitus, the two most commonly awarded service-connected disabilities, are high priority initiatives in the Department of Veterans Affairs (VA). At least 4,000 Veterans, most with significant hearing loss, will receive cisplatin this year, with more than half sustaining permanent hearing shift and nearly 40% developing new tinnitus. With improved survivability following cancer treatment, Veterans treated with cisplatin are approached with the dual goals of effective treatment and preserved quality of life. This article describes COMP-VA, a comprehensive ototoxicity monitoring program developed for VA patients receiving cisplatin. The program includes an individualized pretreatment prediction model that identifies the likelihood of hearing shift given cisplatin dose and patient factors. It supports both manual and automated hearing testing with a newly developed portable audiometer capable of performing the recommended procedures on the chemotherapy unit during treatment. It also includes objective methods for identifying outer hair cell changes and predicting audiogram changes using distortion-product otoacoustic emissions. We describe this program of evidence-based ototoxicity monitoring protocols using a case example to give the reader an understanding of how this program would be applied, along with a plan for future work to accomplish the final stages of program development. PMID:24805896

The Health and Social Isolation of American Veterans Denied Veterans Affairs Disability Compensation.

PubMed

Fried, Dennis Adrian; Passannante, Marian; Helmer, Drew; Holland, Bart K; Halperin, William E

2017-02-01

Authors comparatively analyzed health and social isolation between U.S. military veterans denied Veterans Affairs (VA) disability compensation and veterans awarded VA disability compensation. The 2001 National Survey of Veterans was used to create a sample of 4,522 veterans denied or awarded VA disability compensation. Using the Andersen health services utilization model as a conceptual framework, multivariate logistic regression was applied to assess relationships between VA disability compensation award status, three separate domains of health, and correlates of social isolation. Results indicate that denied applicants were more likely than those awarded to have poor overall health (odds ratio [OR] = 1.45, 95% confidence interval [CI]: 1.23, 1.70), and limitations in activities of daily living (OR = 1.12, 95% CI: 1.03, 1.21). Denied applicants' physical functioning (40.3) and mental functioning (41.2) composite summary scores were not clinically different from those of awarded applicants (39.0 and 40.1, respectively), indicating that both were comparably impaired. Veterans denied VA disability compensation had poor health and functional impairments. They also experienced poverty and isolation, suggesting that they may be in need of additional supportive services. Connecting veterans to community resources could be a vital service to provide to all veterans applying for disability compensation. © 2016 National Association of Social Workers.

Development and Properties of Valine-Alanine based Antibody-Drug Conjugates with Monomethyl Auristatin E as the Potent Payload.

PubMed

Wang, Yanming; Fan, Shiyong; Zhong, Wu; Zhou, Xinbo; Li, Song

2017-08-25

Antibody-drug conjugates (ADCs), designed to selectively deliver cytotoxic agents to antigen-bearing cells, are poised to become an important class of cancer therapeutics. Human epithelial growth factor receptor (HER2) is considered an effective target for cancer treatment, and a HER2-targeting ADC has shown promising results. Most ADCs undergoing clinical evaluation contain linkers that have a lysosomal protease-cleavable dipeptide, of which the most common is valine-citrulline (VC). However, valine-alanine (VA), another dipeptide comprising two human essential amino acids, has been used in next generation ADCs loading new toxins, but the druggable properties of ADCs loaded the most popular monomethyl auristatin E (MMAE) remain to be further explored. In this study, we generated VA-based ADCs that connected MMAE to an anti-HER2 antibody. We studied the differences in the preparation process, in vitro stability, cathepsin B activity and in vitro cytotoxicity of VA-based ADC compared to the ADC of VC. VA had comparable performance to VC, which preliminarily displays its practicability. Additional efficacy and safety studies in a xenograft model indicate this novel ADC exerted potent anti-tumor activity and negligible toxicity. The results of this study show the application potential of VA-based ADC with MMAE as the payload.

THE STRUCTURE OF SPIRAL SHOCKS EXCITED BY PLANETARY-MASS COMPANIONS

DOE Office of Scientific and Technical Information (OSTI.GOV)

Zhu, Zhaohuan; Stone, James M.; Rafikov, Roman R.

2015-11-10

Direct imaging observations have revealed spiral structures in protoplanetary disks. Previous studies have suggested that planet-induced spiral arms cannot explain some of these spiral patterns, due to the large pitch angle and high contrast of the spiral arms in observations. We have carried out three-dimensional (3D) hydrodynamical simulations to study spiral wakes/shocks excited by young planets. We find that, in contrast with linear theory, the pitch angle of spiral arms does depend on the planet mass, which can be explained by the nonlinear density wave theory. A secondary (or even a tertiary) spiral arm, especially for inner arms, is alsomore » excited by a massive planet. With a more massive planet in the disk, the excited spiral arms have larger pitch angle and the separation between the primary and secondary arms in the azimuthal direction is also larger. We also find that although the arms in the outer disk do not exhibit much vertical motion, the inner arms have significant vertical motion, which boosts the density perturbation at the disk atmosphere. Combining hydrodynamical models with Monte-Carlo radiative transfer calculations, we find that the inner spiral arms are considerably more prominent in synthetic near-IR images using full 3D hydrodynamical models than images based on two-dimensional models assuming vertical hydrostatic equilibrium, indicating the need to model observations with full 3D hydrodynamics. Overall, companion-induced spiral arms not only pinpoint the companion’s position but also provide three independent ways (pitch angle, separation between two arms, and contrast of arms) to constrain the companion’s mass.« less

11. VIEW LOOKING EAST AT MODEL AIRCRAFT CONTROL ROOM; MODEL ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

11. VIEW LOOKING EAST AT MODEL AIRCRAFT CONTROL ROOM; MODEL OF BOEING 737 AT TOP OF PHOTOGRAPH IN FULL-SCALE WIND TUNNEL. - NASA Langley Research Center, Full-Scale Wind Tunnel, 224 Hunting Avenue, Hampton, Hampton, VA

48 CFR 853.215-70 - VA Form 10-1170, Application for Furnishing Nursing Home Care to Beneficiaries of VA.

Code of Federal Regulations, 2011 CFR

2011-10-01

..., Application for Furnishing Nursing Home Care to Beneficiaries of VA. 853.215-70 Section 853.215-70 Federal... 853.215-70 VA Form 10-1170, Application for Furnishing Nursing Home Care to Beneficiaries of VA. VA Form 10-1170, Application for Furnishing Nursing Home Care to Beneficiaries of VA, will be used for...

48 CFR 853.215-70 - VA Form 10-1170, Application for Furnishing Nursing Home Care to Beneficiaries of VA.

Code of Federal Regulations, 2012 CFR

2012-10-01

..., Application for Furnishing Nursing Home Care to Beneficiaries of VA. 853.215-70 Section 853.215-70 Federal... 853.215-70 VA Form 10-1170, Application for Furnishing Nursing Home Care to Beneficiaries of VA. VA Form 10-1170, Application for Furnishing Nursing Home Care to Beneficiaries of VA, will be used for...

48 CFR 853.215-70 - VA Form 10-1170, Application for Furnishing Nursing Home Care to Beneficiaries of VA.

Code of Federal Regulations, 2013 CFR

2013-10-01

..., Application for Furnishing Nursing Home Care to Beneficiaries of VA. 853.215-70 Section 853.215-70 Federal... 853.215-70 VA Form 10-1170, Application for Furnishing Nursing Home Care to Beneficiaries of VA. VA Form 10-1170, Application for Furnishing Nursing Home Care to Beneficiaries of VA, will be used for...

48 CFR 853.215-70 - VA Form 10-1170, Application for Furnishing Nursing Home Care to Beneficiaries of VA.

Code of Federal Regulations, 2010 CFR

2010-10-01

..., Application for Furnishing Nursing Home Care to Beneficiaries of VA. 853.215-70 Section 853.215-70 Federal... 853.215-70 VA Form 10-1170, Application for Furnishing Nursing Home Care to Beneficiaries of VA. VA Form 10-1170, Application for Furnishing Nursing Home Care to Beneficiaries of VA, will be used for...

48 CFR 853.215-70 - VA Form 10-1170, Application for Furnishing Nursing Home Care to Beneficiaries of VA.

Code of Federal Regulations, 2014 CFR

2014-10-01

..., Application for Furnishing Nursing Home Care to Beneficiaries of VA. 853.215-70 Section 853.215-70 Federal... 853.215-70 VA Form 10-1170, Application for Furnishing Nursing Home Care to Beneficiaries of VA. VA Form 10-1170, Application for Furnishing Nursing Home Care to Beneficiaries of VA, will be used for...

Bee Venom Ameliorates Cognitive Dysfunction Caused by Neuroinflammation in an Animal Model of Vascular Dementia.

PubMed

Cai, Mudan; Lee, Jun Hwan; Yang, Eun Jin

2017-10-01

Vascular dementia (VaD) is caused by the reduction of blood supply by vessel occlusion and is characterized by progressive cognitive decline. VaD incidence has been growing due to the aging population, placing greater strain on social and economic resources. However, the pathological mechanisms underlying VaD remain unclear. Many studies have used the bilateral common carotid artery occlusion (BCCAO) animal model to investigate potential therapeutics for VaD. In this study, we investigated whether bee venom (BV) improves cognitive function and reduces neuroinflammation in the hippocampus of BCCAO animals. Animals were randomly divided into three groups: a sham group (n = 15), BCCAO control group (n = 15), and BV-treated BCCAO group (n = 15). BCCAO animals were treated with 0.1 μg/g BV at ST36 ("Joksamli" acupoint) four times every other day. In order to investigate the effect of BV treatment on cognitive function, we performed a Y-maze test. In order to uncover any potential relationship between these results and neuroinflammation, we also performed Western blotting in the BCCAO group. Animals that had been treated with BV showed an improved cognitive function and a reduced expression of neuroinflammatory proteins in the hippocampus, including Iba-1, TLR4, CD14, and TNF-α. Furthermore, we demonstrated that BV treatment increased pERK and BDNF in the hippocampus. The present study thus underlines the neuroprotective effect of BV treatment against BCCAO-induced cognitive impairment and neuroinflammation. Our findings suggest that BV may be an effective complementary treatment for VaD, as it may improve cognitive function and attenuate neuroinflammation associated with dementia.

Strategic plan for geriatrics and extended care in the veterans health administration: background, plan, and progress to date.

PubMed

Shay, Kenneth; Hyduke, Barbara; Burris, James F

2013-04-01

The leaders of Geriatrics and Extended Care (GEC) in the Veterans Health Administration (VHA) undertook a strategic planning process that led to approval in 2009 of a multidisciplinary, evidence-guided strategic plan. This article reviews the four goals contained in that plan and describes VHA's progress in addressing them. The goals included transforming the healthcare system to a veteran-centric approach, achieving universal access to a panel of services, ensuring that the Veterans Affair's (VA) healthcare workforce was adequately prepared to manage the needs of the growing elderly veteran population, and integrating continuous improvement into all care enhancements. There has been substantial progress in addressing all four goals. All VHA health care has undergone an extensive transformation to patient-centered care, has enriched the services it can offer caregivers of dependent veterans, and has instituted models to better integrate VA and non-VA cares and services. A range of successful models of geriatric care described in the professional literature has been adapted to VA environments to gauge suitability for broader implementation. An executive-level task force developed a three-pronged approach for enhancing the VA's geriatric workforce. The VHA's performance measurement approaches increasingly include incentives to enhance the quality of management of vulnerable elderly adults in primary care. The GEC strategic plan was intended to serve as a road map for keeping VHA aligned with an ambitious but important long-term vision for GEC services. Although no discrete set of resources was appropriated for fulfillment of the plan's recommendations, this initial report reflects substantial progress in addressing most of its goals. © 2013, Copyright the Authors Journal compilation © 2013, The American Geriatrics Society.

Relation of Gemfibrozil Treatment and High Density Lipoprotein (HDL) Subpopulation Profile with Cardiovascular Events in the Veterans Affairs HDL Intervention Trial (VA-HIT)

PubMed Central

Asztalos, Bela F.; Collins, Dorothea; Horvath, Katalin V.; Bloomfield, Hanna E.; Robins, Sander J.; Schaefer, Ernst J.

2007-01-01

Objective The significant cardiovascular disease (CVD) event reduction in VA-HIT could not be fully explained by the 6% increase in HDL-C with the fibrate, gemfibrozil. We examined whether measurement of HDL subpopulations provided additional information relative to CVD-risk reduction. Methods and Results HDL subpopulations were characterized by 2-dimensional gel-electrophoresis in subjects who were treated with gemfibrozil (n=754) or placebo (n=741). In this study, samples obtained at the 3-month visit were used and data were analyzed prospectively using CVD events (CHD death, MI, or stroke) during the 5.1 years follow up. Analyses in the gemfibrozil arm showed that subjects with recurrent CVD events had significantly higher preβ-1 and had significantly lower α-1 and α-2 HDL levels than those without such events. Preβ-1 level was a significant positive predictor; α-1 and α-2 levels were significant negative risk factors for future CVD events. α-2 level was superior to HDL-C level in CVD-risk assessment after adjustment for established risk factors. Gemfibrozil treatment was associated with 3%-6% decreases in the small, lipid-poor preβ-1 HDL and in the large, lipid-rich α-1 and α-2 HDL and with increases in the small α-3 (3%) and preα-3 (16%) HDLs. Conclusions While the use of gemfibrozil has been associated with reduction in CVD events in VA-HIT, HDL subpopulation analysis indicates that gemfibrozil-mediated improvement in CVD risk might not be the result of its effects on HDL. It is quite possible that much of the cardiovascular benefits of gemfibrozil are due to a much wider spectrum of effects on metabolic processes that is not reflected by changes in blood lipids and HDL subpopulations. PMID:18078862

Distribution of cause of death in rural Bangladesh during 2003-2010: evidence from two rural areas within Matlab Health and Demographic Surveillance site.

PubMed

Alam, Nurul; Chowdhury, Hafizur R; Ahmed, Ali; Rahman, Mahfuzur; Streatfield, P Kim

2014-01-01

This study used the InterVA-4 computerised model to assign probable cause of death (CoD) to verbal autopsies (VAs) generated from two rural areas, with a difference in health service provision, within the Matlab Health and Demographic Surveillance site (HDSS). This study aimed to compare CoD by gender, as well as discussing possible factors which could influence differences in the distribution of CoD between the two areas. Data for this study came from the Matlab the HDSS maintained by the International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b) since 1966. In late 1977, icddr,b divided HDSS and implemented a high-quality maternal, newborn and child health and family planning (MNCH-FP) services project in one half, called the icddr,b service area (SA), in addition to the usual public and private MNCH-FP services that serve the other half, called the government SA. HDSS field workers registered 12,144 deaths during 2003-2010, and trained interviewers obtained VA for 98.9% of them. The probabilistic model InterVA-4 probabilistic model (version 4.02) was used to derive probable CoD from VA symptoms. Cause-specific mortality rates and fractions were compared across gender and areas. Appropriate statistical tests were applied for significance testing. Mortality rates due to neonatal causes and communicable diseases (CDs) were lower in the icddr,b SA than in the government SA, where mortality rates due to non-communicable diseases (NCDs) were lower. Cause-specific mortality fractions (CSMFs) due to CDs (23.2% versus 18.8%) and neonatal causes (7.4% versus 6%) were higher in the government SA, whereas CSMFs due to NCDs were higher (58.2% versus 50.7%) in the icddr,b SA. The rank-order of CSMFs by age group showed marked variations, the largest category being acute respiratory infection/pneumonia in infancy, injury in 1-4 and 5-14 years, neoplasms in 15-49 and 50-64 years, and stroke in 65+ years. Automated InterVA-4 coding of VA to determine probable CoD revealed the difference in the structure of CoD between areas with prominence of NCDs in both areas. Such information can help local planning of health services for prevention and management of disease burden.

Head-to-head immunogenicity comparison of Edmonston-Zagreb vs. AIK-C measles vaccine strains in infants aged 8-12 months: A randomized clinical trial.

PubMed

Izadi, Shahrokh; Zahraei, Seyed Mohsen; Salehi, Masoud; Mohammadi, Mahdi; Tabatabaei, Seyed Mehdi; Mokhtari-Azad, Talat

2018-01-29

A non-inferiority multi-centre parallel randomized double-blind trial was implemented in Zahedan district, Sistan-va-Baluchestan province, Iran, to compare the performance of the two measles vaccines which are in use in the National Immunization Programme of Iran and are of two different measles virus vaccine strains: Edmonston-Zagreb (EZ) strain vs. AIK-C strain. The main outcome measure was appearance of anti-measles antibody in sera. 200 infants, 8-12 months old, whose parents consented for their children to be included in the study, were randomized in permutation blocks of size 4-8 in four Urban Health Clinics. Having given a pre-vaccination blood sample, they received measles-rubella vaccine containing one of the vaccine strains mentioned before. After 60 days, the second blood sample was taken. The sera of the pre- and post-vaccination blood samples were tested for anti-measles antibodies in the National Reference Measles Laboratory. Parents, laboratory technicians and statistician were blind to groupings. Of the 200 children equally randomized in the two arms, 185 who were seronegative before vaccination (88 in the EZ arm and 97 in the AIK-C arm) were entered in the final analysis. The seroconversion rate in the EZ arm was 76.1% (95% CI: 60.2-85.2%), and that in the AIK-C arm was 58.7%; (95% CI: 48.8-68.7%). The absolute rate difference was 17. 4% (4.1-30.9%; P-value: .012), and the relative seroconversion rate of EZ to AIK-C was 1.3 (95% CI: 1.1-1.6; P-value: .012). No adverse events were reported during the study period. A considerable difference in the seropositivity of different measles containing vaccines could be demonstrated in the first year of life. Iranian Registry of Clinical Trials Registration Number: IRCT2016032827144N1; May 10, 2016 (www.who.int/ictrp/network/irct/en/). Copyright © 2017 Elsevier Ltd. All rights reserved.

Headache diagnoses among Iraq and Afghanistan war veterans enrolled in VA: a gender comparison.

PubMed

Carlson, Kathleen F; Taylor, Brent C; Hagel, Emily M; Cutting, Andrea; Kerns, Robert; Sayer, Nina A

2013-01-01

To examine the prevalence and correlates of headache diagnoses, by gender, among Iraq and Afghanistan War Veterans who use Department of Veterans Affairs (VA) health care. Understanding the health care needs of recent Veterans, and how these needs differ between women and men, is a priority for the VA. The potential for a large burden of headache disorders among Veterans seeking VA services exists but has not been examined in a representative sample. We conducted a historical cohort study using national VA inpatient and outpatient data from fiscal year 2011. Participants were all (n = 470,215) Iraq and Afghanistan War Veteran VA users in 2011; nearly 13% were women. We identified headache diagnoses using International Classification of Diseases (ICD-9) diagnosis codes assigned during one or more VA inpatient or outpatient encounters. Descriptive analyses included frequencies of patient characteristics, prevalence and types of headache diagnoses, and prevalence of comorbid diagnoses. Prevalence ratios (PR) with 95% confidence intervals (CI) were used to estimate associations between gender and headache diagnoses. Multivariate models adjusted for age and race. Additional models also adjusted for comorbid diagnoses. In 2011, 56,300 (11.9%) Veterans received a headache-related diagnosis. While controlling for age and race, headache diagnoses were 1.61 times more prevalent (95% CI = 1.58-1.64) among women (18%) than men (11%). Most of this difference was associated with migraine diagnoses, which were 2.66 times more prevalent (95% CI = 2.59-2.73) among women. Cluster and post-traumatic headache diagnoses were less prevalent in women than in men. These patterns remained the same when also controlling for comorbid diagnoses, which were common among both women and men with headache diagnoses. The most prevalent comorbid diagnoses examined were depression (46% of women with headache diagnoses vs 40% of men), post-traumatic stress disorder (38% vs 58%), and back pain (38% vs 46%). Results of this study have implications for the delivery of post-deployment health services to Iraq and Afghanistan War Veterans. Migraine and other headache diagnoses are common among Veterans, particularly women, and tend to occur in combination with other post-deployment health conditions for which patients are being treated. Published 2013. This article is a U.S. Government work and is in the public domain in the USA.

A Kinematic Calibration Process for Flight Robotic Arms

NASA Technical Reports Server (NTRS)

Collins, Curtis L.; Robinson, Matthew L.

2013-01-01

The Mars Science Laboratory (MSL) robotic arm is ten times more massive than any Mars robotic arm before it, yet with similar accuracy and repeatability positioning requirements. In order to assess and validate these requirements, a higher-fidelity model and calibration processes were needed. Kinematic calibration of robotic arms is a common and necessary process to ensure good positioning performance. Most methodologies assume a rigid arm, high-accuracy data collection, and some kind of optimization of kinematic parameters. A new detailed kinematic and deflection model of the MSL robotic arm was formulated in the design phase and used to update the initial positioning and orientation accuracy and repeatability requirements. This model included a higher-fidelity link stiffness matrix representation, as well as a link level thermal expansion model. In addition, it included an actuator backlash model. Analytical results highlighted the sensitivity of the arm accuracy to its joint initialization methodology. Because of this, a new technique for initializing the arm joint encoders through hardstop calibration was developed. This involved selecting arm configurations to use in Earth-based hardstop calibration that had corresponding configurations on Mars with the same joint torque to ensure repeatability in the different gravity environment. The process used to collect calibration data for the arm included the use of multiple weight stand-in turrets with enough metrology targets to reconstruct the full six-degree-of-freedom location of the rover and tool frames. The follow-on data processing of the metrology data utilized a standard differential formulation and linear parameter optimization technique.

78 FR 76064 - Authorization for Non-VA Medical Services; Withdrawal

Federal Register 2010, 2011, 2012, 2013, 2014

2013-12-16

... DEPARTMENT OF VETERANS AFFAIRS 38 CFR Part 17 RIN 2900-AO47 Authorization for Non-VA Medical... November 28, 2012, that would have amended its regulations regarding payment by VA for medical services under VA's statutory authority to provide non-VA medical care. VA sought to remove an outdated...

1. Oblique view of east portion of Portsmouth Naval Hospital ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

1. Oblique view of east portion of Portsmouth Naval Hospital Complex showing in middle ground, from left to right, Medical Ward A (HABS No. VA01287-G), Medical Ward B (HABS No. VA-1287-H), Medical Ward C (HABS No. VA-1287-I, Portsmouth Naval Hospital Building (HABS No. VA-1287-A), Hospital Point; and in foreground, from left to right, gardener's tool shed (HABS No. VA-1287-C), Service Building (HABS No. VA01287-D), garage (HABS No. VA-1287-F), Medical Officer's Quarters C (HABS No. VA-1287-B), and Medical Officer's Quarters B (HAQBS No. VA-1287-E), view to north from roof of 1960 high-rise hospital - Portsmouth Naval Hospital, Bounded by Elizabeth River, Crawford Street, Portsmouth General Hospital, Parkview Avenue, & Scotts Creek, Portsmouth, Portsmouth, VA

The relation between magnetic and material arms in models for spiral galaxies

NASA Astrophysics Data System (ADS)

Moss, D.; Beck, R.; Sokoloff, D.; Stepanov, R.; Krause, M.; Arshakian, T. G.

2013-08-01

Context. Observations of polarized radio emission show that large-scale (regular) magnetic fields in spiral galaxies are not fully axisymmetric, but generally stronger in interarm regions. In some nearby galaxies such as NGC 6946 they are organized in narrow magnetic arms situated between the material spiral arms. Aims: The phenomenon of magnetic arms and their relation to the optical spiral arms (the material arms) calls for an explanation in the framework of galactic dynamo theory. Several possibilities have been suggested but are not completely satisfactory; here we attempt a consistent investigation. Methods: We use a 2D mean-field dynamo model in the no-z approximation and add injections of small-scale magnetic field, taken to result from supernova explosions, to represent the effects of dynamo action on smaller scales. This injection of small scale field is situated along the spiral arms, where star-formation mostly occurs. Results: A straightforward explanation of magnetic arms as a result of modulation of the dynamo mechanism by material arms struggles to produce pronounced magnetic arms, at least with realistic parameters, without introducing new effects such as a time lag between Coriolis force and α-effect. In contrast, by taking into account explicitly the small-scale magnetic field that is injected into the arms by the action of the star forming regions that are concentrated there, we can obtain dynamo models with magnetic structures of various forms that can be compared with magnetic arms. These are rather variable entities and their shape changes significantly on timescales of a few 100 Myr. Properties of magnetic arms can be controlled by changing the model parameters. In particular, a lower injection rate of small-scale field makes the magnetic configuration smoother and eliminates distinct magnetic arms. Conclusions: We conclude that magnetic arms can be considered as coherent magnetic structures generated by large-scale dynamo action, and associated with spatially modulated small-scale magnetic fluctuations, caused by enhanced star formation rates within the material arms.

Organizational Cost of Quality Improvement for Depression Care

PubMed Central

Liu, Chuan-Fen; Rubenstein, Lisa V; Kirchner, JoAnn E; Fortney, John C; Perkins, Mark W; Ober, Scott K; Pyne, Jeffrey M; Chaney, Edmund F

2009-01-01

Objective We documented organizational costs for depression care quality improvement (QI) to develop an evidence-based, Veterans Health Administration (VA) adapted depression care model for primary care practices that performed well for patients, was sustained over time, and could be spread nationally in VA. Data Sources and Study Setting Project records and surveys from three multistate VA administrative regions and seven of their primary care practices. Study Design Descriptive analysis. Data Collection We documented project time commitments and expenses for 86 clinical QI and 42 technical expert support team participants for 4 years from initial contact through care model design, Plan–Do–Study–Act cycles, and achievement of stable workloads in which models functioned as routine care. We assessed time, salary costs, and costs for conference calls, meetings, e-mails, and other activities. Principle Findings Over an average of 27 months, all clinics began referring patients to care managers. Clinical participants spent 1,086 hours at a cost of $84,438. Technical experts spent 2,147 hours costing $197,787. Eighty-five percent of costs derived from initial regional engagement activities and care model design. Conclusions Organizational costs of the QI process for depression care in a large health care system were significant, and should be accounted for when planning for implementation of evidence-based depression care. PMID:19146566

An Overview of the Technical Basis of HENRE 2.0 Models

DTIC Science & Technology

2015-08-01

Defense Threat Reduction Agency 8725 John J . Kingman Road, MS-6201 Fort Belvoir, VA 22060-6201...Agency 8725 John J . Kingman Road, Mail Stop 6201 Fort Belvoir, VA 22060-6201 DTRA J9NTSN DTRA-TR-15-070 DISTRIBUTION A. Approved for public release...10–19 joule ( J ) erg 1 × 10–7 joule ( J ) kiloton (kT) (TNT equivalent) 4.184 × 1012 joule ( J ) British thermal unit (Btu) (thermochemical) 1.054 350

Annual Historical Report - AMEDD Activities, Calendar Year 1986

DTIC Science & Technology

1987-01-01

experimentation . A method was devised to determine the heat transfer properties of the head by use of a copper model which is unique and allows independent ...Church, VA 22041 Commander US Army Training and Doctrine Command ATTN: ATCD-S ATCD-ATMD Fort Monroe, VA 23651 Commander US Army Test and Experimentation ...4500 m). Soldiers with less than 20 torr increase test have only a 40-50% probability of acute mountain sickness. Therefore, CPT at sea level may be used

Forecasting Tehran stock exchange volatility; Markov switching GARCH approach

NASA Astrophysics Data System (ADS)

Abounoori, Esmaiel; Elmi, Zahra (Mila); Nademi, Younes

2016-03-01

This paper evaluates several GARCH models regarding their ability to forecast volatility in Tehran Stock Exchange (TSE). These include GARCH models with both Gaussian and fat-tailed residual conditional distribution, concerning their ability to describe and forecast volatility from 1-day to 22-day horizon. Results indicate that AR(2)-MRSGARCH-GED model outperforms other models at one-day horizon. Also, the AR(2)-MRSGARCH-GED as well as AR(2)-MRSGARCH-t models outperform other models at 5-day horizon. In 10 day horizon, three models of AR(2)-MRSGARCH outperform other models. Concerning 22 day forecast horizon, results indicate no differences between MRSGARCH models with that of standard GARCH models. Regarding Risk management out-of-sample evaluation (95% VaR), a few models seem to provide reasonable and accurate VaR estimates at 1-day horizon, with a coverage rate close to the nominal level. According to the risk management loss functions, there is not a uniformly most accurate model.

Global Modeling of Spur Formation in Spiral Galaxies

NASA Astrophysics Data System (ADS)

Shetty, Rahul; Ostriker, Eve C.

2006-08-01

We investigate the formation of substructure in spiral galaxies using global MHD simulations, including gas self-gravity. Local modeling by Kim & Ostriker previously showed that self-gravity and magnetic fields cause rapid growth of overdensities in spiral arms; differential compression of gas flowing through the arms then results in the formation of sheared structures in the interarms. These sheared structures resemble features described as spurs or feathers in optical and IR observations of many spiral galaxies. Global modeling extends previous local models by including the full effects of curvilinear coordinates, a realistic log-spiral perturbation, self-gravitational contribution from five radial wavelengths of the spiral shock, and variation of density and epicyclic frequency with radius. We show that with realistic Toomre Q-values self-gravity and galactic differential rotation produce filamentary gaseous structures with kiloparsec-scale separations, regardless of the strength-or even presence-of a stellar spiral potential. However, a sufficiently strong spiral potential is required to produce true spurs, consisting of interarm structures emerging from gas concentrations in the main spiral arms. In models where Q is initially constant, filaments due to interarm self-gravity grow mainly in the outer regions, whereas true arm spurs grow only in the inner regions. For models with Q~R, outer regions are intrinsically more stable, so background interarm filaments do not grow, but arm spurs can develop if the spiral potential is strong. Unlike independently growing background filaments, the orientation of arm spurs depends on galactic location. Inside corotation, spurs emanate outward, on the convex side of the arm; outside corotation, spurs grow inward, on the concave side of the arm. Based on orientation and the relation to arm clumps, it is possible to distinguish true spurs that originate as instabilities in the arms from independently growing background filaments. We measure spur spacings of ~3-5 times the Jeans length in the arm and arm clump masses of ~107 Msolar. Finally, we have also studied models without self-gravity, finding that magnetic fields suppress a purely hydrodynamic instability recently proposed by Wada & Koda as a means of growing interarm spurs and feathers. Our models also suggest that magnetic fields are important in preserving grand-design spiral structure when gas in the arms fragments via self-gravity into GMCs.

All-distance visual acuity and contrast visual acuity in eyes with a refractive multifocal intraocular lens with minimal added power.

PubMed

Hayashi, Ken; Yoshida, Motoaki; Hayashi, Hideyuki

2009-03-01

To compare visual acuity (VA) from far to near distances, photopic and mesopic contrast VA, and contrast VA in the presence of a glare source (glare VA), between eyes with a new refractive multifocal intraocular lens (IOL) with added power of only +3.0 diopters and those with a monofocal IOL. Comparative, nonrandomized, interventional study. Forty-four eyes of 22 patients who were scheduled for implantation of a refractive multifocal IOL (Hoya SFX MV1; Tokyo, Japan) and 44 eyes of 22 patients scheduled for implantation of a monofocal IOL. All patients underwent phacoemulsification with bilateral implantation of either multifocal or monofocal IOLs. At approximately 3 months after surgery, monocular and binocular VA from far to near distances was measured using the all-distance vision tester (Kowa AS-15; Tokyo, Japan), whereas photopic and mesopic contrast VA and glare VA were examined using the Contrast Sensitivity Accurate Tester (Menicon CAT-2000, Nagoya, Japan). Pupillary diameter and the degree of IOL decentration and tilt were correlated with VA at all distances. Mean VA in both the multifocal and monofocal IOL groups decreased gradually from far to near distances. When comparing the 2 groups, however, both uncorrected and best distance-corrected intermediate VA at 0.5 m and near VA at 0.3 m in the multifocal IOL group were significantly better than those in the monofocal IOL group (P

Accessing VA Healthcare During Large-Scale Natural Disasters.

PubMed

Der-Martirosian, Claudia; Pinnock, Laura; Dobalian, Aram

2017-01-01

Natural disasters can lead to the closure of medical facilities including the Veterans Affairs (VA), thus impacting access to healthcare for U.S. military veteran VA users. We examined the characteristics of VA patients who reported having difficulty accessing care if their usual source of VA care was closed because of natural disasters. A total of 2,264 veteran VA users living in the U.S. northeast region participated in a 2015 cross-sectional representative survey. The study used VA administrative data in a complex stratified survey design with a multimode approach. A total of 36% of veteran VA users reported having difficulty accessing care elsewhere, negatively impacting the functionally impaired and lower income VA patients.

38 CFR 1.203 - Information to be reported to VA Police.

Code of Federal Regulations, 2010 CFR

2010-07-01

... reported to VA Police. 1.203 Section 1.203 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS... be reported to VA Police. Information about actual or possible violations of criminal laws related to... occurs on VA premises, will be reported by VA management officials to the VA police component with...

Using Action, Reflection and Modelling (ARM) in Malaysian Primary Schools: Connecting "The ARM Theory" with Student Teachers' Reported Practice

ERIC Educational Resources Information Center

Dickerson, Claire; Jarvis, Joy; Levy, Roger; Thomas, Kit

2017-01-01

This article presents Malaysian student teachers' reports of using an action, reflection and modelling (ARM) pedagogical approach during their placements in Malaysian primary schools. The ARM approach was designed to support the implementation of the Malaysian primary school mathematics curriculum, which involved changing classroom practice in…

Association of Admission to Veterans Affairs Hospitals Versus non-Veterans Affairs Hospitals with Mortality and Readmission Rates Among Older Men Hospitalized with Acute Myocardial Infarction, Heart Failure, and Pneumonia

PubMed Central

Nuti, Sudhakar V.; Qin, Li; Rumsfeld, John S.; Ross, Joseph S.; Masoudi, Frederick A.; Normand, Sharon-Lise T.; Murugiah, Karthik; Bernheim, Susannah M.; Suter, Lisa G.; Krumholz, Harlan M.

2017-01-01

Importance Little contemporary information is available about comparative performance between Veterans Affairs (VA) and non-VA hospitals, particularly related to mortality and readmission rates, 2 important outcomes of care. Objective To assess and compare mortality and readmission rates among men in VA and non-VA hospitals. To avoid confounding geographic effects with health care system effects, we studied VA and non-VA hospitals within the same metropolitan statistical area (MSA). Design Cross-sectional analysis between 2010 and 2013 Setting Medicare Standard Analytic Files and Enrollment Database Participants Male Medicare Fee-for-Service beneficiaries aged 65 or older hospitalized between 2010 and 2013 in VA and non-VA acute care hospitals for acute myocardial infarction (AMI), heart failure (HF), or pneumonia. Exposures Hospitalization in a VA or non-VA hospital in urban MSAs that contained at least 1 VA and non-VA hospital Main Outcomes and Measures For each condition, 30-day risk-standardized mortality rates and risk-standardized readmission rates for VA and non-VA hospitals. Mean-aggregated within-MSA differences in mortality and readmission rates were also assessed. Results We studied 104 VA and 1,513 non-VA hospitals, with each condition-outcome analysis cohort for VA and non-VA hospitals containing at least 7,900 patients, in 92 MSAs. Mortality rates were lower in VA hospitals than non-VA hospitals for AMI (13.5% vs. 13.7%, p=0.02; −0.2 percentage point difference) and HF (11.4% vs. 11.9%, p=0.008; −0.5 percentage point difference), but higher for pneumonia (12.6% vs. 12.2%, p<0.05; 0.4 percentage point difference). In contrast, readmission rates were higher in VA hospitals for all 3 conditions (AMI: 17.8% vs. 17.2%, 0.6 percentage point difference; HF: 24.7% vs. 23.5%, 1.2 percentage point difference; pneumonia: 19.4% vs. 18.7%, 0.7 percentage point difference, all p<0.001). In within-MSA comparisons, VA hospitals had lower mortality rates for AMI (percentage point difference: −0.22, 95% CI: −0.40 to −0.04) and HF (−0.63, 95% CI: −0.95 to −0.31), and mortality rates for pneumonia were not significantly different (−0.03, 95% CI: −0.46 to 0.40); however, VA hospitals had higher readmission rates (AMI: 0.62, 95% CI: 0.48 to 0.75; HF: 0.97, 95% CI: 0.59 to 1.34; pneumonia: 0.66, 95% CI: 0.41 to 0.91). Conclusion and Relevance Among older men with AMI, HF, and pneumonia, hospitalization at VA hospitals, compared with hospitalization at non-VA hospitals, was associated with lower risk-standardized 30-day all-cause mortality rates for AMI and HF, and higher risk-standardized 30 day all-cause readmission rates for all 3 conditions, both nationally and within similar geographic areas, although absolute differences between these outcomes at VA and non-VA hospitals were small. PMID:26864412

Relationship between the baseline alveolar volume-to-total lung capacity ratio and airway responsiveness.

PubMed

Kaminsky, David A; Daud, Anees; Chapman, David G

2014-10-01

Ventilation heterogeneity (VH) has been linked to airway responsiveness (AR) based on various measures of VH involving inert gas washout, forced oscillation and lung imaging. We explore whether VH at baseline, as measured by the simple ratio of single breath alveolar volume to plethysmographically determined total lung capacity (VA/TLC), would correlate with AR as measured by methacholine challenge testing. We analysed data from spirometry, lung volumes, diffusing capacity and methacholine challenge to derive the VA/TLC and the dose-response slope (DRS) of forced expiratory volume in 1 s (DRS-FEV1) during methacholine challenge from 136 patients. We separated out airway closure versus narrowing by examining the DRS for forced vital capacity (DRS-FVC) and the DRS for FEV1/FVC (DRS-FEV1/FVC), respectively. Similarly, we calculated the DRS for sGaw (DRS-sGaw) as another measure of airway narrowing. We performed statistical analysis using Spearman rank correlation and multifactor linear regression using a backward stepwise modelling procedure. We found that the DRS-FEV1 correlated with baseline VA/TLC (rho = -0.26, P < 0.01), and VA/TLC and FEV1 were independently associated with DRS-FEV1 (R(2)  = 0.14, P = 0.01). In addition, VA/TLC was associated with both airway narrowing and closure in response to methacholine. These results confirm that baseline VA/TLC is associated with AR, and reflects both airway closure and airway narrowing following methacholine challenge. © 2014 Asian Pacific Society of Respirology.

Serious mental illnesses associated with receipt of surgery in retrospective analysis of patients in the Veterans Health Administration.

PubMed

Copeland, Laurel A; Zeber, John E; Sako, Edward Y; Mortensen, Eric M; Pugh, Mary Jo; Wang, Chen-Pin; Restrepo, Marcos I; Flynn, Julianne; MacCarthy, Andrea A; Lawrence, Valerie A

2015-06-18

The STOPP study (Surgical Treatment Outcomes for Patients with Psychiatric Disorders) analyzed variation in rates and types of major surgery by serious mental illness status among patients treated in the Veterans Health Administration (VA). VA patients are veterans of United States military service who qualify for federal care by reason of disability, special service experiences, or poverty. STOPP conducted a secondary data analysis of medical record extracts for seven million VA patients treated Oct 2005-Sep 2009. The retrospective study aggregated inpatient surgery events, comorbid diagnoses, demographics, and postoperative 30-day mortality. Serious mental illness -- schizophrenia, bipolar disorder, posttraumatic stress disorder, or major depressive disorder, was identified in 12 % of VA patients. Over the 4-year study period, 321,131 patients (4.5 %) underwent surgery with same-day preoperative or immediate post-operative admission including14 % with serious mental illness. Surgery patients were older (64 vs. 61 years) and more commonly African-American, unmarried, impoverished, highly disabled (24 % vs 12 % were Priority 1), obese, with psychotic disorder (4.3 % vs 2.9 %). Among surgery patients, 3.7 % died within 30 days postop. After covariate adjustment, patients with pre-existing serious mental illness were relatively less likely to receive surgery (adjusted odds ratios 0.4-0.7). VA patients undergoing major surgery appeared, in models controlling for comorbidity and demographics, to disproportionately exclude those with serious mental illness. While VA preferentially treats the most economically and medically disadvantaged veterans, the surgery subpopulation may be especially ill, potentially warranting increased postoperative surveillance.

Individual and group cognitive processing therapy: Effectiveness across two veterans affairs posttraumatic stress disorder treatment clinics.

PubMed

Lamp, Kristen E; Avallone, Kimberly M; Maieritsch, Kelly P; Buchholz, Katherine R; Rauch, Sheila A M

2018-05-14

In accordance with Veterans Affairs (VA) policy, VA posttraumatic stress disorder (PTSD) clinics offer evidence-based treatments including cognitive processing therapy (CPT). To facilitate access to care, CPT is offered in both group and individual formats in many VA PTSD clinics. Group and individual delivery of CPT have been directly compared in active duty samples, but these findings have not been extended to VA populations. The present article directly compares the effectiveness of group and individual CPT with a written trauma account (CPT+A) across two VA PTSD clinics. Veterans (N = 465) completed initial evaluations and enrolled in either group CPT+A (N = 146) or individual CPT+A (N = 319). Self-report measures of PTSD and depression symptoms were collected at pre-, mid-, and posttreatment; combined across treatment sites; and analyzed using hierarchical linear modeling. PTSD and depression symptoms reduced significantly over the course of group and individual CPT+A. Medium treatment effects were found for group CPT+A (d = .66 for PTSD, d = .68 for depression), and large treatment effects were found for individual CPT+A (d = .96 for PTSD, d = .79 for depression). Individual CPT+A led to significantly greater PTSD and depression symptom reduction than group CPT+A, indicating that in VA outpatient PTSD clinic settings, individual CPT+A may be a more effective approach than group CPT-A. In addition, PTSD symptoms reduced significantly more for Caucasian veterans than for African American veterans during CPT+A, indicating the importance of providing culturally competent trauma-focused care. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Telemedicine broadening access to care for complex cases.

PubMed

Jue, Joshua S; Spector, Sydney A; Spector, Seth A

2017-12-01

Surgical and nonsurgical specialists are highly centralized, making access to high-quality care difficult for many Americans. We explored the feasibility, benefits, preliminary outcomes, and patient satisfaction with a new type of health visit, in which a surgical oncologist used video telecommunication to manage and treat complex cancer diseases, including patients with severe comorbidities. Patients visited local VA medical centers throughout Florida to engage in video telecommunication visits with a centralized surgical oncologist in Miami, who directed their oncology treatment. The average length of stay and rate of unplanned readmission were calculated within each organ. The total mileage saved was calculated by subtracting the distance between the patient's home address and the local VA from the distance between the patient's home address and the Miami VA. Travel costs were determined by the VA's reimbursement of $0.415/mile for health-related travel and reimbursement of $150.00 for an overnight hotel stay. A Likert scale with both positively and negatively keyed questions was used to assess patient satisfaction. In 24 mo, seven unplanned readmissions occurred among 195 operations. Patients experienced an 80.7% reduction in travel distance and saved a total of 213,007.58 miles by visiting their local VA instead of the Miami VA. Survey results indicate that 86% of patients believed that the telemedicine program made medical care more accessible. The Specialist-Directed Telemedicine Model can save patients substantial time and money by not traveling to centralized areas, while delivering greater continuity of care and patient satisfaction. Copyright © 2017 Elsevier Inc. All rights reserved.

Dynamic model of the octopus arm. II. Control of reaching movements.

PubMed

Yekutieli, Yoram; Sagiv-Zohar, Roni; Hochner, Binyamin; Flash, Tamar

2005-08-01

The dynamic model of the octopus arm described in the first paper of this 2-part series was used here to investigate the neural strategies used for controlling the reaching movements of the octopus arm. These are stereotypical extension movements used to reach toward an object. In the dynamic model, sending a simple propagating neural activation signal to contract all muscles along the arm produced an arm extension with kinematic properties similar to those of natural movements. Control of only 2 parameters fully specified the extension movement: the amplitude of the activation signal (leading to the generation of muscle force) and the activation traveling time (the time the activation wave takes to travel along the arm). We found that the same kinematics could be achieved by applying activation signals with different activation amplitudes all exceeding some minimal level. This suggests that the octopus arm could use minimal amplitudes of activation to generate the minimal muscle forces required for the production of the desired kinematics. Larger-amplitude signals would generate larger forces that increase the arm's stability against perturbations without changing the kinematic characteristics. The robustness of this phenomenon was demonstrated by examining activation signals with either a constant or a bell-shaped velocity profile. Our modeling suggests that the octopus arm biomechanics may allow independent control of kinematics and resistance to perturbation during arm extension movements.

Separation of large mammalian ventricular myosin differing in ATPase activity.

PubMed

Rupp, Heinz; Maisch, Bernhard

2007-01-01

To investigate a possible heterogeneity of human ventricular myosin, papillary muscles of patients with valvular dysfunction were examined using a modified native gel electrophoresis. Myosin was separated into 2 components termed VA and VB, whereby the VA to VB proportion appeared to depend on the ventricular load. The proportion of the faster migrating band VA was correlated (P<0.05) with end-diastolic pressure and the aortic pressure-cardiac index product. The regression based on these variables accounted for 67% of the variation in VA (R2=0.67). The VA proportion was, however, not significantly correlated with cardiac norepinephrine concentration. The ATPase activity of the 2 components of myosin was assessed from the Ca3(PO4)2 precipitation by incubating the gel in the presence of ATP and CaCl2. The ATPase activity of VA was 60% of that of VB. The VA and VB forms were observed also in the cat (31.4% VA), dog (32.1% VA), pig (28.5% VA), wild pig (33.7% VA), and roe deer (30.5% VA). VA and VB were not detected in the rat exhibiting the 3 isoforms V1, V2, and V3, rabbit (100% V3), and hare (86% V1). The data demonstrate a heterogeneity of large mammalian ventricular myosin, whereby an increased cardiac load appeared to be associated with a higher myosin VA proportion that exhibited a reduced ATPase activity.

User ratings of prosthetic usability and satisfaction in VA study to optimize DEKA arm.

PubMed

Resnik, Linda; Borgia, Matthew

2014-01-01

The Department of Veterans Affairs study to optimize the DEKA Arm provided feedback to inform optimization of the gen 2 (second-generation) prototype and evaluate the gen 3 (third-generation) prototype. This article summarizes recommendations to improve gen 2 and reports satisfaction and usability ratings of gen 2 and gen 3. Data were collected from 39 subjects; 37 subjects were included in this analysis. Of the subjects, 24 were fit with gen 2 (8 radial configuration [RC], 6 humeral configuration [HC], and 10 shoulder configuration [SC]), 13 were fit with gen 3 (4 RC, 5 HC, and 4 SC), and 5 were fit with both. Usability and satisfaction were evaluated using the Trinity Amputation and Prosthesis Experience Scale (TAPES) and study-specific usability and satisfaction scales. Descriptive statistics were examined and prototypes compared using Wilcoxon rank-sum. Results were stratified by configuration level and outcomes compared by prototype. Satisfaction and usability were greater for gen 3 than gen 2. Overall TAPES scores were similar; however, scores of the TAPES aesthetic satisfaction subscale were higher for gen 3. Compared with gen 2 users, gen 3 users were more satisfied with appearance, grips, and doffing and rated overall usability higher. Features of gen 3, including weight, external cables and wires, hand covering, and fingernails, would benefit from further optimization.

Dual redundant arm system operational quality measures and their applications - Dynamic measures

NASA Technical Reports Server (NTRS)

Lee, Sukhan; Kim, Sungbok

1990-01-01

Dual-arm dynamic operation quality measures are presented which quantify the efficiency and capability of generating Cartesian accelerations by two cooperative arms based on the analysis of dual-arm dynamic interactions. Dual-arm dynamic manipulability is defined as the efficiency of generating Cartesian accelerations under the dynamic and kinematic interactions between individual arms and an object under manipulation. The analysis of dual-arm dynamic interactions is based on the so-called Cartesian space agent model of an arm, which represents an individual arm as a force source acting upon a point mass with the effective Cartesian space arm dynamics and an environment or an object under manipulation. The Cartesian space agent model of an arm makes it possible to derive the dynamic and kinematic constraints involved in the transport, assembly and grasping modes of dual-arm cooperation. A task-oriented operational quality measure, (TOQd) is defined by evaluating dual-arm dynamic manipulability in terms of given task requirements. TOQd is used in dual-arm joint configuration optimization. Simulation results are shown. A complete set of forward dynamic equations for a dual-arm system is derived, and dual-arm dynamic operational quality measures for various modes of dual-arm cooperation allowing sliding contacts are established.

Home-based primary care and the risk of ambulatory care-sensitive condition hospitalization among older veterans with diabetes mellitus.

PubMed

Edwards, Samuel T; Prentice, Julia C; Simon, Steven R; Pizer, Steven D

2014-11-01

Primary care services based at home have the potential to reduce the likelihood of hospitalization among older adults with multiple chronic diseases. To characterize the association between enrollment in Home-Based Primary Care (HBPC), a national home care program operated by the US Department of Veterans Affairs (VA), and hospitalizations owing to an ambulatory care-sensitive condition among older veterans with diabetes mellitus. Retrospective cohort study. Patients admitted to VA and non-VA hospitals were followed up from January 1, 2006, through December 31, 2010. Veterans 67 years or older who were fee-for-service Medicare beneficiaries, were diagnosed as having diabetes mellitus and at least 1 other chronic disease, and had at least 1 admission to a VA or non-VA hospital in 2005 or 2006. Enrollment in HBPC, defined as a minimum of 2 HBPC encounters during the study period. Admission to VA and non-VA hospitals owing to an ambulatory care-sensitive condition, as measured by the Agency for Healthcare Research and Quality's Prevention Quality Indicators in VA medical records and Medicare claims. Outcomes were analyzed using distance from the veteran's residence to a VA facility that provides HBPC as an instrumental variable. Among 56 608 veterans, 1978 enrolled in HBPC. These patients were older (mean age, 79.1 vs 77.1 years) and had more chronic diseases (eg, 59.2% vs 53.5% had congestive heart failure). Multivariable predictors for HBPC enrollment included paralysis (odds ratio [OR], 2.11; 95% CI, 1.63-2.74), depression (OR, 1.99; 95% CI, 1.70-2.34), congestive heart failure (OR, 1.36; 95% CI, 1.17-1.58), and distance from the nearest HBPC-providing VA facility (OR, 0.59; 95% CI, 0.50-0.70 for >10-30 vs <5 miles). After controlling for selection using an instrumental variable analysis, HBPC was associated with a significant reduction in the probability of experiencing a hospitalization owing to an ambulatory care-sensitive condition (hazard ratio, 0.71; 95% CI, 0.57-0.89), with an absolute reduction in the probability of hospitalization of 5.8% in 1 year. Home-Based Primary Care is associated with a decreased probability of ambulatory care-sensitive condition hospitalization among elderly veterans with diabetes mellitus. In accountable care models, HBPC may have an important role in the management of older adults with multiple chronic diseases.

A Role for Myosin Va in Human Cytomegalovirus Nuclear Egress.

PubMed

Wilkie, Adrian R; Sharma, Mayuri; Pesola, Jean M; Ericsson, Maria; Fernandez, Rosio; Coen, Donald M

2018-03-15

Herpesviruses replicate and package their genomes into capsids in replication compartments within the nuclear interior. Capsids then move to the inner nuclear membrane for envelopment and release into the cytoplasm in a process called nuclear egress. We previously found that nuclear F-actin is induced upon infection with the betaherpesvirus human cytomegalovirus (HCMV) and is important for nuclear egress and capsid localization away from replication compartment-like inclusions toward the nuclear rim. Despite these and related findings, it has not been shown that any specific motor protein is involved in herpesvirus nuclear egress. In this study, we have investigated whether the host motor protein, myosin Va, could be fulfilling this role. Using immunofluorescence microscopy and coimmunoprecipitation, we observed associations between a nuclear population of myosin Va and the viral major capsid protein, with both concentrating at the periphery of replication compartments. Immunoelectron microscopy showed that nearly 40% of assembled nuclear capsids associate with myosin Va. We also found that myosin Va and major capsid protein colocalize with nuclear F-actin. Importantly, antagonism of myosin Va with RNA interference or a dominant negative mutant revealed that myosin Va is important for the efficient production of infectious virus, capsid accumulation in the cytoplasm, and capsid localization away from replication compartment-like inclusions toward the nuclear rim. Our results lead us to suggest a working model whereby human cytomegalovirus capsids associate with myosin Va for movement from replication compartments to the nuclear periphery during nuclear egress. IMPORTANCE Little is known regarding how newly assembled and packaged herpesvirus capsids move from the nuclear interior to the periphery during nuclear egress. While it has been proposed that an actomyosin-based mechanism facilitates intranuclear movement of alphaherpesvirus capsids, a functional role for any specific myosin in nuclear egress has not been reported. Furthermore, the notion that an actomyosin-based mechanism facilitates intranuclear capsid movement is controversial. Here we show that human cytomegalovirus capsids associate with nuclear myosin Va and F-actin and that antagonism of myosin Va impairs capsid localization toward the nuclear rim and nuclear egress. Together with our previous results showing that nuclear F-actin is induced upon HCMV infection and is also important for these processes, our results lend support to the hypothesis that nascent human cytomegalovirus capsids migrate to the nuclear periphery via actomyosin-based movement. These results shed light on a poorly understood viral process and the cellular machinery involved. Copyright © 2018 American Society for Microbiology.

The impact of visual impairment on self-reported visual functioning in Latinos: The Los Angeles Latino Eye Study.

PubMed

Globe, Denise R; Wu, Joanne; Azen, Stanley P; Varma, Rohit

2004-06-01

To assess the association between presenting binocular visual acuity (VA) and self-reported visual function as measured by the 25-item National Eye Institute Visual Function Questionnaire (NEI-VFQ-25). A population-based, prevalence study of eye disease in Latinos 40 years and older residing in La Puente, California (Los Angeles Latino Eye Study [LALES]). Six thousand three hundred fifty-seven Latinos 40 years and older from 6 census tracts in La Puente. All participants completed a standardized interview, including the NEI-VFQ-25 to measure visual functioning, and a detailed eye examination. Two definitions of visual impairment were used: (1) presenting binocular distance VA of 20/40 or worse and (2) presenting binocular distance VA worse than 20/40. Analysis of variance was used to determine any systematic differences in mean NEI-VFQ-25 scores by visual impairment. Regression analyses were completed (1) to determine the association of age, gender, number of systemic comorbidities, depression, and VA with self-reported visual function and (2) to estimate a visual impairment-related difference for each subscale based on differences in VA. The NEI-VFQ-25 scores in persons with visual impairment. Of the 5287 LALES participants with complete NEI-VFQ-25 data, 6.3% (including 20/40) and 4.2% (excluding 20/40) were visually impaired. In the visually impaired participants, the NEI-VFQ-25 subscale scores ranged from 46.2 (General Health) to 93.8 (Color Vision). In the regression model, only VA, depression, and number of comorbidities were significantly associated with all subscale scores (R(2) ranged from 0.09 for Ocular Pain to 0.33 for the composite score). For 9 of 11 subscales, a 5-point change was equivalent to a 1- or 2-line difference in VA. Relationships were similar regardless of the definition of visual impairment. In this population-based study of Latinos, the NEI-VFQ-25 was sensitive to differences in VA. A 5-point difference on the NEI-VFQ-25 seems to be a minimal criterion for a visual impairment-related difference. Self-reported visual function is essentially unchanged if the definition of visual impairment includes or excludes a VA of 20/40.

Development of the Veterans Healthcare Administration (VHA) Ophthalmic Surgical Outcome Database (OSOD) project and the role of ophthalmic nurse reviewers.

PubMed

Lara-Smalling, Agueda; Cakiner-Egilmez, Tulay; Miller, Dawn; Redshirt, Ella; Williams, Dale

2011-01-01

Currently, ophthalmic surgical cases are not included in the Veterans Administration Surgical Quality Improvement Project data collection. Furthermore, there is no comprehensive protocol in the health system for prospectively measuring outcomes for eye surgery in terms of safety and quality. There are 400,000 operative cases in the system per year. Of those, 48,000 (12%) are ophthalmic surgical cases, with 85% (41,000) of those being cataract cases. The Ophthalmic Surgical Outcome Database Pilot Project was developed to incorporate ophthalmology into VASQIP, thus evaluating risk factors and improving cataract surgical outcomes. Nurse reviewers facilitate the monitoring and measuring of these outcomes. Since its inception in 1778, the Veterans Administration (VA) Health System has provided comprehensive healthcare to millions of deserving veterans throughout the U.S. and its territories. Historically, the quality of healthcare provided by the VA has been the main focus of discussion because it did not meet a standard of care comparable to that of the private sector. Information regarding quality of healthcare services and outcomes data had been unavailable until 1986, when Congress mandated the VA to compare its surgical outcomes to those of the private sector (PL-99-166). 1 Risk adjustment of VA surgical outcomes began in 1987 with the Continuous Improvement in Cardiac Surgery Program (CICSP) in which cardiac surgical outcomes were reported and evaluated. 2 Between 1991 and 1993, the National VA Surgical Risk Study (NVASRS) initiated a validated risk-adjustment model for predicting surgical outcomes and comparative assessment of the quality of surgical care in 44 VA medical centers. 3 The success of NVASRS encouraged the VA to establish an ongoing program for monitoring and improving the quality of surgical care, thus developing the National Surgical Quality Improvement Program (NSQIP) in 1994. 4 According to a prospective study conducted between 1991-1997 in 123 VA medical centers by Khuri et al., the 30-day mortality and morbidity rates for major surgeries had decreased by 9% and 30%, respectively. 5 Recently renamed the VA Surgical Quality Improvement Program (VASQIP) in 2010, the quality of surgical outcomes has continued to improve among all documented surgical specialties. Ophthalmic surgery is presumed to have a very low mortality rate and therefore has not been included in the VASQIP database.

Modeling preferential water flow and solute transport in unsaturated soil using the active region model

DOE Office of Scientific and Technical Information (OSTI.GOV)

Sheng, F.; Wang, K.; Zhang, R.

2009-03-15

Preferential flow and solute transport are common processes in the unsaturated soil, in which distributions of soil water content and solute concentrations are often characterized as fractal patterns. An active region model (ARM) was recently proposed to describe the preferential flow and transport patterns. In this study, ARM governing equations were derived to model the preferential soil water flow and solute transport processes. To evaluate the ARM equations, dye infiltration experiments were conducted, in which distributions of soil water content and Cl{sup -} concentration were measured. Predicted results using the ARM and the mobile-immobile region model (MIM) were compared withmore » the measured distributions of soil water content and Cl{sup -} concentration. Although both the ARM and the MIM are two-region models, they are fundamental different in terms of treatments of the flow region. The models were evaluated based on the modeling efficiency (ME). The MIM provided relatively poor prediction results of the preferential flow and transport with negative ME values or positive ME values less than 0.4. On the contrary, predicted distributions of soil water content and Cl- concentration using the ARM agreed reasonably well with the experimental data with ME values higher than 0.8. The results indicated that the ARM successfully captured the macroscopic behavior of preferential flow and solute transport in the unsaturated soil.« less

Experimental validation of flexible robot arm modeling and control

NASA Technical Reports Server (NTRS)

Ulsoy, A. Galip

1989-01-01

Flexibility is important for high speed, high precision operation of lightweight manipulators. Accurate dynamic modeling of flexible robot arms is needed. Previous work has mostly been based on linear elasticity with prescribed rigid body motions (i.e., no effect of flexible motion on rigid body motion). Little or no experimental validation of dynamic models for flexible arms is available. Experimental results are also limited for flexible arm control. Researchers include the effects of prismatic as well as revolute joints. They investigate the effect of full coupling between the rigid and flexible motions, and of axial shortening, and consider the control of flexible arms using only additional sensors.

75 FR 61252 - Proposed Information Collection (Create Payment Request for the VA Funding Fee Payment System (VA...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-10-04

... Payment Request for the VA Funding Fee Payment System (VA FFPS); A Computer Generated Funding Fee Receipt... Payment Request for the VA Funding Fee Payment System (VA FFPS); A Computer Generated Funding Fee Receipt... information through the Federal Docket Management System (FDMS) at http://www.Regulations.gov or to Nancy J...

75 FR 61859 - Proposed Information Collection (Create Payment Request for the VA Funding Fee Payment System (VA...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-10-06

... Payment Request for the VA Funding Fee Payment System (VA FFPS); A Computer Generated Funding Fee Receipt... Payment Request for the VA Funding Fee Payment System (VA FFPS); A Computer Generated Funding Fee Receipt... information through the Federal Docket Management System (FDMS) at http://www.Regulations.gov or to Nancy J...

75 FR 57920 - Kerr-Philpott System

Federal Register 2010, 2011, 2012, 2013, 2014

2010-09-23

... schedules VA-1-B, VA-2-B, VA-3- B, VA-4-B, CP&L-1-B, CP&L-2-B, CP&L-3-B, CP&L-4-B, AP-1-B, AP-2-B, AP- 3-B..., CP&L-1-A, CP&L-2-A, CP&L-3-A, CP&L-4-A, AP-1-A, AP-2-A, AP-3-A, AP-4-A, NC-1-A, and Replacement-2... Schedules VA-1-A, VA-2-A, VA-3-A, VA-4-A, CP&L-1- A, CP&L-2-A, CP&L-3-A, CP&L-4-A, AP-1-A, AP-2-A, AP-3-A...

Medical Modeling of Particle Size Effects for CB Inhalation Hazards

DTIC Science & Technology

2015-09-01

0:: 0 D.. w 0:: ... J <C 0 -z J : 0 w ~ Defense Threat Reduction Agency 8725 John J . Kingman Road, MS-6201 Fort Belvoir, VA 22060...DTRIAC/ J9STT, 8725 JOHN J . KINGMAN ROAD, MS-6201, FT BELVOIR, VA 22060-6201, IF YOUR ADDRESS IS INCORRECT, IF YOU WISH THAT IT BE DELETED FROM...Millage, Gene E. McClellan, Bahman Asgharian, Joshua J . Bergman, Darren R. Oldson, and Sharon A. Watson Applied Research Associates, Inc. Health

An Approximate Analytical Model of Shock Waves from Underground Nuclear Explosions

DTIC Science & Technology

1990-12-01

Explosions, University of California Radiation Laboratory, Rep. UCRL -5675,1 pp. 120 134, 1959. Perret, W. R., and R. C. Bass, Free-field ground motion...Park, PA 16802 Blacksburg, VA 24061 Dr. Ralph Alewine, Ii Dr. Stephen Bratt DARPAJNMRO Center for Seismic Studies 3701 North Fairfax Drive 1300 North...DARP,,NMRO Patrick AFB, FL 3 2925-6001 3701 North Fairfax Drive Arlington, VA 222CN-171a l)r. Richard Sailor Donald L. Springer TASC, Inc. Lawrence

A Comparison in the Accuracy of Mapping Nuclear Fallout Patterns Using HPAC, HYSPLIT, DELFIC FPT and an AFIT FORTRAN95 Fallout Deposition ode

DTIC Science & Technology

2011-03-01

Capability (HPAC), HPAC 4.04 On-Line Help. Alexandria VA , April 2005. 13. Draxler, Roland R. and G.D. Hess. Description of the HYSPLIT_4 Modeling...Effects of Nuclear Weapons. Alexandria, VA : The United States Department of Defense and the United States Department of Energy, 1977. 18...77: 437-431 (3 March 1996). 25. Moroz , Brian E., Harold L. Beck, Andre Bouville, and Steven L. Simon. “Predictions of Dispersion and Deposition

Women and War

PubMed Central

Murdoch, Maureen; Bradley, Arlene; Mather, Susan H; Klein, Robert E; Turner, Carole L; Yano, Elizabeth M

2006-01-01

Most of today's 1.7 million women veterans obtain all or most of their medical care outside the VA health care system, where their veteran status is rarely recognized or acknowledged. Several aspects of women's military service have been associated with adverse psychologic and physical outcomes, and failure to assess women's veteran status, their deployment status, and military trauma history could delay identifying or treating such conditions. Yet few clinicians know of women's military history—or of military service's impact on women's subsequent health and well being. Because an individual's military service may be best understood within the historical context in which it occurred, we provide a focused historical overview of women's military contributions and their steady integration into the Armed Forces since the War for Independence. We then describe some of the medical and psychiatric conditions associated with military service. PMID:16637946

Cancer-related Imaging in the Veterans Affairs Health Care System versus Medicare: Does a System with Lower Use Exhibit Less Geographic Variation?

PubMed Central

McWilliams, J. Michael; Dalton, Jesse B.; Landrum, Mary Beth; Frakt, Austin B.; Pizer, Steven D.; Keating, Nancy L.

2014-01-01

Background Geographic variations in use of medical services have been interpreted as indirect evidence of wasteful care. Less overuse of services, however, may not be reliably associated with less geographic variation. Objective To compare average use and geographic variation in use of cancer-related imaging between fee-for-service Medicare and the Department of Veterans Affairs (VA) health care system. Design Observational analysis of cancer-related imaging from 2003–2005, using Medicare and VA utilization data linked to cancer registry data. We used multilevel models to estimate mean differences in annual imaging use between cohorts of Medicare and VA patients within geographic areas and variation in use across areas for each cohort, adjusting for sociodemographic and tumor characteristics. Setting 40 hospital referral regions. Patients Older men with lung, colorectal, or prostate cancer, including 34,475 traditional Medicare beneficiaries (Medicare cohort) and 6,835 VA patients (VA cohort). Measurements 1)Per-patient count of imaging studies for which lung, colorectal, or prostate cancer was the primary diagnosis (each study weighted by a standardized price); 2)a direct measure of overuse—advanced imaging for prostate cancer at low risk of metastasis. Results Adjusted annual use of cancer-related imaging was lower in the VA cohort than the Medicare cohort (price-weighted count, $197 vs. $379/patient; P<0.001), as was annual use of advanced imaging for prostate cancer at low risk of metastasis ($41 vs. $117/patient; P<0.001). Geographic variation in cancer-related imaging use was similar in magnitude in the VA and Medicare cohorts. Limitations Observational study design. Conclusions Use of cancer-related imaging was lower in the VA health care system than in fee-for-service Medicare, but lower use was not associated with less geographic variation. Geographic variation in service use may not be a reliable indicator of the extent of overuse. Primary Funding Source Doris Duke Charitable Foundation and Department of Veterans Affairs Office of Policy and Planning. PMID:25437407

Regional variation in post-stroke multidisciplinary rehabilitation care among veteran residents in community nursing homes.

PubMed

Jia, Huanguang; Pei, Qinglin; Sullivan, Charles T; Cowper Ripley, Diane C; Wu, Samuel S; Vogel, W Bruce; Wang, Xinping; Bidelspach, Douglas E; Hale-Gallardo, Jennifer L; Bates, Barbara E

2017-01-01

Effective post-acute multidisciplinary rehabilitation therapy improves stroke survivors' functional recovery and daily living activities. The US Department of Veterans Affairs (VA) places veterans needing post-acute institutional care in private community nursing homes (CNHs). These placements are made under the same rules and regulations across the VA health care system and through individual per diem contracts between local VA facilities and CNHs. However, there is limited information about utilization of these veterans' health services as well as the geographic variation of the service utilization. The aims of this study were to determine rehabilitation therapy and restorative nursing care utilization by veterans with stroke in VA-contracted CNHs and to assess risk-adjusted regional variations in the utilization of rehabilitation therapy and restorative nursing care. This retrospective study included all veterans diagnosed with stroke residing in VA-contracted CNHs between 2006 and 2009. Minimum Dataset (a health status assessment tool for CNH residents) for the study CNHs was linked with veterans' inpatient and outpatient data within the VA health care system. CNHs were grouped into five VA-defined geographic regions: the North Atlantic, Southeast, Midwest, Continental, and Pacific regions. A two-part model was applied estimating risk-adjusted utilization probability and average weekly utilization days. Two dependent variables were rehabilitation therapy and restorative nursing care utilization by veterans during their CNH stays. The study comprised 6,206 veterans at 2,511 CNHs. Rates for utilization of rehabilitation therapy and restorative nursing care were 75.7% and 30.1%, respectively. Veterans in North Atlantic and Southeast CNHs were significantly ( p <0.001) more likely to receive rehabilitation therapies than veterans from other regions. However, veterans in Southeast CNHs were significantly ( p <0.001) less likely to receive restorative nursing care compared with veterans in all other regions, before and after risk adjustment. The majority of veterans with stroke received rehabilitation therapy, and about one-third had restorative nursing care during their stay at VA-contracted CNHs. Significant regional variations in weekly days for rehabilitation therapy and restorative nursing care utilization were observed even after adjusting for potential risk factors.

Modeling veterans healthcare administration disclosure processes :

DOE Office of Scientific and Technical Information (OSTI.GOV)

Beyeler, Walter E; DeMenno, Mercy B.; Finley, Patrick D.

As with other large healthcare organizations, medical adverse events at the Department of Veterans Affairs (VA) facilities can expose patients to unforeseen negative risks. VHA leadership recognizes that properly handled disclosure of adverse events can minimize potential harm to patients and negative consequences for the effective functioning of the organization. The work documented here seeks to help improve the disclosure process by situating it within the broader theoretical framework of issues management, and to identify opportunities for process improvement through modeling disclosure and reactions to disclosure. The computational model will allow a variety of disclosure actions to be tested acrossmore » a range of incident scenarios. Our conceptual model will be refined in collaboration with domain experts, especially by continuing to draw on insights from VA Study of the Communication of Adverse Large-Scale Events (SCALE) project researchers.« less

Single-arm phase II trial design under parametric cure models.

PubMed

Wu, Jianrong

2015-01-01

The current practice of designing single-arm phase II survival trials is limited under the exponential model. Trial design under the exponential model may not be appropriate when a portion of patients are cured. There is no literature available for designing single-arm phase II trials under the parametric cure model. In this paper, a test statistic is proposed, and a sample size formula is derived for designing single-arm phase II trials under a class of parametric cure models. Extensive simulations showed that the proposed test and sample size formula perform very well under different scenarios. Copyright © 2015 John Wiley & Sons, Ltd.

Spatiotemporal integration for tactile localization during arm movements: a probabilistic approach.

PubMed

Maij, Femke; Wing, Alan M; Medendorp, W Pieter

2013-12-01

It has been shown that people make systematic errors in the localization of a brief tactile stimulus that is delivered to the index finger while they are making an arm movement. Here we modeled these spatial errors with a probabilistic approach, assuming that they follow from temporal uncertainty about the occurrence of the stimulus. In the model, this temporal uncertainty converts into a spatial likelihood about the external stimulus location, depending on arm velocity. We tested the prediction of the model that the localization errors depend on arm velocity. Participants (n = 8) were instructed to localize a tactile stimulus that was presented to their index finger while they were making either slow- or fast-targeted arm movements. Our results confirm the model's prediction that participants make larger localization errors when making faster arm movements. The model, which was used to fit the errors for both slow and fast arm movements simultaneously, accounted very well for all the characteristics of these data with temporal uncertainty in stimulus processing as the only free parameter. We conclude that spatial errors in dynamic tactile perception stem from the temporal precision with which tactile inputs are processed.

Diagnostic cost groups (DCGs) and concurrent utilization among patients with substance abuse disorders.

PubMed

Rosen, Amy K; Loveland, Susan A; Anderson, Jennifer J; Hankin, Cheryl S; Breckenridge, James N; Berlowitz, Dan R

2002-08-01

To assess the performance of Diagnostic Cost Groups (DCGs) in explaining variation in concurrent utilization for a defined subgroup, patients with substance abuse (SA) disorders, within the Department of Veterans Affairs (VA). A 60 percent random sample of veterans who used health care services during Fiscal Year (FY) 1997 was obtained from VA administrative databases. Patients with SA disorders (13.3 percent) were identified from primary and secondary ICD-9-CM diagnosis codes. Concurrent risk adjustment models were fitted and tested using the DCG/HCC model. Three outcome measures were defined: (1) "service days" (the sum of a patient's inpatient and outpatient visit days), (2) mental health/substance abuse (MH/SA) service days, and (3) ambulatory provider encounters. To improve model performance, we ran three DCG/HCC models with additional indicators for patients with SA disorders. To create a single file of veterans who used health care services in FY 1997, we merged records from all VA inpatient and outpatient files. Adding indicators for patients with mild/moderate SA disorders did not appreciably improve the R-squares for any of the outcome measures. When indicators were added for patients with severe SA who were in the most costly category, the explanatory ability of the models was modestly improved for all three outcomes. Modifying the DCG/HCC model with additional markers for SA modestly improved homogeneity and model prediction. Because considerable variation still remained after modeling, we conclude that health care systems should evaluate "off-the-shelf" risk adjustment systems before applying them to their own populations.

Diagnostics Cost Groups and Concurrent Utilization among Patients

PubMed Central

Rosen, Amy K; Loveland, Susan A; Anderson, Jennifer J; Hankin, Cheryl S; Breckenridge, James N; Berlowitz, Dan R

2002-01-01

Objective To assess the performance of Diagnostic Cost Groups (DCGs) in explaining variation in concurrent utilization for a defined subgroup, patients with substance abuse (SA) disorders, within the Department of Veterans Affairs (VA). Data Sources A 60 percent random sample of veterans who used health care services during Fiscal Year (FY) 1997 was obtained from VA administrative databases. Patients with SA disorders (13.3 percent) were identified from primary and secondary ICD-9-CM diagnosis codes. Study Design Concurrent risk adjustment models were fitted and tested using the DCG/HCC model. Three outcome measures were defined: (1) “service days” (the sum of a patient's inpatient and outpatient visit days), (2) mental health/substance abuse (MH/SA) service days, and (3) ambulatory provider encounters. To improve model performance, we ran three DCG/HCC models with additional indicators for patients with SA disorders. Data Collection To create a single file of veterans who used health care services in FY 1997, we merged records from all VA inpatient and outpatient files. Principal Findings Adding indicators for patients with mild/moderate SA disorders did not appreciably improve the R-squares for any of the outcome measures. When indicators were added for patients with severe SA who were in the most costly category, the explanatory ability of the models was modestly improved for all three outcomes. Conclusions Modifying the DCG/HCC model with additional markers for SA modestly improved homogeneity and model prediction. Because considerable variation still remained after modeling, we conclude that health care systems should evaluate “off-the-shelf” risk adjustment systems before applying them to their own populations. PMID:12236385

DOE Office of Scientific and Technical Information (OSTI.GOV)

Gebis, Joseph; Oliker, Leonid; Shalf, John

The disparity between microprocessor clock frequencies and memory latency is a primary reason why many demanding applications run well below peak achievable performance. Software controlled scratchpad memories, such as the Cell local store, attempt to ameliorate this discrepancy by enabling precise control over memory movement; however, scratchpad technology confronts the programmer and compiler with an unfamiliar and difficult programming model. In this work, we present the Virtual Vector Architecture (ViVA), which combines the memory semantics of vector computers with a software-controlled scratchpad memory in order to provide a more effective and practical approach to latency hiding. ViVA requires minimal changesmore » to the core design and could thus be easily integrated with conventional processor cores. To validate our approach, we implemented ViVA on the Mambo cycle-accurate full system simulator, which was carefully calibrated to match the performance on our underlying PowerPC Apple G5 architecture. Results show that ViVA is able to deliver significant performance benefits over scalar techniques for a variety of memory access patterns as well as two important memory-bound compact kernels, corner turn and sparse matrix-vector multiplication -- achieving 2x-13x improvement compared the scalar version. Overall, our preliminary ViVA exploration points to a promising approach for improving application performance on leading microprocessors with minimal design and complexity costs, in a power efficient manner.« less

Do Older Rural and Urban Veterans Experience Different Rates of Unplanned Readmission to VA and Non-VA Hospitals?

ERIC Educational Resources Information Center

Weeks, William B.; Lee, Richard E.; Wallace, Amy E.; West, Alan N.; Bagian, James P.

2009-01-01

Context: Unplanned readmission within 30 days of discharge is an indicator of hospital quality. Purpose: We wanted to determine whether older rural veterans who were enrolled in the VA had different rates of unplanned readmission to VA or non-VA hospitals than their urban counterparts. Methods: We used the combined VA/Medicare dataset to examine…

Home Health Care and Patterns of Subsequent VA and Medicare Health Care Utilization for Veterans

ERIC Educational Resources Information Center

Van Houtven, Courtney Harold; Jeffreys, Amy S.; Coffman, Cynthia J.

2008-01-01

Purpose: The Veterans Affairs or VA health care system is in the process of significantly expanding home health care (HOC) nationwide. We describe VA HHC use in 2003 for all VA HHC users from 2002; we examine whether VA utilization across a broad spectrum of services differed for a sample of VA HHC users and their propensity-score-matched…

Veterans Affairs general surgery service: the last bastion of integrated specialty care.

PubMed

Poteet, Stephen; Tarpley, Margaret; Tarpley, John L; Pearson, A Scott

2011-11-01

In a time of increasing specialization, academic training institutions provide a compartmentalized learning environment that often does not reflect the broad clinical experience of general surgery practice. This study aimed to evaluate the contribution of the Veterans Affairs (VA) general surgery surgical experience to both index Accreditation Council for Graduate Medical Education (ACGME) requirements and as a unique integrated model in which residents provide concurrent care of multiple specialty patients. Institutional review board approval was obtained for retrospective analysis of electronic medical records involving all surgical cases performed by the general surgery service from 2005 to 2009 at the Nashville VA. Over a 5-year span general surgery residents spent an average of 5 months on the VA general surgery service, which includes a postgraduate year (PGY)-5, PGY-3, and 2 PGY-1 residents. Surgeries involved the following specialties: surgical oncology, endocrine, colorectal, hepatobiliary, transplant, gastrointestinal laparoscopy, and elective and emergency general surgery. The surgeries were categorized according to ACGME index requirements. A total of 2,956 surgeries were performed during the 5-year period from 2005 through 2009. Residents participated in an average of 246 surgeries during their experience at the VA; approximately 50 cases are completed during the chief year. On the VA surgery service alone, 100% of the ACGME requirement was met for the following categories: endocrine (8 cases); skin, soft tissue, and breast (33 cases); alimentary tract (78 cases); and abdominal (88 cases). Approximately 50% of the ACGME requirement was met for liver, pancreas, and basic laparoscopic categories. The VA hospital provides an authentic, broad-based, general surgery training experience that integrates complex surgical patients simultaneously. Opportunities for this level of comprehensive care are decreasing or absent in many general surgery training programs. The increasing level of responsibility and simultaneous care of multiple specialty patients through the VA hospital systems offers a crucial experience for those pursuing a career in general surgery. Published by Elsevier Inc.

Absence of race- or gender-specific income disparities among full-time white and Asian general internists working for the Veterans Administration.

PubMed

Weeks, William B; Wallace, Amy E

2010-02-01

Gender-based, but not race-based, income disparities exist among general internists who practice medicine in the private sector. The aim of this study was to assess whether race- or gender-based income disparities existed among full-time white and Asian general internists who worked for the Veterans Health Administration of the US Department of Veterans Affairs (VA) between fiscal years 2004 and 2007, and whether any disparities changed after the VA enacted physician pay reform in early 2006. A retrospective study was conducted of all nonsupervisory, board-certified, full-time white or Asian VA general internists who did not change their location of practice between fiscal years 2004 and 2007. A longitudinal cohort design and linear regression modeling, adjusted for physician characteristics, were used to compare race- and gender-specific incomes in fiscal years 2004-2007. A total of 176 physicians were included in the study: 82 white males, 33 Asian males, 30 white females, and 31 Asian females. In all fiscal years examined, white males had the highest mean annual incomes, though not statistically significantly so. Regression analyses for fiscal years 2004 through 2006 revealed that physician age and years of service were predictive of total income. After physician pay reform was enacted, Asian male VA primary care physicians had higher annual incomes than did physicians in all other race or gender categories, after adjustment for age and years of VA service, though these differences were not statistically significant. No significant gender-based income disparities were noted among these white and Asian VA physicians. Our findings for white and Asian general internists suggest that the VA' s goal of maintaining a racially diverse workforce may have been effected, in part, through use of market pay among primary care general internists. Copyright 2010. Published by Elsevier Inc.

The 5'-end heterogeneity of adenovirus virus-associated RNAI contributes to the asymmetric guide strand incorporation into the RNA-induced silencing complex.

PubMed

Xu, Ning; Gkountela, Sofia; Saeed, Khalid; Akusjärvi, Göran

2009-11-01

Human Adenovirus type 5 encodes two short RNA polymerase III transcripts, the virus-associated (VA) RNAI and VA RNAII, which can adopt stable hairpin structures that resemble micro-RNA precursors. The terminal stems of the VA RNAs are processed into small RNAs (mivaRNAs) that are incorporated into RISC. It has been reported that VA RNAI has two transcription initiation sites, which produce two VA RNAI species; a major species, VA RNAI(G), which accounts for 75% of the VA RNAI pool, and a minor species, VA RNAI(A), which initiates transcription three nucleotides upstream compared to VA RNAI(G). We show that this 5'-heterogeneity results in a dramatic difference in RISC assembly. Thus, both VA RNAI(G) and VA RNAI(A) are processed by Dicer at the same position in the terminal stem generating the same 3'-strand mivaRNA. This mivaRNA is incorporated into RISC with 200-fold higher efficiency compared to the 5'-strand of mivaRNAI. Of the small number of 5'-strands used in RISC assembly only VA RNAI(A) generated active RISC complexes. We also show that the 3'-strand of mivaRNAI, although being the preferred substrate for RISC assembly, generates unstable RISC complexes with a low in vitro cleavage activity, only around 2% compared to RISC assembled on the VA RNAI(A) 5'-strand.

Home health care and patterns of subsequent VA and medicare health care utilization for veterans.

PubMed

Van Houtven, Courtney Harold; Jeffreys, Amy S; Coffman, Cynthia J

2008-10-01

The Veterans Affairs or VA health care system is in the process of significantly expanding home health care (HHC) nationwide. We describe VA HHC use in 2003 for all VA HHC users from 2002; we examine whether VA utilization across a broad spectrum of services differed for a sample of VA HHC users and their propensity-score-matched controls. We also consider crossover between the VA and Medicare. This is a retrospective study using propensity score and stratified analysis to control for selection bias on observable characteristics. We examined the full cohort of 2002 VA HHC users (n = 24,169) and a 2:1 sample of age- and race-based nonusers (n = 53,356). Utilization measures included VA and Medicare outpatient, inpatient, nursing home, and hospice use, as well as VA home-based primary care, respite care, and adult day health care. VA HHC users had a higher absolute probability of outpatient use by around 3%, of inpatient use by 12%, and nursing home use by 6% than their propensity-score-matched controls. Veterans who used HHC services had a higher rate of VA service use in the subsequent year than controls did, even after we adjusted for differences in observed health status, eligibility advantages, and supplemental insurance status. High utilization for VA home health users spilled over into high Medicare utilization.

Regulation of resveratrol production in Vitis amurensis cell cultures by calcium-dependent protein kinases.

PubMed

Aleynova, O A; Dubrovina, A S; Manyakhin, A Y; Karetin, Y A; Kiselev, K V

2015-02-01

Resveratrol is a naturally occurring plant stilbene that exhibits a wide range of valuable biological and pharmacological properties. Although the beneficial effects of trans-resveratrol to human health and plant protection against fungal pathogens are well-established, little is known about the molecular mechanisms regulating stilbene biosynthesis in plant cells. It has been recently shown that overexpression of the calcium-dependent protein kinase VaCPK20 gene considerably increased resveratrol accumulation in cell cultures of Vitis amurensis. It is possible that calcium-dependent protein kinases (CDPKs) play an important role in the regulation of resveratrol biosynthesis. In the present work, we investigated the effects of overexpression of other members of the CDPK multigene family (VaCPK9, VaCPK13, VaCPK21, and VaCPK29) on resveratrol accumulation and growth parameters of grape cell cultures. The obtained data show that overexpression of VaCPK29 increased resveratrol content 1.6-2.4-fold and fresh biomass accumulation 1.1-1.4-fold in the four independently transformed cell lines of V. amurensis compared with that in the empty vector-transformed calli. However, overexpression of the VaCPK9, VaCPK13, and VaCPK21 genes did not considerably affect resveratrol content and fresh/dry biomass accumulation in the independently transformed cell lines of V. amurensis. VaCPK29-transformed calli were capable of producing between 1.02 and 1.39 mg/l of resveratrol, while the control calli produced 0.48 to 0.79 mg/l of resveratrol. The data indicate that the VaCPK9, VaCPK13, and VaCPK21 genes are not involved in the regulation of stilbene biosynthesis in grape cells, while the VaCPK29 and VaCPK20 genes are implicated in resveratrol biosynthesis as positive regulators.

Impact of the REACH II and REACH VA Dementia Caregiver Interventions on Healthcare Costs.

PubMed

Nichols, Linda O; Martindale-Adams, Jennifer; Zhu, Carolyn W; Kaplan, Erin K; Zuber, Jeffrey K; Waters, Teresa M

2017-05-01

Examine caregiver and care recipient healthcare costs associated with caregivers' participation in Resources for Enhancing Alzheimer's Caregivers Health (REACH II or REACH VA) behavioral interventions to improve coping skills and care recipient management. RCT (REACH II); propensity-score matched, retrospective cohort study (REACH VA). Five community sites (REACH II); 24 VA facilities (REACH VA). Care recipients with Alzheimer's disease and related dementias (ADRD) and their caregivers who participated in REACH II study (analysis sample of 110 caregivers and 197 care recipients); care recipients whose caregivers participated in REACH VA and a propensity matched control group (analysis sample of 491). Previously collected data plus Medicare expenditures (REACH II) and VA costs plus Medicare expenditures (REACH VA). There was no increase in VA or Medicare expenditures for care recipients or their caregivers who participated in either REACH intervention. For VA care recipients, REACH was associated with significantly lower total VA costs of care (33.6%). VA caregiver cost data was not available. In previous research, both REACH II and REACH VA have been shown to provide benefit for dementia caregivers at a cost of less than $5/day; however, concerns about additional healthcare costs may have hindered REACH's widespread adoption. Neither REACH intervention was associated with additional healthcare costs for caregivers or patients; in fact, for VA patients, there were significantly lower healthcare costs. The VA costs savings may be related to the addition of a structured format for addressing the caregiver's role in managing complex ADRD care to an existing, integrated care system. These findings suggest that behavioral interventions are a viable mechanism to support burdened dementia caregivers without additional healthcare costs. © 2017, Copyright the Authors Journal compilation © 2017, The American Geriatrics Society.

Prenatal Care for Women Veterans Who Use Department of Veterans Affairs Health Care.

PubMed

Katon, Jodie G; Washington, Donna L; Cordasco, Kristina M; Reiber, Gayle E; Yano, Elizabeth M; Zephyrin, Laurie C

2015-01-01

The number of women Veterans of childbearing age enrolling in Department of Veterans Affairs (VA) health care is increasing. Our objective was to describe characteristics of women veterans and resumption of VA care after delivery by use of VA prenatal benefits. We used data from the National Survey of Women Veterans, a population-based survey. VA-eligible women veterans with at least one live birth who had ever used VA and were younger than 45 years when VA prenatal benefits became available were categorized based on self-reported receipt of VA prenatal benefits. Characteristics of by use of VA prenatal benefits were compared using χ2 tests with Rao-Scott adjustment. All analyses used sampling weights. In our analytic sample, of those who potentially had the opportunity to use VA prenatal benefits, 25% used these benefits and 75% did not. Compared with women veterans not using VA prenatal benefits, those who did were more likely to be 18 to 24 years old (39.9% vs. 3.7%; p=.03), and more likely to have self-reported diagnosed depression (62.5% vs. 24.5%; p=.02) and current depression or posttraumatic stress disorder (PTSD) symptoms (depression, 46.1% vs. 8% [p=.02]; PTSD, 52.5% vs. 14.8% [p=.02]). Compared with women veterans not using VA prenatal benefits, those who did were more likely to resume VA use after delivery (p<.001). Pregnant women veterans who use VA prenatal benefits are a high-risk group. Among those who opt not to use these benefits, pregnancy is an important point of attrition from VA health care, raising concerns regarding retention of women veterans within VA and continuity of care. Published by Elsevier Inc.

Modeling, design, and control of flexible manipulator arms: Status and trends

NASA Technical Reports Server (NTRS)

Book, Wayne J.

1989-01-01

The desire for higher performance manipulators has lead to dynamic behavior in which the flexibility is an essential aspect. The mathematical representations commonly used in modeling flexible arms and arms with flexible drives are examined first. Then design considerations directly arising from the flexible nature of the arm are discussed. Finally, controls of joints for general and tip motion are discussed.

A dynamic model for generating actuator specifications for small arms barrel active stabilization

NASA Astrophysics Data System (ADS)

Pathak, Anupam; Brei, Diann; Luntz, Jonathan; Lavigna, Chris

2006-03-01

Due to stresses encountered in combat, it is known that soldier marksmanship noticeably decreases regardless of prior training. Active stabilization systems in small arms have potential to address this problem to increase soldier survivability and mission effectiveness. The key to success is proper actuator design, but this is highly dependent on proper specification which is challenging due to the human/weapon interaction. This paper presents a generic analytical dynamic model which is capable of defining the necessary actuation specifications for a wide range of small arms platforms. The model is unique because it captures the human interface--shoulder and arm--that introduces the jitter disturbance in addition to the geometry, inertial properties and active stabilization stiffness of the small arms platform. Because no data to date is available for actual shooter-induced disturbance in field conditions, a method is given using the model to back-solve from measured shooting range variability data the disturbance amplitude information relative to the input source (arm or shoulder). As examples of the applicability of the model to various small arms systems, two different weapon systems were investigated: the M24 sniper weapon and the M16 assault rifle. In both cases, model based simulations provided valuable insight into impact on the actuation specifications (force, displacement, phase, frequency) due to the interplay of the human-weapon-active stabilization interface including the effect of shooter-disturbance frequency, disturbance location (shoulder vs. arm), and system parameters (stiffness, barrel rotation).

Dynamic model of the octopus arm. I. Biomechanics of the octopus reaching movement.

PubMed

Yekutieli, Yoram; Sagiv-Zohar, Roni; Aharonov, Ranit; Engel, Yaakov; Hochner, Binyamin; Flash, Tamar

2005-08-01

The octopus arm requires special motor control schemes because it consists almost entirely of muscles and lacks a rigid skeletal support. Here we present a 2D dynamic model of the octopus arm to explore possible strategies of movement control in this muscular hydrostat. The arm is modeled as a multisegment structure, each segment containing longitudinal and transverse muscles and maintaining a constant volume, a prominent feature of muscular hydrostats. The input to the model is the degree of activation of each of its muscles. The model includes the external forces of gravity, buoyancy, and water drag forces (experimentally estimated here). It also includes the internal forces generated by the arm muscles and the forces responsible for maintaining a constant volume. Using this dynamic model to investigate the octopus reaching movement and to explore the mechanisms of bend propagation that characterize this movement, we found the following. 1) A simple command producing a wave of muscle activation moving at a constant velocity is sufficient to replicate the natural reaching movements with similar kinematic features. 2) The biomechanical mechanism that produces the reaching movement is a stiffening wave of muscle contraction that pushes a bend forward along the arm. 3) The perpendicular drag coefficient for an octopus arm is nearly 50 times larger than the tangential drag coefficient. During a reaching movement, only a small portion of the arm is oriented perpendicular to the direction of movement, thus minimizing the drag force.

Myosin Va binding to neurofilaments is essential for correct myosin Va distribution and transport and neurofilament density

PubMed Central

Rao, Mala V.; Engle, Linda J.; Mohan, Panaiyur S.; Yuan, Aidong; Qiu, Dike; Cataldo, Anne; Hassinger, Linda; Jacobsen, Stephen; Lee, Virginia M-Y.; Andreadis, Athena; Julien, Jean-Pierre; Bridgman, Paul C.; Nixon, Ralph A.

2002-01-01

The identification of molecular motors that modulate the neuronal cytoskeleton has been elusive. Here, we show that a molecular motor protein, myosin Va, is present in high proportions in the cytoskeleton of mouse CNS and peripheral nerves. Immunoelectron microscopy, coimmunoprecipitation, and blot overlay analyses demonstrate that myosin Va in axons associates with neurofilaments, and that the NF-L subunit is its major ligand. A physiological association is indicated by observations that the level of myosin Va is reduced in axons of NF-L–null mice lacking neurofilaments and increased in mice overexpressing NF-L, but unchanged in NF-H–null mice. In vivo pulse-labeled myosin Va advances along axons at slow transport rates overlapping with those of neurofilament proteins and actin, both of which coimmunoprecipitate with myosin Va. Eliminating neurofilaments from mice selectively accelerates myosin Va translocation and redistributes myosin Va to the actin-rich subaxolemma and membranous organelles. Finally, peripheral axons of dilute-lethal mice, lacking functional myosin Va, display selectively increased neurofilament number and levels of neurofilament proteins without altering axon caliber. These results identify myosin Va as a neurofilament-associated protein, and show that this association is essential to establish the normal distribution, axonal transport, and content of myosin Va, and the proper numbers of neurofilaments in axons. PMID:12403814

A comprehensive payment model for short- and long-stay psychiatric patients.

PubMed

Fries, B E; Durance, P W; Nerenz, D R; Ashcraft, M L

1993-01-01

In this article, a payment model is developed for a hospital system with both acute- and chronic-stay psychiatric patients. "Transition pricing" provides a balance between the incentives of an episode-based system and the necessity of per diem long-term payments. Payment is dependent on two new psychiatric resident classification systems for short- and long-term stays. Data on per diem cost of inpatient care, by day of stay, was computed from a sample of 2,968 patients from 100 psychiatric units in 51 Department of Veterans Affairs (VA) Medical Centers. Using a 9-month cohort of all VA psychiatric discharges nationwide (79,337 with non-chronic stays), profits and losses were simulated.

A Quantitative Risk Analysis of Deficient Contractor Business System

DTIC Science & Technology

2012-04-30

Mathematically , Jorion’s concept of VaR looks like this: ( > ) ≤ 1 − (2) where, = ^Åèìáëáíáçå=oÉëÉ~êÅÜ=éêçÖê~ãW= `êÉ~íáåÖ=póåÉêÖó=Ñçê=fåÑçêãÉÇ=ÅÜ...presents three models for calculating VaR. The local-valuation method determines the value of a portfolio once and uses mathematical derivatives...management. In the insurance industry, actuarial data is applied to model risk and risk capital reserves are “held” to cover the expected values for

Fireworks algorithm for mean-VaR/CVaR models

NASA Astrophysics Data System (ADS)

Zhang, Tingting; Liu, Zhifeng

2017-10-01

Intelligent algorithms have been widely applied to portfolio optimization problems. In this paper, we introduce a novel intelligent algorithm, named fireworks algorithm, to solve the mean-VaR/CVaR model for the first time. The results show that, compared with the classical genetic algorithm, fireworks algorithm not only improves the optimization accuracy and the optimization speed, but also makes the optimal solution more stable. We repeat our experiments at different confidence levels and different degrees of risk aversion, and the results are robust. It suggests that fireworks algorithm has more advantages than genetic algorithm in solving the portfolio optimization problem, and it is feasible and promising to apply it into this field.

VA Health Service Utilization for Homeless and Low-income Veterans

PubMed Central

Gabrielian, Sonya; Yuan, Anita H.; Andersen, Ronald M.; Rubenstein, Lisa V.; Gelberg, Lillian

2016-01-01

Background The US Department of Housing and Urban Development (HUD)-VA Supportive Housing (VASH) program—the VA’s Housing First effort—is central to efforts to end Veteran homelessness. Yet, little is known about health care utilization patterns associated with achieving HUD-VASH housing. Objectives We compare health service utilization at the VA Greater Los Angeles among: (1) formerly homeless Veterans housed through HUD-VASH (HUD-VASH Veterans); (2) currently homeless Veterans; (3) housed, low-income Veterans not in HUD-VASH; and (4) housed, not low-income Veterans. Research Design We performed a secondary database analysis of Veterans (n = 62,459) who received VA Greater Los Angeles care between October 1, 2010 and September 30, 2011. We described medical/surgical and mental health utilization [inpatient, outpatient, and emergency department (ED)]. We controlled for demographics, need, and primary care use in regression analyses of utilization data by housing and income status. Results HUD-VASH Veterans had more inpatient, outpatient, and ED use than currently homeless Veterans. Adjusting for demographics and need, HUD-VASH Veterans and the low-income housed Veterans had similar likelihoods of medical/surgical inpatient and outpatient utilization, compared with the housed, not low-income group. Adjusting first for demographics and need (model 1), then also for primary care use (model 2), HUD-VASH Veterans had the greatest decrease in incident rates of specialty medical/surgical, mental health, and ED care from models 1 to 2, becoming similar to the currently homeless, compared with the housed, not low-income group. Conclusions Our findings suggest that currently homeless Veterans underuse health care relative to housed Veterans. HUD-VASH may address this disparity by providing housing and linkages to primary care. PMID:24714583

Comparing Catheter-associated Urinary Tract Infection Prevention Programs Between VA and Non-VA Nursing Homes

PubMed Central

Mody, Lona; Greene, M. Todd; Saint, Sanjay; Meddings, Jennifer; Trautner, Barbara W.; Wald, Heidi L.; Crnich, Christopher; Banaszak-Holl, Jane; McNamara, Sara E.; King, Beth J.; Hogikyan, Robert; Edson, Barbara; Krein, Sarah L.

2018-01-01

OBJECTIVE The impact of healthcare system integration on infection prevention programs is unknown. Using catheter-associated urinary tract infection (CAUTI) prevention as an example, we hypothesize that U.S. Department of Veterans Affairs (VA) nursing homes have a more robust infection prevention infrastructure due to integration and centralization compared with non-VA nursing homes. SETTING VA and non-VA nursing homes participating in the “AHRQ Safety Program for Long-term Care” collaborative. METHODS Nursing homes provided baseline information about their infection prevention programs to assess strengths and gaps related to CAUTI prevention. RESULTS A total of 353 (71%; 47 VA, 306 non-VA) of 494 nursing homes from 41 states responded. VA nursing homes reported more hours/week devoted to infection prevention-related activities (31 vs. 12 hours, P<.001), and were more likely to have committees that reviewed healthcare-associated infections. Compared with non-VA facilities, a higher percentage of VA nursing homes reported tracking CAUTI rates (94% vs. 66%, P<.001), sharing CAUTI data with leadership (94% vs. 70%, P=.014) and nursing personnel (85% vs. 56%, P=.003). However, fewer VA nursing homes reported having policies for appropriate catheter use (64% vs. 81%, P=.004) and catheter insertion (83% vs. 94%, P=.004). CONCLUSIONS Among nursing homes participating in an AHRQ-funded collaborative, VA and non-VA nursing homes differed in their approach to CAUTI prevention. Best practices from both settings should be applied universally to create an optimal infection prevention program within emerging integrated healthcare systems. PMID:27917728

77 FR 70893 - Authorization for Non-VA Medical Services

Federal Register 2010, 2011, 2012, 2013, 2014

2012-11-28

... professions, Health records, Homeless, Mental health programs, Nursing homes, Reporting and recordkeeping... restrictive modes of healthcare delivery. Although VA has made great strides to expand the delivery of... expand VA's authority to provide non-VA medical services under the non- VA care authority. As amended...

GUIDELINES TO ASSESSING REGIONAL VULNERABILITIES

EPA Science Inventory

Decision-makers today face increasingly complex environmental problems that require integrative and innovative approaches for analyzing, modeling, and interpreting various types of information. ReVA acknowledges this need and is designed to evaluate methods and models for synthe...

New velocimetry and revised cartography of the spiral arms in the Milky Way—a consistent symbiosis

DOE Office of Scientific and Technical Information (OSTI.GOV)

Vallée, Jacques P., E-mail: jacques.vallee@cnrc.gc.ca

Recent advances in the determinations of the positions (pitch angle, shape, numbers, interarm separation) and velocities (rotation curve) of the spiral arms are evaluated and compared to previous determinations. Based on these results, an average cartographic model is developed that fits the means of basic input data and provides predictions for the locations of the arms in the Milky Way, for each galactic quadrant. For each spiral arm segment in each galactic quadrant, the LSR radial velocities are calculated for the radial distance as well as for its galactic longitude. From our velocimetric model, arm intercepts (between line of sightsmore » and spiral arms) are indicated in velocity space and may be used to find the distance and velocity to any arm, in a given longitude range. Velocity comparisons between model predictions and published CO velocity distribution are done for each galactic quadrant, with good results. Our velocimetric model is not hydromagnetic in character, nor is it a particle-simulation scheme, yet it is simple to use for comparisons with the observations and it is in symbiosis and consistent with our cartographic model (itself simple to use for comparisons with observations). A blending in velocity of the Perseus and Cygnus arms is further demonstrated, as well as an apparent longitude-velocity blending of the starting points of the four spiral arms near 4 kpc (not a physical ring). An integrated (distance, velocity) model for the mass in the disk is employed, to yield the total mass of 3.0 × 10{sup 11} M{sub ☉} within a galactic radius of 28 kpc.« less

Association between women veterans' experiences with VA outpatient health care and designation as a women's health provider in primary care clinics.

PubMed

Bastian, Lori A; Trentalange, Mark; Murphy, Terrence E; Brandt, Cynthia; Bean-Mayberry, Bevanne; Maisel, Natalya C; Wright, Steven M; Gaetano, Vera S; Allore, Heather; Skanderson, Melissa; Reyes-Harvey, Evelyn; Yano, Elizabeth M; Rose, Danielle; Haskell, Sally

2014-01-01

Women veterans comprise a small percentage of Department of Veterans Affairs (VA) health care users. Prior research on women veterans' experiences with primary care has focused on VA site differences and not individual provider characteristics. In 2010, the VA established policy requiring the provision of comprehensive women's health care by designated women's health providers (DWHPs). Little is known about the quality of health care delivered by DWHPs and women veterans' experience with care from these providers. Secondary data were obtained from the VA Survey of Healthcare Experience of Patients (SHEP) using the Consumer Assessment of Healthcare Providers and Systems (CAHPS) patient-centered medical home (PCMH) survey from March 2012 through February 2013, a survey designed to measure patient experience with care and the DWHPs Assessment of Workforce Capacity that discerns between DWHPs versus non-DWHPs. Of the 28,994 surveys mailed to women veterans, 24,789 were seen by primary care providers and 8,151 women responded to the survey (response rate, 32%). A total of 3,147 providers were evaluated by the SHEP-CAHPS-PCMH survey (40%; n = 1,267 were DWHPs). In a multivariable model, patients seen by DWHPs (relative risk, 1.02; 95% CI, 1.01-1.04) reported higher overall experiences with care compared with patients seen by non-DWHPs. The main finding is that women veterans' overall experiences with outpatient health care are slightly better for those receiving care from DWHPs compared with those receiving care from non-DWHPs. Our findings have important policy implications for how to continue to improve women veterans' experiences. Our work provides support to increase access to DWHPs at VA primary care clinics. Published by Elsevier Inc.

Association between Women Veterans’ Experiences with VA Outpatient Healthcare and Designation as a Women’s Health Provider in Primary Care Clinics

PubMed Central

Bastian, Lori A.; Trentalange, Mark; Murphy, Terrence E.; Brandt, Cynthia; Bean-Mayberry, Bevanne; Maisel, Natalya C.; Wright, Steven M.; Gaetano, Vera S.; Allore, Heather; Skanderson, Melissa; Reyes-Harvey, Evelyn; Yano, Elizabeth M.; Rose, Danielle; Haskell, Sally

2016-01-01

Background Women Veterans comprise a small percentage of VA healthcare users. Prior research on women Veterans’ experiences with primary care has focused on VA site differences and not individual provider characteristics. In 2010, the VA established policy requiring the provision of comprehensive women’s healthcare by designated women’s health providers (DWHPs). Little is known about the quality of healthcare delivered by DWHPs and women Veterans’ experience with care from these providers. Methods Secondary data were obtained from the VA Survey of Healthcare Experience of Patients (SHEP) using the Consumer Assessment of Healthcare Providers and Systems (CAHPS) patient-centered medical home (PCMH) survey from March 2012 through February 2013, a survey designed to measure patient experience with care and the DWHPs Assessment of Workforce Capacity (DAWC) that discerns between DWHPs versus non-DWHPs. Findings Of the 28,994 surveys mailed to women Veterans, 24,789 were seen by primary care providers and 8,151 women responded to the survey (response rate 32%). A total of 3,147 providers were evaluated by the SHEP-CAHPS-PCMH survey (40%; n=1,267 were DWHPs). In a multivariable model, patients seen by DWHPs (RR=1.02 95% CI=1.01−1.04) reported higher overall experiences with care compared to patients seen by non-DWHPs. Conclusions The main finding is that women Veterans’ overall experiences with outpatient healthcare are slightly better for those receiving care from DWHPs compared to those receiving care from non-DWHPs. Our findings have important policy implications for how to continue to improve women Veterans’ experiences. Our work provides support to increase access to DWHPs at VA primary care clinics. PMID:25442706

Vacuum arc behavior and its voltage characteristics in drawing process controlled by composite magnetic fields along axial and transverse directions

DOE Office of Scientific and Technical Information (OSTI.GOV)

Wang, Lijun, E-mail: lijunwang@mail.xjtu.edu.cn; Deng, Jie; Wang, Haijing

In this research, drawing vacuum arc (VA) experiments were conducted using composite contacts under currents ranging from 5 kA to 20 kA root mean square (rms). The new type of contact comprised an axial magnetic field (AMF) configuration and a transverse magnetic field (TMF) configuration. The TMF plate was in the center, surrounded by the AMF plate. The contact generated both AMFs and TMFs simultaneously. VA appearances and arc voltages were recorded, and the VA was modeled as a conductor for electromagnetic force analysis in ANSYS software. The results showed that the coaxiality of operating mechanisms significantly influenced arc behavior just asmore » the arc was ignited. When arc brightness did not increase after ignition, there was a voltage drop accompanied with diffusion of the VA. As to VA development, when an arc was ignited on an AMF plate, it spread on the plate and rotated. Over time the arc current increased, the constricting arc forms, and the arc column rotated on the TMF plate under the action of Ampere's force. With regard to the influence of a magnetic field on a VA at different stages, in the initial drawing arc stage the TMF was dominant, and the arc started to rotate under the action of Ampere's force. Afterwards, the AMF was dominant, with a steadily burning arc. As for contact melting, in the initial arcing period, a contracted short arc caused severe melting and erosion of the contact plate. When the ignition spot or root was close to the slot of plate, the electromagnetic force pushed the arc toward slot and contact edge, resulting in local erosion of the slot region.« less

Animals on VA property. Final rule.

PubMed

2015-08-17

The Department of Veterans Affairs (VA) amends its regulation concerning the presence of animals on VA property. This final rule expands the current VA regulation to authorize the presence of service animals consistent with applicable Federal law when these animals accompany individuals with disabilities seeking admittance to property owned or operated by VA.

77 FR 70967 - Authorization for Non-VA Medical Services

Federal Register 2010, 2011, 2012, 2013, 2014

2012-11-28

... expand the delivery of healthcare to veterans, VA is, like the rest of the healthcare industry...(a)(2)(B) to expand VA's authority to provide non-VA medical services under the non- VA care... furnished hospital care, nursing home care, domiciliary care, or medical services and who requires medical...

77 FR 67063 - VA Directive 0005 on Scientific Integrity

Federal Register 2010, 2011, 2012, 2013, 2014

2012-11-08

... policies that: Foster a culture of transparency, integrity, and ethical behavior in the development and... provided to the VA's Office of Inspector General (OIG), the Office of Government Ethics, and Congress. VA...: VA has amended Directive 0005, ] 5.b., to state that ``VA policy provides an ethical and accountable...

Suppression of RNA Interference by Adenovirus Virus-Associated RNA†

PubMed Central

Andersson, M. Gunnar; Haasnoot, P. C. Joost; Xu, Ning; Berenjian, Saideh; Berkhout, Ben; Akusjärvi, Göran

2005-01-01

We show that human adenovirus inhibits RNA interference (RNAi) at late times of infection by suppressing the activity of two key enzyme systems involved, Dicer and RNA-induced silencing complex (RISC). To define the mechanisms by which adenovirus blocks RNAi, we used a panel of mutant adenoviruses defective in virus-associated (VA) RNA expression. The results show that the virus-associated RNAs, VA RNAI and VA RNAII, function as suppressors of RNAi by interfering with the activity of Dicer. The VA RNAs bind Dicer and function as competitive substrates squelching Dicer. Further, we show that VA RNAI and VA RNAII are processed by Dicer, both in vitro and during a lytic infection, and that the resulting short interfering RNAs (siRNAs) are incorporated into active RISC. Dicer cleaves the terminal stem of both VA RNAI and VA RNAII. However, whereas both strands of the VA RNAI-specific siRNA are incorporated into RISC, the 3′ strand of the VA RNAII-specific siRNA is selectively incorporated during a lytic infection. In summary, our work shows that adenovirus suppresses RNAi during a lytic infection and gives insight into the mechanisms of RNAi suppression by VA RNA. PMID:16014917

Use of Outpatient Care in Veterans Health Administration and Medicare among Veterans Receiving Primary Care in Community-Based and Hospital Outpatient Clinics

PubMed Central

Liu, Chuan-Fen; Chapko, Michael; Bryson, Chris L; Burgess, James F; Fortney, John C; Perkins, Mark; Sharp, Nancy D; Maciejewski, Matthew L

2010-01-01

Objective To examine differences in use of Veterans Health Administration (VA) and Medicare outpatient services by VA primary care patients. Data Sources/Study Setting VA administrative and Medicare claims data from 2001 to 2004. Study Design Retrospective cohort study of outpatient service use by 8,964 community-based and 6,556 hospital-based VA primary care patients. Principal Findings A significant proportion of VA patients used Medicare-reimbursed primary care (>30 percent) and specialty care (>60 percent), but not mental health care (3–4 percent). Community-based patients had 17 percent fewer VA primary care visits (p<.001), 9 percent more Medicare-reimbursed visits (p<.001), and 6 percent fewer total visits (p<.05) than hospital-based patients. Community-based patients had 22 percent fewer VA specialty care visits (p<.0001) and 21 percent more Medicare-reimbursed specialty care visits (p<.0001) than hospital-based patients, but no difference in total visits (p=.80). Conclusions Medicare-eligible VA primary care patients followed over 4 consecutive years used significant primary care and specialty care outside of VA. Community-based patients offset decreased VA use with increased service use paid by Medicare, suggesting that increasing access to VA primary care via community clinics may fragment veteran care in unintended ways. Coordination of care between VA and non-VA providers and health care systems is essential to improve the quality and continuity of care. PMID:20831716

ADVANCED UTILITY SIMULATION MODEL, REPORT OF SENSITIVITY TESTING, CALIBRATION, AND MODEL OUTPUT COMPARISONS (VERSION 3.0)

EPA Science Inventory

The report gives results of activities relating to the Advanced Utility Simulation Model (AUSM): sensitivity testing. comparison with a mature electric utility model, and calibration to historical emissions. The activities were aimed at demonstrating AUSM's validity over input va...

Advanced upper limb prosthetic devices: implications for upper limb prosthetic rehabilitation.

PubMed

Resnik, Linda; Meucci, Marissa R; Lieberman-Klinger, Shana; Fantini, Christopher; Kelty, Debra L; Disla, Roxanne; Sasson, Nicole

2012-04-01

The number of catastrophic injuries caused by improvised explosive devices in the Afghanistan and Iraq Wars has increased public, legislative, and research attention to upper limb amputation. The Department of Veterans Affairs (VA) has partnered with the Defense Advanced Research Projects Agency and DEKA Integrated Solutions to optimize the function of an advanced prosthetic arm system that will enable greater independence and function. In this special communication, we examine current practices in prosthetic rehabilitation including trends in adoption and use of prosthetic devices, financial considerations, and the role of rehabilitation team members in light of our experiences with a prototype advanced upper limb prosthesis during a VA study to optimize the device. We discuss key challenges in the adoption of advanced prosthetic technology and make recommendations for service provision and use of advanced upper limb prosthetics. Rates of prosthetic rejection are high among upper limb amputees. However, these rates may be reduced with sufficient training by a highly specialized, multidisciplinary team of clinicians, and a focus on patient education and empowerment throughout the rehabilitation process. There are significant challenges emerging that are unique to implementing the use of advanced upper limb prosthetic technology, and a lack of evidence to establish clinical guidelines regarding prosthetic prescription and treatment. Finally, we make recommendations for future research to aid in the identification of best practices and development of policy decisions regarding insurance coverage of prosthetic rehabilitation. Copyright © 2012 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

Electron-capture Isotopes Could Constrain Cosmic-Ray Propagation Models

NASA Astrophysics Data System (ADS)

Benyamin, David; Shaviv, Nir J.; Piran, Tsvi

2017-12-01

Electron capture (EC) isotopes are known to provide constraints on the low-energy behavior of cosmic rays (CRs), such as reacceleration. Here, we study the EC isotopes within the framework of the dynamic spiral-arms CR propagation model in which most of the CR sources reside in the galactic spiral arms. The model was previously used to explain the B/C and sub-Fe/Fe ratios. We show that the known inconsistency between the 49Ti/49V and 51V/51Cr ratios remains also in the spiral-arms model. On the other hand, unlike the general wisdom that says the isotope ratios depend primarily on reacceleration, we find here that the ratio also depends on the halo size (Z h) and, in spiral-arms models, also on the time since the last spiral-arm passage ({τ }{arm}). Namely, EC isotopes can, in principle, provide interesting constraints on the diffusion geometry. However, with the present uncertainties in the lab measurements of both the electron attachment rate and the fragmentation cross sections, no meaningful constraint can be placed.

Distribution of cause of death in rural Bangladesh during 2003–2010: evidence from two rural areas within Matlab Health and Demographic Surveillance site

PubMed Central

Alam, Nurul; Chowdhury, Hafizur R.; Ahmed, Ali; Rahman, Mahfuzur; Streatfield, P. Kim

2014-01-01

Objective This study used the InterVA-4 computerised model to assign probable cause of death (CoD) to verbal autopsies (VAs) generated from two rural areas, with a difference in health service provision, within the Matlab Health and Demographic Surveillance site (HDSS). This study aimed to compare CoD by gender, as well as discussing possible factors which could influence differences in the distribution of CoD between the two areas. Design Data for this study came from the Matlab the HDSS maintained by the International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b) since 1966. In late 1977, icddr,b divided HDSS and implemented a high-quality maternal, newborn and child health and family planning (MNCH-FP) services project in one half, called the icddr,b service area (SA), in addition to the usual public and private MNCH-FP services that serve the other half, called the government SA. HDSS field workers registered 12,144 deaths during 2003–2010, and trained interviewers obtained VA for 98.9% of them. The probabilistic model InterVA-4 probabilistic model (version 4.02) was used to derive probable CoD from VA symptoms. Cause-specific mortality rates and fractions were compared across gender and areas. Appropriate statistical tests were applied for significance testing. Results Mortality rates due to neonatal causes and communicable diseases (CDs) were lower in the icddr,b SA than in the government SA, where mortality rates due to non-communicable diseases (NCDs) were lower. Cause-specific mortality fractions (CSMFs) due to CDs (23.2% versus 18.8%) and neonatal causes (7.4% versus 6%) were higher in the government SA, whereas CSMFs due to NCDs were higher (58.2% versus 50.7%) in the icddr,b SA. The rank-order of CSMFs by age group showed marked variations, the largest category being acute respiratory infection/pneumonia in infancy, injury in 1–4 and 5–14 years, neoplasms in 15–49 and 50–64 years, and stroke in 65+ years. Conclusions Automated InterVA-4 coding of VA to determine probable CoD revealed the difference in the structure of CoD between areas with prominence of NCDs in both areas. Such information can help local planning of health services for prevention and management of disease burden. PMID:25377333

Vanillylacetone up-regulates anthocyanin accumulation and expression of anthocyanin biosynthetic genes by inducing endogenous abscisic acid in grapevine tissues.

PubMed

Enoki, Shinichi; Hattori, Tomoki; Ishiai, Shiho; Tanaka, Sayumi; Mikami, Masachika; Arita, Kayo; Nagasaka, Shu; Suzuki, Shunji

2017-12-01

We investigated the effect of vanillylacetone (VA) on anthocyanin accumulation with aim of improving grape berry coloration. Spraying Vitis vinifera cv. Muscat Bailey A berries with VA at veraison increased sugar/acid ratio, an indicator of maturation and total anthocyanin accumulation. To elucidate the molecular mechanism underlying the effect of VA on anthocyanin accumulation, in vitro VA treatment of a grapevine cell culture was carried out. Endogenous abscisic acid (ABA) content was higher in the VA-treated cell cultures than in control at 3h after treatment. Consistent with this, the relative expression levels of anthocyanin-synthesis-related genes, including DFR, LDOX, MybA1 and UFGT, in VA-treated cell cultures were much higher than those in control, and high total anthocyanin accumulation was noted in the VA-treated cell cultures as well. These results suggest that VA up-regulates the expression of genes leading to anthocyanin accumulation by inducing endogenous ABA. In addition, VA increased total anthocyanin content in a dose-dependent manner. Although VA treatment in combination with exogenous ABA did not exhibit any synergistic effect, treatment with VA alone showed an equivalent effect to that with exogenous ABA alone on total anthocyanin accumulation. These findings point to the possibility of using VA for improving grape berry coloration. Copyright © 2017 Elsevier GmbH. All rights reserved.

Whole-brain low-intensity pulsed ultrasound therapy markedly improves cognitive dysfunctions in mouse models of dementia - Crucial roles of endothelial nitric oxide synthase.

PubMed

Eguchi, Kumiko; Shindo, Tomohiko; Ito, Kenta; Ogata, Tsuyoshi; Kurosawa, Ryo; Kagaya, Yuta; Monma, Yuto; Ichijo, Sadamitsu; Kasukabe, Sachie; Miyata, Satoshi; Yoshikawa, Takeo; Yanai, Kazuhiko; Taki, Hirofumi; Kanai, Hiroshi; Osumi, Noriko; Shimokawa, Hiroaki

2018-05-22

Therapeutic focused-ultrasound to the hippocampus has been reported to exert neuroprotective effects on dementia. In the present study, we examined whether the whole-brain LIPUS (low-intensity pulsed ultrasound) therapy is effective and safe in 2 mouse models of dementia (vascular dementia, VaD and Alzheimer's disease, AD), and if so, to elucidate the common underlying mechanism(s) involved. We used bilateral carotid artery stenosis (BCAS) model with micro-coils in male C57BL/6 mice as a VaD model and 5XFAD transgenic mice as an AD model. We applied the LIPUS therapy (1.875 MHz, 6.0 kHz, 32cycles) to the whole brain. In both models, the LIPUS therapy markedly ameliorated cognitive impairments (Y-maze test and/or passive avoidance test) associated with improved cerebral blood flow (CBF). Mechanistically, the LIPUS therapy significantly increased CD31-positive endothelial cells and Olig2-positive oligodendrocyte precursor cells (OPCs) in the VaD model, while it reduced Iba-1-positive microglias and amyloid-β (Aβ) plaque in the AD model. In both models, endothelium-related genes were significantly upregulated in RNA-sequencing, and expressions of endothelial nitric oxide synthase (eNOS) and neurotrophins were upregulated in Western blotting. Interestingly, the increases in glia cells and neurotrophin expressions showed significant correlations with eNOS expression. Importantly, these beneficial effects of LIPUS were absent in eNOS-knockout mice. These results indicate that the whole-brain LIPUS is an effective and non-invasive therapy for dementia by activating specific cells corresponding to each pathology, for which eNOS activation plays an important role as a common mechanism. Copyright © 2018. Published by Elsevier Inc.

Modal kinematics for multisection continuum arms.

PubMed

Godage, Isuru S; Medrano-Cerda, Gustavo A; Branson, David T; Guglielmino, Emanuele; Caldwell, Darwin G

2015-05-13

This paper presents a novel spatial kinematic model for multisection continuum arms based on mode shape functions (MSF). Modal methods have been used in many disciplines from finite element methods to structural analysis to approximate complex and nonlinear parametric variations with simple mathematical functions. Given certain constraints and required accuracy, this helps to simplify complex phenomena with numerically efficient implementations leading to fast computations. A successful application of the modal approximation techniques to develop a new modal kinematic model for general variable length multisection continuum arms is discussed. The proposed method solves the limitations associated with previous models and introduces a new approach for readily deriving exact, singularity-free and unique MSF's that simplifies the approach and avoids mode switching. The model is able to simulate spatial bending as well as straight arm motions (i.e., pure elongation/contraction), and introduces inverse position and orientation kinematics for multisection continuum arms. A kinematic decoupling feature, splitting position and orientation inverse kinematics is introduced. This type of decoupling has not been presented for these types of robotic arms before. The model also carefully accounts for physical constraints in the joint space to provide enhanced insight into practical mechanics and impose actuator mechanical limitations onto the kinematics thus generating fully realizable results. The proposed method is easily applicable to a broad spectrum of continuum arm designs.

Evaluating the effectiveness of beta-carotene-rich food interventions for improving vitamin A status

USDA-ARS?s Scientific Manuscript database

Despite years of interventions with vitamin A (VA) supplement programs, VA deficiency remains a leading cause of morbidity and blindness in Southern Asia and Africa. Although high dose VA supplements can be a very effective means of preventing VA deficiency, they have several drawbacks: VA capsules ...

76 FR 42769 - Privacy Act of 1974; Report of Matching Program

Federal Register 2010, 2011, 2012, 2013, 2014

2011-07-19

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75 FR 72873 - Privacy Act Of 1974; System of Records

Federal Register 2010, 2011, 2012, 2013, 2014

2010-11-26

...) is amending two existing systems of records 121VA19, ``National Patient Databases--VA'', and 136VA19E... being amended for additional databases. DATES: Comments on the amendment of these systems of records... system identified as 121VA19, ``National Patient Databases--VA,'' as set forth in the Federal Register...

78 FR 26250 - Payment for Home Health Services and Hospice Care to Non-VA Providers

Federal Register 2010, 2011, 2012, 2013, 2014

2013-05-06

... Hospice Care to Non-VA Providers AGENCY: Department of Veterans Affairs. ACTION: Final rule. SUMMARY: The Department of Veterans Affairs (VA) amends its regulations concerning the billing methodology for non-VA... billing methodology for non-VA providers of home health services and hospice care. The proposed rulemaking...

A Triangulated Qualitative Study of Veteran Decision-Making to Seek Care During Heart Failure Exacerbation: Implications of Dual Health System Use

PubMed Central

Pope, Charlene A.; Davis, Boyd H.; Wine, Leticia; Nemeth, Lynne S.; Axon, Robert N.

2018-01-01

Among Veterans, heart failure (HF) contributes to frequent emergency department visits and hospitalization. Dual health care system use (dual use) occurs when Veterans Health Administration (VA) enrollees also receive care from non-VA sources. Mounting evidence suggests that dual use decreases efficiency and patient safety. This qualitative study used constructivist grounded theory and content analysis to examine decision making among 25 Veterans with HF, for similarities and differences between all-VA users and dual users. In general, all-VA users praised specific VA providers, called services helpful, and expressed positive capacity for managing HF. In addition, several Veterans who described inadvertent one-time non-VA health care utilization in emergent situations more closely mirrored all-VA users. By contrast, committed dual users more often reported unmet needs, nonresponse to VA requests, and faster services in non-VA facilities. However, a primary trigger for dual use was VA telephone referral for escalating symptoms, instead of care coordination or primary/specialty care problem-solving. PMID:29482411

A systematic review and synthesis of the strengths and limitations of measuring malaria mortality through verbal autopsy.

PubMed

Herrera, Samantha; Enuameh, Yeetey; Adjei, George; Ae-Ngibise, Kenneth Ayuurebobi; Asante, Kwaku Poku; Sankoh, Osman; Owusu-Agyei, Seth; Yé, Yazoume

2017-10-23

Lack of valid and reliable data on malaria deaths continues to be a problem that plagues the global health community. To address this gap, the verbal autopsy (VA) method was developed to ascertain cause of death at the population level. Despite the adoption and wide use of VA, there are many recognized limitations of VA tools and methods, especially for measuring malaria mortality. This study synthesizes the strengths and limitations of existing VA tools and methods for measuring malaria mortality (MM) in low- and middle-income countries through a systematic literature review. The authors searched PubMed, Cochrane Library, Popline, WHOLIS, Google Scholar, and INDEPTH Network Health and Demographic Surveillance System sites' websites from 1 January 1990 to 15 January 2016 for articles and reports on MM measurement through VA. article presented results from a VA study where malaria was a cause of death; article discussed limitations/challenges related to measurement of MM through VA. Two authors independently searched the databases and websites and conducted a synthesis of articles using a standard matrix. The authors identified 828 publications; 88 were included in the final review. Most publications were VA studies; others were systematic reviews discussing VA tools or methods; editorials or commentaries; and studies using VA data to develop MM estimates. The main limitation were low sensitivity and specificity of VA tools for measuring MM. Other limitations included lack of standardized VA tools and methods, lack of a 'true' gold standard to assess accuracy of VA malaria mortality. Existing VA tools and methods for measuring MM have limitations. Given the need for data to measure progress toward the World Health Organization's Global Technical Strategy for Malaria 2016-2030 goals, the malaria community should define strategies for improving MM estimates, including exploring whether VA tools and methods could be further improved. Longer term strategies should focus on improving countries' vital registration systems for more robust and timely cause of death data.

The Veterans Administration Library Network: VALNET.

PubMed Central

van Vuren, D D

1982-01-01

Given substantial federal budget cuts and ever-increasing quantities of print and nonprint material, Veterans Administration (VA) Library Services have pooled their resources in a network to improve the scope and efficiency of the services they provide. The VA Library Network, VALNET, composed of 176 libraries, serves health care facilities throughout the continental United States and Puerto Rico. This paper outlines VALNET's organization and the range of individual VA Library Services. It also describes centrally provided services and resource-sharing tools being developed by the VA, as well as significant sharing arrangement among VA Library Services and between the VA and non-VA libraries. PMID:7052164

Volatile anesthetic rescue therapy in children with acute asthma: innovative but costly or just costly?.

PubMed

Char, Danton S; Ibsen, Laura M; Ramamoorthy, Chandra; Bratton, Susan L

2013-05-01

To describe volatile anesthesia (VA) use for pediatric asthma, including complications and outcomes. Retrospective cohort study. Children's hospitals contributing to the Pediatric Health Information System between 2004-2008. Children 2-18 years old with a primary diagnosis code for asthma supported with mechanical ventilation. Those treated with VA were compared to those not treated with VA or extracorporeal membrane oxygenation. Hospital VA use was grouped as none, <5%, 5-10% and >10% among intubated children. One thousand five hundred and fifty-eight patients received mechanical ventilation at 40 hospitals for asthma: 47 (3%) received VA treatment at 11 (28%) hospitals. Those receiving a VA were significantly less likely to receive inhaled b-agonists, ipratropium bromide, and heliox, but more likely to receive neuromuscular blocking agents than patients treated without VA. Length of mechanical ventilation, hospital stay (length of stay [LOS]) and charges were significantly greater for those treated with VA. Aspiration was more common but death and air leak did not differ. Patients at hospitals with VA use >10% were significantly less likely to receive inhaled b agonist, ipratropium bromide, methylxanthines, and heliox, but more likely to receive systemic b agonist, neuromuscular blocking agents compared to those treated at hospitals not using VA. LOS, duration of ventilation, and hospital charges were significantly greater for patients treated at centers with high VA use. Mortality does not differ between centers that use VA or not. Patients treated at centers with high VA use had significantly increased hospital charges and increased LOS.

The WHO 2016 verbal autopsy instrument: An international standard suitable for automated analysis by InterVA, InSilicoVA, and Tariff 2.0

PubMed Central

Chandramohan, Daniel; Clark, Samuel J.; Jakob, Robert; Leitao, Jordana; Rao, Chalapati; Riley, Ian; Setel, Philip W.

2018-01-01

Background Verbal autopsy (VA) is a practical method for determining probable causes of death at the population level in places where systems for medical certification of cause of death are weak. VA methods suitable for use in routine settings, such as civil registration and vital statistics (CRVS) systems, have developed rapidly in the last decade. These developments have been part of a growing global momentum to strengthen CRVS systems in low-income countries. With this momentum have come pressure for continued research and development of VA methods and the need for a single standard VA instrument on which multiple automated diagnostic methods can be developed. Methods and findings In 2016, partners harmonized a WHO VA standard instrument that fully incorporates the indicators necessary to run currently available automated diagnostic algorithms. The WHO 2016 VA instrument, together with validated approaches to analyzing VA data, offers countries solutions to improving information about patterns of cause-specific mortality. This VA instrument offers the opportunity to harmonize the automated diagnostic algorithms in the future. Conclusions Despite all improvements in design and technology, VA is only recommended where medical certification of cause of death is not possible. The method can nevertheless provide sufficient information to guide public health priorities in communities in which physician certification of deaths is largely unavailable. The WHO 2016 VA instrument, together with validated approaches to analyzing VA data, offers countries solutions to improving information about patterns of cause-specific mortality. PMID:29320495

1. AERIAL VIEW OF WEST/FRONT AND NORTH/SIDE FACADES, LOOKING SOUTHEAST ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

1. AERIAL VIEW OF WEST/FRONT AND NORTH/SIDE FACADES, LOOKING SOUTHEAST (FROM LEFT TO RIGHT): VA-1272 Ball Building, 1437 N. Court House Road. VA-1273 Jesse Building, 1423-27 N. Court House Road. VA-1276 Jesse-Hosmer Building, 1419 N. Court House Road. VA-1275 Moncure (Adams, Porter, Radigan) Building, N. 1415 Court House Road. VA-1274 Rucker Building, N. 1403 Court House Road. - Lawyers' Row Block, North Court House Road between Fourteenth & Fifteenth Streets, Arlington, Arlington County, VA

Electrospray performance of interacting multi-capillary emitters in a linear array

NASA Astrophysics Data System (ADS)

Kumar, V.; Srivastava, A.; Shanbhogue, K. M.; Ingersol, S.; Sen, A. K.

2018-03-01

Here, we report electrospray performance of multiple emitters (of internal diameter 200 µm) arranged in a linear (inline) array. For a fixed flow rate Q , at higher voltages {{V}a} , multi-jet mode is observed, which leads to a rapid increase in the spray current (I∼ {{V}a} ) as compared to the single cone-jet case (I∼ Va0.8 ). A theoretical model is presented that predicts (within 10% of experimental data) the divergence of sprays g(x) issued from a pair of interacting emitters due to the mutual Columbic interaction of space charges. The variation of onset voltage {{V}o} and spray current I with spacing between the emitters p is studied and it is found that {{V}o}∼ {{p}-0.2} and I∼ {{p}0.8} . The effect of the flow rate Q , voltage V and number of emitters ~n~ on the spray current I is investigated and it is found that I∼ {{Q}0.5} , I∼ Va0.8 and I∼ \\sqrt{n} . The present work provides insight regarding the behavior of interacting sprays in an inline configuration and could be significant in the design of multiple emitter systems for electrospray applications.

Comparison of Comet Enflow and VA One Acoustic-to-Structure Power Flow Predictions

NASA Technical Reports Server (NTRS)

Grosveld, Ferdinand W.; Schiller, Noah H.; Cabell, Randolph H.

2010-01-01

Comet Enflow is a commercially available, high frequency vibroacoustic analysis software based on the Energy Finite Element Analysis (EFEA). In this method the same finite element mesh used for structural and acoustic analysis can be employed for the high frequency solutions. Comet Enflow is being validated for a floor-equipped composite cylinder by comparing the EFEA vibroacoustic response predictions with Statistical Energy Analysis (SEA) results from the commercial software program VA One from ESI Group. Early in this program a number of discrepancies became apparent in the Enflow predicted response for the power flow from an acoustic space to a structural subsystem. The power flow anomalies were studied for a simple cubic, a rectangular and a cylindrical structural model connected to an acoustic cavity. The current investigation focuses on three specific discrepancies between the Comet Enflow and the VA One predictions: the Enflow power transmission coefficient relative to the VA One coupling loss factor; the importance of the accuracy of the acoustic modal density formulation used within Enflow; and the recommended use of fast solvers in Comet Enflow. The frequency region of interest for this study covers the one-third octave bands with center frequencies from 16 Hz to 4000 Hz.

77 FR 30593 - Agency Information Collection (Applications and Appraisals for Employment for Title 38 Positions...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-05-23

... Optometrists, Chiropractors, VA Form 10-2850--7,450 hours. b. Application for Nurses and Nurse Anesthetists, VA... Optometrists, Chiropractors, VA Form 10-2850--30 minutes. b. Application for Nurses and Nurse Anesthetists, VA..., Podiatrists and Optometrists, Chiropractors, VA Form 10-2850--14,900. b. Application for Nurses and Nurse...

38 CFR 77.17 - Recovery of funds by VA.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 38 Pensions, Bonuses, and Veterans' Relief 2 2014-07-01 2014-07-01 false Recovery of funds by VA....17 Recovery of funds by VA. (a) Recovery of funds. VA may recover from the grantee any funds that are... additional adaptive sports grant payments. When VA makes a final decision that action will be taken to...

Grand-design Spiral Arms in a Young Forming Circumstellar Disk

DOE Office of Scientific and Technical Information (OSTI.GOV)

Tomida, Kengo; Lin, Chia Hui; Machida, Masahiro N.

We study formation and long-term evolution of a circumstellar disk in a collapsing molecular cloud core using a resistive magnetohydrodynamic simulation. While the formed circumstellar disk is initially small, it grows as accretion continues, and its radius becomes as large as 200 au toward the end of the Class-I phase. A pair of grand-design spiral arms form due to gravitational instability in the disk, and they transfer angular momentum in the highly resistive disk. Although the spiral arms disappear in a few rotations as expected in a classical theory, new spiral arms form recurrently as the disk, soon becoming unstablemore » again by gas accretion. Such recurrent spiral arms persist throughout the Class-0 and I phases. We then perform synthetic observations and compare our model with a recent high-resolution observation of a young stellar object Elias 2–27, whose circumstellar disk has grand-design spiral arms. We find good agreement between our theoretical model and the observation. Our model suggests that the grand-design spiral arms around Elias 2–27 are consistent with material arms formed by gravitational instability. If such spiral arms commonly exist in young circumstellar disks, it implies that young circumstellar disks are considerably massive and gravitational instability is the key process of angular momentum transport.« less

A New Cure for Medical Errors

NASA Technical Reports Server (NTRS)

2002-01-01

In May 2000, senior officials of the U.S. Department of Veterans Affairs (VA) and NASA signed an agreement that would commit the two agencies to create the Patient Safety Reporting System (PSRS) to report: events or situations that could have resulted in accident, injury, or illness, but did not, either by chance or through timely intervention (close-calls); unexpected serious occurrences that involved a patient or employee's death, physical injury, or psychological injury; lessens learned; and safety ideas. The VA provided NASA with funding for the initial development of the new system, which automatically removes all personal names, facility names and locations, and other potentially identifying information before entering reports into its database. Designed to complement the VA's current internal reporting systems, the PSRS is modeled after NASA's Aviation Safety Reporting System, which was established in 1975 under a Memorandum of Agreement between the Federal Aviation Administration and NASA and began operation in 1976.

Authorities and Mechanisms for Purchased Care at the Department of Veterans Affairs

PubMed Central

Greenberg, Michael D.; Batka, Caroline; Buttorff, Christine; Dunigan, Molly; Lovejoy, Susan L.; McGovern, Geoffrey; Pace, Nicholas M.; Pillemer, Francesca; Williams, Kayla M.; Apaydin, Eric; Aranibar, Clara; Buenaventura, Maya; Carter, Phillip; Cherney, Samantha; Davis, Lynn E.; Donohue, Amy Grace; Geyer, Lily; Hemler, Joslyn; Roshan, Parisa; Skrabala, Lauren; Simmons, Stephen; Thompson, Joseph; Welch, Jonathan; Hosek, Susan D.; Farmer, Carrie M.

2016-01-01

Abstract The Veterans Access, Choice, and Accountability Act of 2014 addressed the need for access to timely, high-quality health care for veterans. Section 201 of the legislation called for an independent assessment of various aspects of veterans' health care. The RAND Corporation was tasked with an assessment of the authorities and mechanisms by which the Department of Veterans Affairs (VA) pays for health care services from non-VA providers. Purchased care accounted for 10 percent, or around $5.6 billion, of VA's health care budget in fiscal year 2014, and the amount of care purchased from outside VA is growing rapidly. VA purchases non-VA care through an array of programs, each with different payment processes and eligibility requirements for veterans and outside providers. A review and analysis of statutes, regulations, legislation, and literature on VA purchased care, along with interviews with expert stakeholders, a survey of VA medical facilities, and an evaluation of local-level policy documents revealed that VA's purchased care system is complex and decentralized. Inconsistencies in procedures, unclear goals, and a lack of cohesive strategy for purchased care could have ramifications for veterans' access to care. Adding to the complexity of VA's purchased care system is a lack of systematic data collection on access to and quality of care provided through VA's purchased care programs. The analysis also explored concepts of “episodes of care” and their implications for purchased care by VA. PMID:28083425

Budget Impact Analysis of Veterans Affairs Medical Foster Homes versus Community Living Centers.

PubMed

Sutton, Bryce S; Pracht, Étienne; Williams, Arthur R; Alemi, Farrokh; Williams, Allison E; Levy, Cari

2017-02-01

The objectives were to determine whether and by what amounts the US Department of Veterans Affairs (VA) use of Medical Foster Homes (MFH) rather than Community Living Centers (CLC) reduced budget impacts to the VA. This was a retrospective, matched, case-control study of veterans residing in MFH or CLC in the VA health care system from 2008 to 2012. Administrative data sets, nearest neighbor matching, generalized linear models, and a secondary analysis were used to capture and analyze budget impacts by veterans who used MFH or CLC exclusively in 2008-2012. Controls of 1483 veterans in CLC were matched to 203 cases of veterans in MFH. Use of MFH instead of CLC reduced budget impacts to the VA by at least $2645 per veteran per month. A secondary analysis of the data using different matching criteria and statistical methods produced similar results, demonstrating the robustness of the estimates of budget impact. When the average out-of-pocket payments made by MFH residents, not made by CLC residents, were included in the analysis, the net reduction of budget impact ranged from $145 to $2814 per veteran per month or a savings of $1740 to $33,768 per veteran per year. Even though outpatient costs of MFH are higher, much of the reduced budget impact of MFH use arises from lower inpatient or hospital costs. Reduced budget impacts on the VA system indicate that expansion of the MFH program may be cost-effective. Implications for further research are suggested.

Population mental health among U.S. military veterans: results of the Veterans Health Module of the Behavioral Risk Factor Surveillance System, 2011-2012.

PubMed

Blosnich, John R; Brenner, Lisa A; Bossarte, Robert M

2016-08-01

To examine mental health indicators, in aggregate and stratified by sex, among a population-based sample of U.S. military veterans. Data are from veteran who completed the Veterans Health Module (VHM) of the 2011 and 2012 Behavioral Risk Factor Surveillance System (n = 10,406). VHM items included lifetime diagnoses of mental illnesses, service in a combat zone, sources of mental health care, and past 12-month suicidal ideation and attempt. We used weighted, multiple logistic regression models, adjusted for sociodemographics, to examine differences in suicidal ideation and attempt among men and women. Overall, 5.0% of the sample reported recent suicidal ideation and 1.0% reported attempting suicide. Among men, unemployment was positively associated with suicidal ideation, and combat exposure was negatively associated with suicidal ideation. Being separated, divorced, or widowed was positively associated with suicidal ideation among women. After adjusting for sociodemographic and VHM variables, veterans who sought mental health treatment from both Veterans Affairs (VA) and non-VA facilities had more than fourfold increased odds of suicidal ideation than veteran who sought mental health treatment from only VA facilities (adjusted odds ratio = 4.02; 95% confidence interval 1.23-13.13). Correlates of suicidal ideation differ between male and female veterans. Veterans who use both non-VA and VA facilities for mental health services may have greater risk of self-directed violence. Published by Elsevier Inc.

John M. Eisenberg Patient Safety Awards. System innovation: Veterans Health Administration National Center for Patient Safety.

PubMed

Heget, Jeffrey R; Bagian, James P; Lee, Caryl Z; Gosbee, John W

2002-12-01

In 1998 the Veterans Health Administration (VHA) created the National Center for Patient Safety (NCPS) to lead the effort to reduce adverse events and close calls systemwide. NCPS's aim is to foster a culture of safety in the Department of Veterans Affairs (VA) by developing and providing patient safety programs and delivering standardized tools, methods, and initiatives to the 163 VA facilities. To create a system-oriented approach to patient safety, NCPS looked for models in fields such as aviation, nuclear power, human factors, and safety engineering. Core concepts included a non-punitive approach to patient safety activities that emphasizes systems-based learning, the active seeking out of close calls, which are viewed as opportunities for learning and investigation, and the use of interdisciplinary teams to investigate close calls and adverse events through a root cause analysis (RCA) process. Participation by VA facilities and networks was voluntary. NCPS has always aimed to develop a program that would be applicable both within the VA and beyond. NCPS's full patient safety program was tested and implemented throughout the VA system from November 1999 to August 2000. Program components included an RCA system for use by caregivers at the front line, a system for the aggregate review of RCA results, information systems software, alerts and advisories, and cognitive acids. Following program implementation, NCPS saw a 900-fold increase in reporting of close calls of high-priority events, reflecting the level of commitment to the program by VHA leaders and staff.

An innovative approach for modeling and simulation of an automated industrial robotic arm operated electro-pneumatically

NASA Astrophysics Data System (ADS)

Popa, L.; Popa, V.

2017-08-01

The article is focused on modeling an automated industrial robotic arm operated electro-pneumatically and to simulate the robotic arm operation. It is used the graphic language FBD (Function Block Diagram) to program the robotic arm on Zelio Logic automation. The innovative modeling and simulation procedures are considered specific problems regarding the development of a new type of technical products in the field of robotics. Thus, were identified new applications of a Programmable Logic Controller (PLC) as a specialized computer performing control functions with a variety of high levels of complexit.

THE B/C AND SUB-IRON/IRON COSMIC RAY RATIOS—FURTHER EVIDENCE IN FAVOR OF THE SPIRAL-ARM DIFFUSION MODEL

DOE Office of Scientific and Technical Information (OSTI.GOV)

Benyamin, David; Piran, Tsvi; Shaviv, Nir J.

The boron to carbon (B/C) and sub-Fe/Fe ratios provide an important clue on cosmic ray (CR) propagation within the Galaxy. These ratios estimate the grammage that the CRs traverse as they propagate from their sources to Earth. Attempts to explain these ratios within the standard CR propagation models require ad hoc modifications and even with those these models necessitate inconsistent grammages to explain both ratios. As an alternative, physically motivated model, we have proposed that CRs originate preferably within the galactic spiral arms. CR propagation from dynamic spiral arms has important imprints on various secondary to primary ratios, such asmore » the B/C ratio and the positron fraction. We use our spiral-arm diffusion model with the spallation network extended up to nickel to calculate the sub-Fe/Fe ratio. We show that without any additional parameters the spiral-arm model consistently explains both ratios with the same grammage, providing further evidence in favor of this model.« less

Baseline predictors for one-year visual outcomes with ranibizumab or bevacizumab for neovascular age-related macular degeneration.

PubMed

Ying, Gui-shuang; Huang, Jiayan; Maguire, Maureen G; Jaffe, Glenn J; Grunwald, Juan E; Toth, Cynthia; Daniel, Ebenezer; Klein, Michael; Pieramici, Dante; Wells, John; Martin, Daniel F

2013-01-01

To determine the baseline predictors of visual acuity (VA) outcomes 1 year after treatment with ranibizumab or bevacizumab for neovascular age-related macular degeneration (AMD). Cohort study within the Comparison of Age-related Macular Degeneration Treatments Trials (CATT). A total of 1105 participants with neovascular AMD, baseline VA 20/25 to 20/320, and VA measured at 1 year. Participants were randomly assigned to ranibizumab or bevacizumab on a monthly or as-needed schedule. Masked readers evaluated fundus morphology and features on optical coherence tomography (OCT). Visual acuity was measured using electronic VA testing. Independent predictors were identified using regression techniques. The VA score, VA score change from baseline, and ≥3-line gain at 1 year. At 1 year, the mean VA score was 68 letters, mean improvement from baseline was 7 letters, and 28% of participants gained ≥3 lines. Older age, larger area of choroidal neovascularization (CNV), and elevation of retinal pigment epithelium (RPE) were associated with worse VA (all P<0.005), less gain in VA (all P<0.02), and a lower proportion gaining ≥3 lines (all P<0.04). Better baseline VA was associated with better VA at 1 year, less gain in VA, and a lower proportion gaining ≥3 lines (all P<0.0001). Predominantly or minimally classic lesions were associated with worse VA than occult lesions (66 vs. 69 letters; P=0.0003). Retinal angiomatous proliferans (RAP) lesions were associated with more gain in VA (10 vs. 7 letters; P=0.03) and a higher proportion gaining ≥3 lines (odds ratio, 1.9; 95% confidence interval, 1.2-3.1). Geographic atrophy (GA) was associated with worse VA (64 vs. 68 letters; P=0.02). Eyes with total foveal thickness in the second quartile (325-425 μm) had the best VA (P=0.01) and were most likely to gain ≥3 lines (P=0.004). Predictors did not vary by treatment group. For all treatment groups, older age, better baseline VA, larger CNV area, predominantly or minimally classic lesion, absence of RAP lesion, presence of GA, greater total fovea thickness, and RPE elevation on optical coherence tomography were independently associated with less improvement in VA at 1 year. The author(s) have no proprietary or commercial interest in any materials discussed in this article. Copyright © 2013 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.

CHARACTERISTICS OF SPIRAL ARMS IN LATE-TYPE GALAXIES

DOE Office of Scientific and Technical Information (OSTI.GOV)

Honig, Z. N.; Reid, M. J., E-mail: mreid@cfa.harvard.edu

2015-02-10

We have measured the positions of large numbers of H II regions in four nearly face-on, late-type, spiral galaxies: NGC 628 (M74), NGC 1232, NGC 3184, and NGC 5194 (M51). Fitting log-periodic spiral models to segments of each arm yields local estimates of spiral pitch angle and arm width. While pitch angles vary considerably along individual arms, among arms within a galaxy, and among galaxies, we find no systematic trend with galactocentric distance. We estimate the widths of the arm segments from the scatter in the distances of the H II regions from the spiral model. All major arms in these galaxies show spiralmore » arm width increasing with distance from the galactic center, similar to the trend seen in the Milky Way. However, in the outermost parts of the galaxies, where massive star formation declines, some arms reverse this trend and narrow. We find that spiral arms often appear to be composed of segments of ∼5 kpc length, which join to form kinks and abrupt changes in pitch angle and arm width; these characteristics are consistent with properties seen in the large N-body simulations of D'Onghia et al. and others.« less

75 FR 859 - Exposure Modeling Public Meeting

Federal Register 2010, 2011, 2012, 2013, 2014

2010-01-06

... ENVIRONMENTAL PROTECTION AGENCY [EPA-HQ-OPP-2009-0879; FRL-8806-4] Exposure Modeling Public Meeting AGENCY: Environmental Protection Agency (EPA). ACTION: Notice of Cancellation and Rescheduling of... S. Crystal Drive, Arlington, VA 22202. FOR FURTHER INFORMATION CONTACT: Chuck Peck, Environmental...

76 FR 27381 - Proposed Information Collection (Notice of Waiver of VA Compensation or Pension To Receive...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-05-11

... of Waiver of VA Compensation or Pension To Receive Military Pay and Allowances) Activity; Comment... Pension to Receive Military Pay and Allowances, VA Form 21-8951 and VA Form 21-8951-2. OMB Control Number... to waive VA disability benefits in order to receive active or inactive duty training pay are required...

The impact of the Department of Veterans Affairs Health Care Personnel Enhancement Act of 2004 on VA physicians' salaries and retention.

PubMed

Weeks, William B; Wallace, Tanner A; Wallace, Amy E

2009-01-01

To determine whether the Department of Veterans Affairs Health Care Personnel Enhancement Act (the Act), which was designed to achieve VA physician salary parity with American Academy of Medical Colleges (AAMC) Associate Professors and enacted in 2006, had achieved its goal. Using VA human resources datasets and data from the AAMC, we calculated mean VA physician salaries, with 95 percent confidence intervals, for 15 different medical specialties. For each specialty, we compared VA salaries to the median, 25th, and 75th percentile of AAMC Associate Professors' incomes. The Act's passage resulted in a $20,000 annual increase in VA physicians' salaries. VA primary care physicians, medical subspecialists, and psychiatrists had salaries that were comparable to their AAMC counterparts prior to and after enactment of the Act. However, VA surgical specialists', anesthesiologists', and radiologists' salaries lagged their AAMC counterparts both before and after the Act's enactment. Income increases were negatively correlated with full-time workforce changes. VA does not appear to provide comparable salaries for physicians necessary for surgical care. In certain cases, VA should consider outsourcing surgical services.

Regional ventilation-perfusion distribution is more uniform in the prone position

NASA Technical Reports Server (NTRS)

Mure, M.; Domino, K. B.; Lindahl, S. G.; Hlastala, M. P.; Altemeier, W. A.; Glenny, R. W.

2000-01-01

The arterial blood PO(2) is increased in the prone position in animals and humans because of an improvement in ventilation (VA) and perfusion (Q) matching. However, the mechanism of improved VA/Q is unknown. This experiment measured regional VA/Q heterogeneity and the correlation between VA and Q in supine and prone positions in pigs. Eight ketamine-diazepam-anesthetized, mechanically ventilated pigs were studied in supine and prone positions in random order. Regional VA and Q were measured using fluorescent-labeled aerosols and radioactive-labeled microspheres, respectively. The lungs were dried at total lung capacity and cubed into 603-967 small ( approximately 1.7-cm(3)) pieces. In the prone position the homogeneity of the ventilation distribution increased (P = 0.030) and the correlation between VA and Q increased (correlation coefficient = 0.72 +/- 0.08 and 0.82 +/- 0.06 in supine and prone positions, respectively, P = 0.03). The homogeneity of the VA/Q distribution increased in the prone position (P = 0.028). We conclude that the improvement in VA/Q matching in the prone position is secondary to increased homogeneity of the VA distribution and increased correlation of regional VA and Q.

The Development of the Speaker Independent ARM Continuous Speech Recognition System

DTIC Science & Technology

1992-01-01

spokeTi airborne reconnaissance reports u-ing a speech recognition system based on phoneme-level hidden Markov models (HMMs). Previous versions of the ARM...will involve automatic selection from multiple model sets, corresponding to different speaker types, and that the most rudimen- tary partition of a...The vocabulary size for the ARM task is 497 words. These words are related to the phoneme-level symbols corresponding to the models in the model set

Posttraumatic Stress Disorder Symptom Severity and Socioeconomic Factors Associated with Veterans Health Administration Use among Women Veterans.

PubMed

Lehavot, Keren; O'Hara, Ruth; Washington, Donna L; Yano, Elizabeth M; Simpson, Tracy L

2015-01-01

The Veterans Health Administration (VA) has historically focused on treating men. Although women veterans' VA use is increasing, they remain more likely than male veterans to receive their care in non-VA settings. To date, there is limited research on factors associated with VA use among women. We examined the relationship between demographic, civilian, military, and health-related variables with past-year VA use among women veterans. Women veterans were recruited over the internet to participate in an anonymous national survey (n = 617) in 2013. An empirically derived decision tree was computed using signal detection software for iterative receiver operator characteristics (ROC) to identify variables with the best sensitivity/specificity balance associated with past-year VA use. ROC analysis indicated that 85% of participants with high posttraumatic stress disorder (PTSD) and depressive symptoms and who were younger than 54 years of age used VA in the past year. Of those who were 54 years of age or older and had very high PTSD symptoms, 94% used the VA in the last year. By contrast, only 40% of participants with relatively lower PTSD symptoms had VA past-year use, although among these individuals, VA past-year use increased to 65% for those with a relatively lower income. Findings suggest that greater PTSD symptoms, depressive symptoms, and low income correlate with VA use, with very high PTSD symptoms in older groups, high PTSD symptoms coupled with high depressive symptoms in younger groups, and low income in those with lower PTSD symptoms each associated with greater past-year VA use. Ensuring PTSD assessment and treatment, and addressing socioeconomic factors, may be key strategies for health care delivered directly or through contract with VA facilities. Published by Elsevier Inc.

Mortality of Department of Veterans Affairs patients undergoing coronary revascularization in private sector hospitals.

PubMed

Vaughan-Sarrazin, Mary S; Wakefield, Bonnie; Rosenthal, Gary E

2007-10-01

A limitation of studies comparing outcomes of Veterans Affairs (VA) and private sector hospitals is uncertainty about the methods of accounting for risk factors in VA populations. This study estimates whether use of VA services is a marker for increased risk by comparing outcomes of VA users and other patients undergoing coronary revascularization in private sector hospitals. Males 67 years and older undergoing coronary artery bypass graft (CABG; n=687,936) surgery or percutaneous coronary intervention (PCI; n=664,124) during 1996-2002 were identified from Medicare administrative data. Patients using VA services during the 2 years preceding the Medicare admission were identified using VA administrative files. Thirty-, 90-, and 365-day mortality were compared in patients who did and did not use VA services, adjusting for demographic and clinical risk factors using generalized estimating equations and propensity score analysis. Adjusted mortality after CABG was higher (p<.001) in VA users compared with nonusers at 30, 90, and 365 days: odds ratio (OR)=1.07 (95 percent confidence interval [CI], 1.03-1.11), 1.07 (95 percent CI, 1.04-1.10), and 1.09 (95 percent CI, 1.06-1.12), respectively. For PCI, mortality at 30 and 90 days was similar (p>.05) for VA users and nonusers, but was higher at 365 days (OR=1.09; 95 percent CI, 1.06-1.12). The increased risk of death in VA users was limited to patients with service-connected disabilities or low incomes. Odds of death for VA users were slightly lower using samples matched by propensity scores. A small difference in risk-adjusted outcomes for VA users and nonusers undergoing revascularization in private sector hospitals was found. This difference reflects unmeasured severity in VA users undergoing revascularization in private sector hospitals.

International experiences in assessing vitamin A status and applying the vitamin A-labeled isotope dilution method.

PubMed

Lopez-Teros, Veronica; Chileshe, Justin; Idohou-Dossou, Nicole; Fajarwati, Tetra; Medoua Nama, Gabriel; Newton, Sam; Vinod Kumar, Malavika; Wang, Zhixu; Wasantwisut, Emorn; Hunt, Janet R

2014-01-01

Inadequate vitamin A (VA) nutrition continues to be a major problem worldwide, and many interventions being implemented to improve VA status in various populations need to be evaluated. The interpretation of results after an intervention depends greatly on the method selected to assess VA status. To evaluate the effect of an intervention on VA status, researchers in Cameroon, India, Indonesia, Mexico, Senegal and Zambia have used serum retinol as an indicator, and have not always found improvement in response to supplementation. One problem is that homeostatic control of serum retinol may mask positive effects of treatment in that changes in concentration are observed only when status is either moderately to severely depleted or excessive. Because VA is stored mainly in the liver, measurements of hepatic VA stores are the “gold standard” for assessing VA status. Dose response tests such as the relative dose response (RDR) and the modified relative dose response (MRDR), allow a qualitative assessment of VA liver stores. On the other hand, the use of the vitamin A-labeled isotope dilution (VALID) technique, (using 13C or 2H-labeled retinyl acetate) serves as an indirect method to quantitatively estimate total body and liver VA stores. Countries including Cameroon, China, Ghana, Mexico, Thailand and Zambia are now applying the VALID method to sensitively assess changes in VA status during interventions, or to estimate a population’s dietary requirement for VA. Transition to the use of more sensitive biochemical indicators of VA status such as the VALID technique is needed to effectively assess interventions in populations where mild to moderate VA deficiency is more prevalent than severe deficiency.

A Comprehensive Payment Model for Short- and Long-Stay Psychiatric Patients

PubMed Central

Fries, Brant E.; Durance, Paul W.; Nerenz, David R.; Ashcraft, Marie L.F.

1993-01-01

In this article, a payment model is developed for a hospital system with both acute- and chronic-stay psychiatric patients. “Transition pricing” provides a balance between the incentives of an episode-based system and the necessity of per diem long-term payments. Payment is dependent on two new psychiatric resident classification systems for short- and long-term stays. Data on per diem cost of inpatient care, by day of stay, was computed from a sample of 2,968 patients from 100 psychiatric units in 51 Department of Veterans Affairs (VA) Medical Centers. Using a 9-month cohort of all VA psychiatric discharges nationwide (79,337 with non-chronic stays), profits and losses were simulated. PMID:10135343

Developing a Health Information Technology Systems Matrix: A Qualitative Participatory Approach.

PubMed

Haun, Jolie N; Chavez, Margeaux; Nazi, Kim M; Antinori, Nicole

2016-10-06

The US Department of Veterans Affairs (VA) has developed various health information technology (HIT) resources to provide accessible veteran-centered health care. Currently, the VA is undergoing a major reorganization of VA HIT to develop a fully integrated system to meet consumer needs. Although extensive system documentation exists for various VA HIT systems, a more centralized and integrated perspective with clear documentation is needed in order to support effective analysis, strategy, planning, and use. Such a tool would enable a novel view of what is currently available and support identifying and effectively capturing the consumer's vision for the future. The objective of this study was to develop the VA HIT Systems Matrix, a novel tool designed to describe the existing VA HIT system and identify consumers' vision for the future of an integrated VA HIT system. This study utilized an expert panel and veteran informant focus groups with self-administered surveys. The study employed participatory research methods to define the current system and understand how stakeholders and veterans envision the future of VA HIT and interface design (eg, look, feel, and function). Directed content analysis was used to analyze focus group data. The HIT Systems Matrix was developed with input from 47 veterans, an informal caregiver, and an expert panel to provide a descriptive inventory of existing and emerging VA HIT in four worksheets: (1) access and function, (2) benefits and barriers, (3) system preferences, and (4) tasks. Within each worksheet is a two-axis inventory. The VA's existing and emerging HIT platforms (eg, My HealtheVet, Mobile Health, VetLink Kiosks, Telehealth), My HealtheVet features (eg, Blue Button, secure messaging, appointment reminders, prescription refill, vet library, spotlight, vitals tracker), and non-VA platforms (eg, phone/mobile phone, texting, non-VA mobile apps, non-VA mobile electronic devices, non-VA websites) are organized by row. Columns are titled with thematic and functional domains (eg, access, function, benefits, barriers, authentication, delegation, user tasks). Cells for each sheet include descriptions and details that reflect factors relevant to domains and the topic of each worksheet. This study provides documentation of the current VA HIT system and efforts for consumers' vision of an integrated system redesign. The HIT Systems Matrix provides a consumer preference blueprint to inform the current VA HIT system and the vision for future development to integrate electronic resources within VA and beyond with non-VA resources. The data presented in the HIT Systems Matrix are relevant for VA administrators and developers as well as other large health care organizations seeking to document and organize their consumer-facing HIT resources.

Modal analysis and control of flexible manipulator arms. Ph.D. Thesis

NASA Technical Reports Server (NTRS)

Neto, O. M.

1974-01-01

The possibility of modeling and controlling flexible manipulator arms was examined. A modal approach was used for obtaining the mathematical model and control techniques. The arm model was represented mathematically by a state space description defined in terms of joint angles and mode amplitudes obtained from truncation on the distributed systems, and included the motion of a two link two joint arm. Three basic techniques were used for controlling the system: pole allocation with gains obtained from the rigid system with interjoint feedbacks, Simon-Mitter algorithm for pole allocation, and sensitivity analysis with respect to parameter variations. An improvement in arm bandwidth was obtained. Optimization of some geometric parameters was undertaken to maximize bandwidth for various payload sizes and programmed tasks. The controlled system is examined under constant gains and using the nonlinear model for simulations following a time varying state trajectory.

Charter for the ARM Atmospheric Modeling Advisory Group

DOE Office of Scientific and Technical Information (OSTI.GOV)

Advisory Group, ARM Atmospheric Modeling

The Atmospheric Modeling Advisory Group of the U.S. Department of Energy (DOE) Atmospheric Radiation Measurement (ARM) Climate Research Facility is guided by the following: 1. The group will provide feedback on the overall project plan including input on how to address priorities and trade-offs in the modeling and analysis workflow, making sure the modeling follows general best practices, and reviewing the recommendations provided to ARM for the workflow implementation. 2. The group will consist of approximately 6 members plus the PI and co-PI of the Large-Eddy Simulation (LES) ARM Symbiotic Simulation and Observation (LASSO) pilot project. The ARM Technical Director,more » or his designee, serves as an ex-officio member. This size is chosen based on the ability to efficiently conduct teleconferences and to span the general needs for input to the LASSO pilot project.« less

An agent-vector-host-environment model for controlling small arms and light weapons.

PubMed

Pinto, Andrew D; Sharma, Malika; Muggah, Robert

2011-05-01

Armed violence is a significant public health problem. It results in fatal and non-fatal injuries and disrupts social and economic processes that are essential to the health of individuals and communities. We argue that an agent-vector-host-environment model can be helpful in understanding and describing the availability and misuse of small arms and light weapons. Moreover, such a model can assist in identifying potential control points and in developing mitigation strategies. These concepts have been developed from analogous vector control programs and are applied to controlling arms to reduce their misuse. So-called 'denormalization' and 'de-legitimization' campaigns that focus on the vector - including the industry producing these commodities - can be based on the experience of public health in controlling tobacco use and exposure. This model can assist health professionals, civil society and governments in developing comprehensive strategies to limit the production, distribution and misuse of small arms and light weapons.

10 CFR 429.12 - General requirements applicable to certification reports.

Code of Federal Regulations, 2012 CFR

2012-01-01

... distribution transformers, the basic model number or kVA grouping model number (depending on the certification... signal modules, Pedestrian modules, and Distribution transformers June 1. Room air conditioners... within one year after the first date of new model manufacture. (3) For distribution transformers, the...

10 CFR 429.12 - General requirements applicable to certification reports.

Code of Federal Regulations, 2013 CFR

2013-01-01

... distribution transformers, the basic model number or kVA grouping model number (depending on the certification... signal modules, Pedestrian modules, and Distribution transformers June 1. Room air conditioners... within one year after the first date of new model manufacture. (3) For distribution transformers, the...

Vibration acceleration promotes bone formation in rodent models

PubMed Central

Uchida, Ryohei; Nakata, Ken; Kawano, Fuminori; Yonetani, Yasukazu; Ogasawara, Issei; Nakai, Naoya; Mae, Tatsuo; Matsuo, Tomohiko; Tachibana, Yuta; Yokoi, Hiroyuki; Yoshikawa, Hideki

2017-01-01

All living tissues and cells on Earth are subject to gravitational acceleration, but no reports have verified whether acceleration mode influences bone formation and healing. Therefore, this study was to compare the effects of two acceleration modes, vibration and constant (centrifugal) accelerations, on bone formation and healing in the trunk using BMP 2-induced ectopic bone formation (EBF) mouse model and a rib fracture healing (RFH) rat model. Additionally, we tried to verify the difference in mechanism of effect on bone formation by accelerations between these two models. Three groups (low- and high-magnitude vibration and control-VA groups) were evaluated in the vibration acceleration study, and two groups (centrifuge acceleration and control-CA groups) were used in the constant acceleration study. In each model, the intervention was applied for ten minutes per day from three days after surgery for eleven days (EBF model) or nine days (RFH model). All animals were sacrificed the day after the intervention ended. In the EBF model, ectopic bone was evaluated by macroscopic and histological observations, wet weight, radiography and microfocus computed tomography (micro-CT). In the RFH model, whole fracture-repaired ribs were excised with removal of soft tissue, and evaluated radiologically and histologically. Ectopic bones in the low-magnitude group (EBF model) had significantly greater wet weight and were significantly larger (macroscopically and radiographically) than those in the other two groups, whereas the size and wet weight of ectopic bones in the centrifuge acceleration group showed no significant difference compared those in control-CA group. All ectopic bones showed calcified trabeculae and maturated bone marrow. Micro-CT showed that bone volume (BV) in the low-magnitude group of EBF model was significantly higher than those in the other two groups (3.1±1.2mm3 v.s. 1.8±1.2mm3 in high-magnitude group and 1.3±0.9mm3 in control-VA group), but BV in the centrifuge acceleration group had no significant difference compared those in control-CA group. Union rate and BV in the low-magnitude group of RFH model were also significantly higher than those in the other groups (Union rate: 60% v.s. 0% in the high-magnitude group and 10% in the control-VA group, BV: 0.69±0.30mm3 v.s. 0.15±0.09mm3 in high-magnitude group and 0.22±0.17mm3 in control-VA group). BV/TV in the low-magnitude group of RFH model was significantly higher than that in control-VA group (59.4±14.9% v.s. 35.8±13.5%). On the other hand, radiographic union rate (10% in centrifuge acceleration group v.s. 20% in control-CA group) and micro-CT parameters in RFH model were not significantly different between two groups in the constant acceleration studies. Radiographic images of non-union rib fractures showed cartilage at the fracture site and poor new bone formation, whereas union samples showed only new bone. In conclusion, low-magnitude vibration acceleration promoted bone formation at the trunk in both BMP-induced ectopic bone formation and rib fracture healing models. However, the micro-CT parameters were not similar between two models, which suggested that there might be difference in the mechanism of effect by vibration between two models. PMID:28264058

Vibration acceleration promotes bone formation in rodent models.

PubMed

Uchida, Ryohei; Nakata, Ken; Kawano, Fuminori; Yonetani, Yasukazu; Ogasawara, Issei; Nakai, Naoya; Mae, Tatsuo; Matsuo, Tomohiko; Tachibana, Yuta; Yokoi, Hiroyuki; Yoshikawa, Hideki

2017-01-01

All living tissues and cells on Earth are subject to gravitational acceleration, but no reports have verified whether acceleration mode influences bone formation and healing. Therefore, this study was to compare the effects of two acceleration modes, vibration and constant (centrifugal) accelerations, on bone formation and healing in the trunk using BMP 2-induced ectopic bone formation (EBF) mouse model and a rib fracture healing (RFH) rat model. Additionally, we tried to verify the difference in mechanism of effect on bone formation by accelerations between these two models. Three groups (low- and high-magnitude vibration and control-VA groups) were evaluated in the vibration acceleration study, and two groups (centrifuge acceleration and control-CA groups) were used in the constant acceleration study. In each model, the intervention was applied for ten minutes per day from three days after surgery for eleven days (EBF model) or nine days (RFH model). All animals were sacrificed the day after the intervention ended. In the EBF model, ectopic bone was evaluated by macroscopic and histological observations, wet weight, radiography and microfocus computed tomography (micro-CT). In the RFH model, whole fracture-repaired ribs were excised with removal of soft tissue, and evaluated radiologically and histologically. Ectopic bones in the low-magnitude group (EBF model) had significantly greater wet weight and were significantly larger (macroscopically and radiographically) than those in the other two groups, whereas the size and wet weight of ectopic bones in the centrifuge acceleration group showed no significant difference compared those in control-CA group. All ectopic bones showed calcified trabeculae and maturated bone marrow. Micro-CT showed that bone volume (BV) in the low-magnitude group of EBF model was significantly higher than those in the other two groups (3.1±1.2mm3 v.s. 1.8±1.2mm3 in high-magnitude group and 1.3±0.9mm3 in control-VA group), but BV in the centrifuge acceleration group had no significant difference compared those in control-CA group. Union rate and BV in the low-magnitude group of RFH model were also significantly higher than those in the other groups (Union rate: 60% v.s. 0% in the high-magnitude group and 10% in the control-VA group, BV: 0.69±0.30mm3 v.s. 0.15±0.09mm3 in high-magnitude group and 0.22±0.17mm3 in control-VA group). BV/TV in the low-magnitude group of RFH model was significantly higher than that in control-VA group (59.4±14.9% v.s. 35.8±13.5%). On the other hand, radiographic union rate (10% in centrifuge acceleration group v.s. 20% in control-CA group) and micro-CT parameters in RFH model were not significantly different between two groups in the constant acceleration studies. Radiographic images of non-union rib fractures showed cartilage at the fracture site and poor new bone formation, whereas union samples showed only new bone. In conclusion, low-magnitude vibration acceleration promoted bone formation at the trunk in both BMP-induced ectopic bone formation and rib fracture healing models. However, the micro-CT parameters were not similar between two models, which suggested that there might be difference in the mechanism of effect by vibration between two models.

Building capacity in VA to provide emergency gynecology services for women.

PubMed

Cordasco, Kristina M; Huynh, Alexis K; Zephyrin, Laurie; Hamilton, Alison B; Lau-Herzberg, Amy E; Kessler, Chad S; Yano, Elizabeth M

2015-04-01

Visits to Veterans Administration (VA) emergency departments (EDs) are increasingly being made by women. A 2011 national inventory of VA emergency services for women revealed that many EDs have gaps in their resources and processes for gynecologic emergency care. To guide VA in addressing these gaps, we sought to understand factors acting as facilitators and/or barriers to improving VA ED capacity for, and quality of, emergency gynecology care. Semistructured interviews with VA emergency and women's health key informants. ED directors/providers (n=14), ED nurse managers (n=13), and Women Veteran Program Managers (n=13) in 13 VA facilities. Leadership, staff, space, demand, funding, policies, and community were noted as important factors influencing VA EDs building capacity and improving emergency gynecologic care for women Veterans. These factors are intertwined and cross multiple organizational levels so that each ED's capacity is a reflection not only of its own factors, but also those of its local medical center and non-VA community context as well as VA regional and national trends and policies. Policies and quality improvement initiatives aimed at building VA's emergency gynecologic services for women need to be multifactorial and aimed at multiple organizational levels. Policies need to be flexible to account for wide variations across EDs and their medical center and community contexts. Approaches that build and encourage local leadership engagement, such as evidence-based quality improvement methodology, are likely to be most effective.

Increases in the prevalence of reduced visual acuity and myopia in Chinese children in Guangzhou over the past 20 years.

PubMed

Xiang, F; He, M; Zeng, Y; Mai, J; Rose, K A; Morgan, I G

2013-12-01

To estimate the prevalence of myopia based on reduced unaided visual acuity (VA) in Chinese school children over the past 20 years. Guangzhou school health authorities have measured VA on Grade 1-12 students from 1988 to 2007 annually, using a LogMAR tumbling E chart. VA is reported as Snellen categories: normal (VA ≥ 6/6), mildly reduced (6/9 < VA <6/6), moderately reduced (6/18 < VA ≤ 6/9), and severely reduced VA (VA ≤ 6/18). In 1988, over 80% of children in Grade 1 (age 6 years) and about 30% in Grade 12 (age 17 years) had normal unaided VA. By 2007, this dropped to only 60% in Grade 1 and about 10% in Grade 12. Conversely, the prevalence of moderately and severely reduced unaided VA increased from 6.2% in Grade 1 and 62.5% in Grade 12 in 1988 to 14.5% in Grade 1 and 84.11% in Grade 12 in 2007. This rate was unchanged from 2003 to 2007 at both the Grade 1 and Grade 12 levels. In Guangzhou, the prevalence of reduced unaided VA has increased markedly in the past 20 years, but has stabilized in the past few years. This increase may result from environmental changes, such as increased schooling intensity and urbanization.

Clinical and MRI activity as determinants of sample size for pediatric multiple sclerosis trials

PubMed Central

Verhey, Leonard H.; Signori, Alessio; Arnold, Douglas L.; Bar-Or, Amit; Sadovnick, A. Dessa; Marrie, Ruth Ann; Banwell, Brenda

2013-01-01

Objective: To estimate sample sizes for pediatric multiple sclerosis (MS) trials using new T2 lesion count, annualized relapse rate (ARR), and time to first relapse (TTFR) endpoints. Methods: Poisson and negative binomial models were fit to new T2 lesion and relapse count data, and negative binomial time-to-event and exponential models were fit to TTFR data of 42 children with MS enrolled in a national prospective cohort study. Simulations were performed by resampling from the best-fitting model of new T2 lesion count, number of relapses, or TTFR, under various assumptions of the effect size, trial duration, and model parameters. Results: Assuming a 50% reduction in new T2 lesions over 6 months, 90 patients/arm are required, whereas 165 patients/arm are required for a 40% treatment effect. Sample sizes for 2-year trials using relapse-related endpoints are lower than that for 1-year trials. For 2-year trials and a conservative assumption of overdispersion (ϑ), sample sizes range from 70 patients/arm (using ARR) to 105 patients/arm (TTFR) for a 50% reduction in relapses, and 230 patients/arm (ARR) to 365 patients/arm (TTFR) for a 30% relapse reduction. Assuming a less conservative ϑ, 2-year trials using ARR require 45 patients/arm (60 patients/arm for TTFR) for a 50% reduction in relapses and 145 patients/arm (200 patients/arm for TTFR) for a 30% reduction. Conclusion: Six-month phase II trials using new T2 lesion count as an endpoint are feasible in the pediatric MS population; however, trials powered on ARR or TTFR will need to be 2 years in duration and will require multicentered collaboration. PMID:23966255

77 FR 65939 - Privacy Act of 1974; System of Records

Federal Register 2010, 2011, 2012, 2013, 2014

2012-10-31

... Technology Architecture (VistA) Records-VA'' (79VA19) as set forth in the Federal Register 75 FR 4454. VA is... Health Information Systems and Technology Architecture (VistA) Records-VA ROUTINE USES OF RECORDS...

Determination of VA health care costs.

PubMed

Barnett, Paul G

2003-09-01

In the absence of billing data, alternative methods are used to estimate the cost of hospital stays, outpatient visits, and treatment innovations in the U.S. Department of Veterans Affairs (VA). The choice of method represents a trade-off between accuracy and research cost. The direct measurement method gathers information on staff activities, supplies, equipment, space, and workload. Since it is expensive, direct measurement should be reserved for finding short-run costs, evaluating provider efficiency, or determining the cost of treatments that are innovative or unique to VA. The pseudo-bill method combines utilization data with a non-VA reimbursement schedule. The cost regression method estimates the cost of VA hospital stays by applying the relationship between cost and characteristics of non-VA hospitalizations. The Health Economics Resource Center uses pseudo-bill and cost regression methods to create an encounter-level database of VA costs. Researchers are also beginning to use the VA activity-based cost allocation system.

Assessment of body composition in dialysis patients by arm bioimpedance compared to MRI and 40K measurements.

PubMed

Carter, M; Zhu, F; Kotanko, P; Kuhlmann, M; Ramirez, L; Heymsfield, S B; Handelman, G; Levin, N W

2009-01-01

This study used multi-frequency bioimpedance spectroscopy (BIS) of the arm and whole body to estimate muscle mass (MM) and subcutaneous adipose tissue (SAT) in 31 hemodialysis (HD) patients comparing these results with magnetic resonance imaging (MRI) and body potassium ((40)K) as gold standards. Total body and arm MM (MM(MRI)) and SAT (SAT(MRI)) were measured by MRI. All measurements were made before dialysis treatment. Regression models with the arm (aBIS) and whole body (wBIS) resistances were established. Correlations between gold standards and the BIS model were high for the arm SAT (r(2) = 0.93, standard error of estimate (SEE) = 3.6 kg), and whole body SAT (r(2) = 0.92, SEE = 3.5 kg), and for arm MM (r(2) = 0.84, SEE = 2.28 kg) and whole body MM (r(2) = 0.86, SEE = 2.28 kg). Total body MM and SAT can be accurately predicted by arm BIS models with advantages of convenience and portability, and it should be useful to assess nutritional status in HD patients. Copyright (c) 2009 S. Karger AG, Basel.

Decadal Vision Progress Report Implementation Plans and Status for the Next Generation ARM Facility

DOE Office of Scientific and Technical Information (OSTI.GOV)

Mather, James

The reconfiguration of the ARM facility, formally initiated in early 2014, is geared toward implementing the Next Generation of the ARM Facility, which will more tightly link ARM measurements and atmospheric models. The strategy is outlined in the ARM Climate Research Facility Decadal Vision (DOE 2014a). The strategy includes the implementation of a high-resolution model, initially at the Southern Great Plains (SGP) site, and enhancements at the SGP and North Slope of Alaska (NSA) sites to provide additional observations to support modeling and process studies. Enhancements at the SGP site focus on ground-based instruments while enhancements at the NSA makemore » use of Unmanned Aerial Systems (UAS) and Tethered Balloon Systems (TBS). It is also recognized that new data tools and data products will need to be developed to take full advantage of these improvements. This document provides an update on the status of these ARM facility enhancements, beginning with the measurement enhancements at the SGP and NSA, followed by a discussion of the modeling project including associated data-processing activities.« less

Galaxy Zoo: constraining the origin of spiral arms

NASA Astrophysics Data System (ADS)

Hart, Ross E.; Bamford, Steven P.; Keel, William C.; Kruk, Sandor J.; Masters, Karen L.; Simmons, Brooke D.; Smethurst, Rebecca J.

2018-07-01

Since the discovery that the majority of low-redshift galaxies exhibit some level of spiral structure, a number of theories have been proposed as to why these patterns exist. A popular explanation is a process known as swing amplification, yet there is no observational evidence to prove that such a mechanism is at play. By using a number of measured properties of galaxies, and scaling relations where there are no direct measurements, we model samples of SDSS and S4G spiral galaxies in terms of their relative halo, bulge, and disc mass and size. Using these models, we test predictions of swing amplification theory with respect to directly measured spiral arm numbers from Galaxy Zoo 2. We find that neither a universal cored nor cuspy inner dark matter profile can correctly predict observed numbers of arms in galaxies. However, by invoking a halo contraction/expansion model, a clear bimodality in the spiral galaxy population emerges. Approximately 40 per cent of unbarred spiral galaxies at z ≲ 0.1 and M* ≳ 1010 M⊙ have spiral arms that can be modelled by swing amplification. This population display a significant correlation between predicted and observed spiral arm numbers, evidence that they are swing amplified modes. The remainder are dominated by two-arm systems for which the model predicts significantly higher arm numbers. These are likely driven by tidal interactions or other mechanisms.

Galaxy Zoo: constraining the origin of spiral arms

NASA Astrophysics Data System (ADS)

Hart, Ross E.; Bamford, Steven P.; Keel, William C.; Kruk, Sandor J.; Masters, Karen L.; Simmons, Brooke D.; Smethurst, Rebecca J.

2018-05-01

Since the discovery that the majority of low-redshift galaxies exhibit some level of spiral structure, a number of theories have been proposed as to why these patterns exist. A popular explanation is a process known as swing amplification, yet there is no observational evidence to prove that such a mechanism is at play. By using a number of measured properties of galaxies, and scaling relations where there are no direct measurements, we model samples of SDSS and S4G spiral galaxies in terms of their relative halo, bulge and disc mass and size. Using these models, we test predictions of swing amplification theory with respect to directly measured spiral arm numbers from Galaxy Zoo 2. We find that neither a universal cored or cuspy inner dark matter profile can correctly predict observed numbers of arms in galaxies. However, by invoking a halo contraction/expansion model, a clear bimodality in the spiral galaxy population emerges. Approximately 40 per cent of unbarred spiral galaxies at z ≲ 0.1 and M* ≳ 1010M⊙ have spiral arms that can be modelled by swing amplification. This population display a significant correlation between predicted and observed spiral arm numbers, evidence that they are swing amplified modes. The remainder are dominated by two-arm systems for which the model predicts significantly higher arm numbers. These are likely driven by tidal interactions or other mechanisms.

48 CFR 852.219-71 - VA mentor-protégé program.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 48 Federal Acquisition Regulations System 5 2010-10-01 2010-10-01 false VA mentor-protégÃ....219-71 VA mentor-protégé program. As prescribed in 819.7115(a), insert the following clause: VA Mentor-Protégé Program (DEC 2009) (a) Large businesses are encouraged to participate in the VA Mentor-Protégé...

77 FR 23322 - Proposed Information Collection (Report of General Information) Activity: Comment Request

Federal Register 2010, 2011, 2012, 2013, 2014

2012-04-18

... Information. d. VA Form 21-0820c, Report of Defense Finance and Accounting Service (DFAS). e. VA Form 21-0820d.... VA Form 21-0820c, Report of Defense Finance and Accounting Service (DFAS)--2,500. e. VA Form 21-0820d... Nursing Home Information--30,000. d. VA Form 21-0820c, Report of Defense Finance and Accounting Service...

Improving Early Palliative Care with a Scalable, Stepped Peer Navigator and Social Work Intervention: A Single-Arm Clinical Trial.

PubMed

Bekelman, David B; Johnson-Koenke, Rachel; Bowles, Daniel W; Fischer, Stacy M

2018-02-20

Patients with cancer could benefit from early primary (i.e., basic) palliative care. Scalable models of care delivery are needed. Examine the feasibility of a stepped peer navigator and social work intervention developed to improve palliative care outcomes. Single-arm prospective clinical trial. The peer navigator educated patients to advocate for pain and symptom management with their healthcare providers, motivated patients to pursue advance care planning, and discussed the role of hospice. The social worker saw patients with persistent psychosocial distress. Patients with advanced cancer at a VA Medical Center not currently in palliative care or hospice whose oncologist would not be surprised if the patient died in the subsequent year. Participation and retention rates, patient-reported symptoms and quality of life, advance directive documentation, patient satisfaction survey, and semistructured interviews. The participation rate was 38% (17/45), and 35% (7/17) completed final survey measures. Patients had stage IV (81%) and primarily genitourinary (47%) and lung (24%) malignancies. Median Eastern Cooperative Oncology Group performance status was 0. Patient-reported surveys indicated low distress (mean scores: Functional Assessment of Cancer Therapy-General, 75.3 [standard deviation {SD} 17.6]; Edmonton Symptom Assessment Scale symptom scores ranged from 1.6 to 3.8; Patient Health Questionnaire-9, 5.7 [SD 5.2]; and Generalized Anxiety Disorder-7, 2.8 [SD 4.1]). Of those who had not completed advance directives at baseline (n = 11, 65%), five completed them by the end of study (5/11, 45%). Patients who completed satisfaction surveys (n = 7) and interviews (n = 4) provided mixed reviews of the intervention. At a single site, a stepped peer navigator and social work palliative care study had several challenges to feasibility, including low patient-reported distress and loss to follow-up.

Veterans' Health Insurance Coverage Under the Affordable Care Act and Implications of Repeal for the Department of Veterans Affairs

PubMed Central

Dworsky, Michael; Farmer, Carrie M.; Shen, Mimi

2018-01-01

Abstract This article describes the Affordable Care Act's (ACA's) effects on nonelderly veterans' insurance coverage and demand for Department of Veterans Affairs (VA) health care and assesses the coverage and VA utilization changes that could result from repealing the ACA. Although prior research has shown that the number of uninsured veterans fell after the ACA took effect, the implications of ACA repeal for veterans and, especially, for VA have received less attention. Besides providing a new coverage option to veterans who are not enrolled in VA, the ACA also had the potential to affect health care use among VA patients. Findings include the following: In 2013, prior to the major coverage expansions under the ACA, nearly one in ten nonelderly veterans were uninsured, lacking access to both VA coverage and non-VA health insurance. Uninsurance among nonelderly veterans fell by an adjusted 36 percent (3.3 percentage points) after implementation of the ACA, from 9.1 percent in 2013 to 5.8 percent in 2015. By increasing non-VA health insurance coverage for VA patients, the ACA likely reduced demand for VA care; the authors estimate that, if the gains in insurance coverage that occurred between 2013 and 2015 had not occurred, nonelderly veterans would have used about 1 percent more VA health care in 2015: 125,000 more office visits, 1,500 more inpatient surgeries, and 375,000 more prescriptions. Recent congressional proposals to repeal and replace the ACA would increase the number of uninsured nonelderly veterans and further increase demand for VA health care. PMID:29607249

Resources and Capabilities of the Department of Veterans Affairs to Provide Timely and Accessible Care to Veterans

PubMed Central

Hussey, Peter S.; Ringel, Jeanne S.; Ahluwalia, Sangeeta; Price, Rebecca Anhang; Buttorff, Christine; Concannon, Thomas W.; Lovejoy, Susan L.; Martsolf, Grant R.; Rudin, Robert S.; Schultz, Dana; Sloss, Elizabeth M.; Watkins, Katherine E.; Waxman, Daniel; Bauman, Melissa; Briscombe, Brian; Broyles, James R.; Burns, Rachel M.; Chen, Emily K.; DeSantis, Amy Soo Jin; Ecola, Liisa; Fischer, Shira H.; Friedberg, Mark W.; Gidengil, Courtney A.; Ginsburg, Paul B.; Gulden, Timothy; Gutierrez, Carlos Ignacio; Hirshman, Samuel; Huang, Christina Y.; Kandrack, Ryan; Kress, Amii; Leuschner, Kristin J.; MacCarthy, Sarah; Maksabedian, Ervant J.; Mann, Sean; Matthews, Luke Joseph; May, Linnea Warren; Mishra, Nishtha; Miyashiro, Lisa; Muchow, Ashley N.; Nelson, Jason; Naranjo, Diana; O'Hanlon, Claire E.; Pillemer, Francesca; Predmore, Zachary; Ross, Rachel; Ruder, Teague; Rutter, Carolyn M.; Uscher-Pines, Lori; Vaiana, Mary E.; Vesely, Joseph V.; Hosek, Susan D.; Farmer, Carrie M.

2016-01-01

Abstract The Veterans Access, Choice, and Accountability Act of 2014 addressed the need for access to timely, high-quality health care for veterans. Section 201 of the legislation called for an independent assessment of various aspects of veterans' health care. The RAND Corporation was tasked with an assessment of the Department of Veterans Affairs (VA) current and projected health care capabilities and resources. An examination of data from a variety of sources, along with a survey of VA medical facility leaders, revealed the breadth and depth of VA resources and capabilities: fiscal resources, workforce and human resources, physical infrastructure, interorganizational relationships, and information resources. The assessment identified barriers to the effective use of these resources and capabilities. Analysis of data on access to VA care and the quality of that care showed that almost all veterans live within 40 miles of a VA health facility, but fewer have access to VA specialty care. Veterans usually receive care within 14 days of their desired appointment date, but wait times vary considerably across VA facilities. VA has long played a national leadership role in measuring the quality of health care. The assessment showed that VA health care quality was as good or better on most measures compared with other health systems, but quality performance lagged at some VA facilities. VA will require more resources and capabilities to meet a projected increase in veterans' demand for VA care over the next five years. Options for increasing capacity include accelerated hiring, full nurse practice authority, and expanded use of telehealth. PMID:28083424

Community Veterans' Decision to Use VA Services: A Multimethod Veteran Health Partnership Study.

PubMed

Franco, Zeno E; Logan, Clinton; Flower, Mark; Curry, Bob; Ruffalo, Leslie; Brazauskas, Ruta; Whittle, Jeff

2016-01-01

Ensuring veterans' access to healthcare is a national priority. Prior studies of veterans' use of Veterans Health Administration (VA) healthcare have had limited success in evaluating barriers to access for certain vulnerable veteran subpopulations. Our coalition of researchers and veteran community members sought to understand factors affecting use of VA, particularly for those less likely to participate in traditional survey studies. We recruited 858 veterans to complete a collaboratively designed survey at community events or via social media. We compared our results regarding VA use with the 2010 National Survey of Veterans (NSV) using chi-square tests, multiple logistic regression to identify predictors of VA use, and content analysis for open-ended descriptions of barriers to VA use. Veterans in our study were more likely than NSV respondents to report using VA healthcare ever (76% vs. 28%; p<0.0001). Within this group, more veterans in our sample were current VA users (83% vs. 68%; p<0.0001). In multivariable analysis, VA use was predicted by self-reported physical problems (comparing "a lot" vs. "none" for each variable, adjusted odds ratio [OR], 8.35), thinking problems (OR, 1.14), need for smoking cessation (OR, 1.54), need for pain management (OR, 1.65), and need for other mental health services (OR, 3.04). We identified 15 themes summarizing veterans' perceived barriers to VA use. Persistent actual and perceived barriers prevent some veterans from using VA services. The VA can better understand and address these issues through community-academic partnerships with veterans' organizations.

Visionary leadership and the future of VA health system.

PubMed

Bezold, C; Mayer, E; Dighe, A

1997-01-01

As the U.S. Department of Veterans Affairs (VA) makes the change over to Veterans Integrated Service Network (VISNs) the need for new and better leadership is warranted if VA wants to not only survive, but thrive in the emerging twenty-first century healthcare system. VA can prepare for the future and meet the challenges facing them by adopting a system of visionary leadership. The use of scenarios and vision techniques are explained as they relate to VA's efforts to move toward their new system of VISNs. The four scenarios provide snapshots of possible futures for the U.S. healthcare system as well as the possible future role and mission of VA--from VA disappearing to its becoming a premier virtual organization.

Adaptation of intensive mental health intensive case management to rural communities in the Veterans Health Administration.

PubMed

Mohamed, Somaia

2013-03-01

There has been increasing concern in recent years about the availability of mental health services for people with serious mental illness in rural areas. To meet these needs the Department of Veterans Affairs (VA) implemented the Rural Access Networks for Growth Enhancement (RANGE) program, in 2007, modeled on the Assertive Community Treatment (ACT) model. This study uses VA administrative data from the RANGE program (N = 343) to compare client characteristics at program entry, patterns of service delivery, and outcomes with those of Veterans who received services from the general VA ACT-like program (Mental Health Intensive Case Management (MHICM) (N = 3,077). Veterans in the rural program entered treatment with similar symptom severity, less likelihood of being diagnosed with schizophrenia and having had long-term hospitalization, but significantly higher suicidality index scores and greater likelihood of being dually diagnosed compared with those in the general program. RANGE Veterans live further away from their treatment teams but did not differ significantly in measures of face-to-face treatment intensity. Similar proportions of RANGE and MHICM Veterans were reported to have received rehabilitation services, crisis intervention and substance abuse treatment. The rural programs had higher scores on overall satisfaction with VA mental health care than general programs, slightly poorer outcomes on quality of life and on the suicidality index but no significant difference on other outcomes. These data demonstrate the clinical need, practical feasibility and potential effectiveness of providing intensive case management through small specialized case management teams in rural areas.

Response to Selection in Finite Locus Models with Nonadditive Effects.

PubMed

Esfandyari, Hadi; Henryon, Mark; Berg, Peer; Thomasen, Jørn Rind; Bijma, Piter; Sørensen, Anders Christian

2017-05-01

Under the finite-locus model in the absence of mutation, the additive genetic variation is expected to decrease when directional selection is acting on a population, according to quantitative-genetic theory. However, some theoretical studies of selection suggest that the level of additive variance can be sustained or even increased when nonadditive genetic effects are present. We tested the hypothesis that finite-locus models with both additive and nonadditive genetic effects maintain more additive genetic variance (VA) and realize larger medium- to long-term genetic gains than models with only additive effects when the trait under selection is subject to truncation selection. Four genetic models that included additive, dominance, and additive-by-additive epistatic effects were simulated. The simulated genome for individuals consisted of 25 chromosomes, each with a length of 1 M. One hundred bi-allelic QTL, 4 on each chromosome, were considered. In each generation, 100 sires and 100 dams were mated, producing 5 progeny per mating. The population was selected for a single trait (h2 = 0.1) for 100 discrete generations with selection on phenotype or BLUP-EBV. VA decreased with directional truncation selection even in presence of nonadditive genetic effects. Nonadditive effects influenced long-term response to selection and among genetic models additive gene action had highest response to selection. In addition, in all genetic models, BLUP-EBV resulted in a greater fixation of favorable and unfavorable alleles and higher response than phenotypic selection. In conclusion, for the schemes we simulated, the presence of nonadditive genetic effects had little effect in changes of additive variance and VA decreased by directional selection. © The American Genetic Association 2017. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Estimating Risk of Natural Gas Portfolios by Using GARCH-EVT-Copula Model.

PubMed

Tang, Jiechen; Zhou, Chao; Yuan, Xinyu; Sriboonchitta, Songsak

2015-01-01

This paper concentrates on estimating the risk of Title Transfer Facility (TTF) Hub natural gas portfolios by using the GARCH-EVT-copula model. We first use the univariate ARMA-GARCH model to model each natural gas return series. Second, the extreme value distribution (EVT) is fitted to the tails of the residuals to model marginal residual distributions. Third, multivariate Gaussian copula and Student t-copula are employed to describe the natural gas portfolio risk dependence structure. Finally, we simulate N portfolios and estimate value at risk (VaR) and conditional value at risk (CVaR). Our empirical results show that, for an equally weighted portfolio of five natural gases, the VaR and CVaR values obtained from the Student t-copula are larger than those obtained from the Gaussian copula. Moreover, when minimizing the portfolio risk, the optimal natural gas portfolio weights are found to be similar across the multivariate Gaussian copula and Student t-copula and different confidence levels.

Estimating Risk of Natural Gas Portfolios by Using GARCH-EVT-Copula Model

PubMed Central

Tang, Jiechen; Zhou, Chao; Yuan, Xinyu; Sriboonchitta, Songsak

2015-01-01

This paper concentrates on estimating the risk of Title Transfer Facility (TTF) Hub natural gas portfolios by using the GARCH-EVT-copula model. We first use the univariate ARMA-GARCH model to model each natural gas return series. Second, the extreme value distribution (EVT) is fitted to the tails of the residuals to model marginal residual distributions. Third, multivariate Gaussian copula and Student t-copula are employed to describe the natural gas portfolio risk dependence structure. Finally, we simulate N portfolios and estimate value at risk (VaR) and conditional value at risk (CVaR). Our empirical results show that, for an equally weighted portfolio of five natural gases, the VaR and CVaR values obtained from the Student t-copula are larger than those obtained from the Gaussian copula. Moreover, when minimizing the portfolio risk, the optimal natural gas portfolio weights are found to be similar across the multivariate Gaussian copula and Student t-copula and different confidence levels. PMID:26351652

12 CFR 217.153 - Internal models approach (IMA).

Code of Federal Regulations, 2014 CFR

2014-01-01

...-regulated institution must have one or more models that: (i) Assess the potential decline in value of its... idiosyncratic risk. (2) The Board-regulated institution's model must produce an estimate of potential losses for its modeled equity exposures that is no less than the estimate of potential losses produced by a VaR...

Modelling Cerebral Blood Flow and Temperature Using a Vascular Porous Model

NASA Astrophysics Data System (ADS)

Blowers, Stephen; Thrippleton, Michael; Marshall, Ian; Harris, Bridget; Andrews, Peter; Valluri, Prashant

2016-11-01

Macro-modelling of cerebral blood flow can assist in determining the impact of temperature intervention to reduce permanent tissue damage during instances of brain trauma. Here we present a 3D two phase fluid-porous model for simulating blood flow through the capillary region linked to intersecting 1D arterial and venous vessel trees. This combined vasculature porous (VaPor) model simulates both flow and energy balances, including heat from metabolism, using a vasculature extracted from MRI data which are expanded upon using a tree generation algorithm. Validation of temperature balance has been achieved using rodent brain data. Direct flow validation is not as straight forward due to the method used in determining regional cerebral blood flow (rCBF). In-vivo measurements are achieved using a tracer, which disagree with direct measurements of simulated flow. However, by modelling a virtual tracer, rCBF values are obtained that agree with those found in literature. Temperature profiles generated with the VaPor model show a reduction in core brain temperature after cooling the scalp not seen previously in other models.

JAVA CLASSES FOR NONPROCEDURAL VARIOGRAM MONITORING

EPA Science Inventory

A set of Java classes was written for variogram modeling to support research for US EPA's Regional Vulnerability Assessment Program (ReVA). The modeling objectives of this research program are to use conceptual programming tools for numerical analysis for regional risk assessm...

Pharmacy Benefits Management in the Veterans Health Administration Revisited: A Decade of Advancements, 2004-2014.

PubMed

Aspinall, Sherrie L; Sales, Mariscelle M; Good, Chester B; Calabrese, Vincent; Glassman, Peter A; Burk, Muriel; Moore, Von R; Neuhauser, Melinda M; Golterman, Lori; Ourth, Heather; Valentino, Michael A; Cunningham, Francesca E

2016-09-01

Over the past decade, the Department of Veterans Affairs (VA) Pharmacy Benefits Management Services (PBM) has enhanced its formulary management activities and added programs to ensure that the national drug plan continues to meet the pharmacy needs of veterans and to promote safe and appropriate drug therapy in the face of rising medication expenditures. This article describes the broad range of services provided by the VA PBM that work in partnership to deliver a high-quality and sustainable pharmacy benefit for veterans. In support of formulary management, VA PBM pharmacists prepare extensive clinical guidance documents (e.g., drug monographs and criteria for use) that are used by physicians and pharmacists with operational and clinical oversight of the VA national formulary. The VA PBM has utilized various contracting techniques and continually evaluates drug utilization data to identify opportunities for potential savings. Remarkably, since before 2004, the average acquisition cost for a 1-month supply of medication has remained fairly stable at approximately $13-$15. Two new VA PBM programs are the VA Center for Medication Safety (VA MedSAFE) and the Clinical Pharmacy Practice Office (CPPO). VA MedSAFE is a comprehensive pharmacovigilance program focused on the detection, assessment, and prevention of adverse drug events, and CPPO is dedicated to improving safe and appropriate medication use by supporting and expanding clinical pharmacy practice. Moving forward, the VA PBM will consider new initiatives to stay at the forefront of providing quality care while maintaining economic viability. No outside funding supported this research. This work was supported by VA Pharmacy Benefits Management Services (VA PBM), Hines, Illinois, and VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania. Glassman is co-director of the VA Center for Medication Safety, which is part of the VA PBM. He is also part of the Medical Advisory Panel for the VA PMB. All other authors are employed by the VA PBM. The views expressed in this article are those of the authors, and no official endorsement by the U.S. Department of Veteran Affairs or the U.S. government is intended or should be inferred. Study concept and design were contributed by Valentino, Cunningham, Good, Aspinall, and Sales. Calabrese and Ourth took the lead in data collection, along with Good, Cunningham, Aspinall, Sales, Burk, Moore, Neuhauser, and Golterman. Data interpretation was performed by Burk, Newhauser, and Golterman, along with Glassman, Calabrese, Moore, and Ourth. The manuscript was written by Aspinall and Sales, along with Burk, Newhauser, Golterman, Ourth, and Cunningham. Good, Glassman, and Moore revised the manuscript, along with Calabrese, Valentino, and Aspinall.

Contributions of Optical and Non-Optical Blur to Variation in Visual Acuity

PubMed Central

McAnany, J. Jason; Shahidi, Mahnaz; Applegate, Raymond A.; Zelkha, Ruth; Alexander, Kenneth R.

2011-01-01

Purpose To determine the relative contributions of optical and non-optical sources of intrinsic blur to variations in visual acuity (VA) among normally sighted subjects. Methods Best-corrected VA of sixteen normally sighted subjects was measured using briefly presented (59 ms) tumbling E optotypes that were either unblurred or blurred through convolution with Gaussian functions of different widths. A standard model of intrinsic blur was used to estimate each subject’s equivalent intrinsic blur (σint) and VA for the unblurred tumbling E (MAR0). For 14 subjects, a radially averaged optical point spread function due to higher-order aberrations was derived by Shack-Hartmann aberrometry and fit with a Gaussian function. The standard deviation of the best-fit Gaussian function defined optical blur (σopt). An index of non-optical blur (η) was defined as: 1-σopt/σint. A control experiment was conducted on 5 subjects to evaluate the effect of stimulus duration on MAR0 and σint. Results Log MAR0 for the briefly presented E was correlated significantly with log σint (r = 0.95, p < 0.01), consistent with previous work. However, log MAR0 was not correlated significantly with log σopt (r = 0.46, p = 0.11). For subjects with log MAR0 equivalent to approximately 20/20 or better, log MAR0 was independent of log η, whereas for subjects with larger log MAR0 values, log MAR0 was proportional to log η. The control experiment showed a statistically significant effect of stimulus duration on log MAR0 (p < 0.01) but a non-significant effect on σint (p = 0.13). Conclusions The relative contributions of optical and non-optical blur to VA varied among the subjects, and were related to the subject’s VA. Evaluating optical and non-optical blur may be useful for predicting changes in VA following procedures that improve the optics of the eye in patients with both optical and non-optical sources of VA loss. PMID:21460756

Action-based Dynamical Modeling for the Milky Way Disk: The Influence of Spiral Arms

NASA Astrophysics Data System (ADS)

Trick, Wilma H.; Bovy, Jo; D'Onghia, Elena; Rix, Hans-Walter

2017-04-01

RoadMapping is a dynamical modeling machinery developed to constrain the Milky Way’s (MW) gravitational potential by simultaneously fitting an axisymmetric parametrized potential and an action-based orbit distribution function (DF) to discrete 6D phase-space measurements of stars in the Galactic disk. In this work, we demonstrate RoadMapping's robustness in the presence of spiral arms by modeling data drawn from an N-body simulation snapshot of a disk-dominated galaxy of MW mass with strong spiral arms (but no bar), exploring survey volumes with radii 500 {pc}≤slant {r}\\max ≤slant 5 {kpc}. The potential constraints are very robust, even though we use a simple action-based DF, the quasi-isothermal DF. The best-fit RoadMapping model always recovers the correct gravitational forces where most of the stars that entered the analysis are located, even for small volumes. For data from large survey volumes, RoadMapping finds axisymmetric models that average well over the spiral arms. Unsurprisingly, the models are slightly biased by the excess of stars in the spiral arms. Gravitational potential models derived from survey volumes with at least {r}\\max =3 {kpc} can be reliably extrapolated to larger volumes. However, a large radial survey extent, {r}\\max ˜ 5 {kpc}, is needed to correctly recover the halo scale length. In general, the recovery and extrapolability of potentials inferred from data sets that were drawn from inter-arm regions appear to be better than those of data sets drawn from spiral arms. Our analysis implies that building axisymmetric models for the Galaxy with upcoming Gaia data will lead to sensible and robust approximations of the MW’s potential.

12 CFR 324.153 - Internal models approach (IMA).

Code of Federal Regulations, 2014 CFR

2014-01-01

... potential decline in value of its modeled equity exposures; (ii) Are commensurate with the size, complexity... produce an estimate of potential losses for its modeled equity exposures that is no less than the estimate of potential losses produced by a VaR methodology employing a 99th percentile one-tailed confidence...

An Integrated Modeling Framework Forecasting Ecosystem Services: Application to the Albemarle Pamlico Basins, NC and VA (USA)

EPA Science Inventory

We demonstrate an Integrated Modeling Framework that predicts the state of freshwater ecosystem services within the Albemarle-Pamlico Basins. The Framework consists of three facilitating technologies: Data for Environmental Modeling (D4EM) that automates the collection and standa...

An Integrated Modeling Framework Forcasting Ecosystem Services--Application to the Albemarle Pamlico Basins, NC and VA (USA) and Beyond

EPA Science Inventory

We demonstrate an Integrated Modeling Framework that predicts the state of freshwater ecosystem services within the Albemarle-Pamlico Basins. The Framework consists of three facilitating technologies: Data for Environmental Modeling (D4EM) that automates the collection and standa...

McCook Reservoir Water Quality Model. Numerical Model Investigation

DTIC Science & Technology

1991-09-01

REPT TYPE AND DATES COVERED ad September Cana Final report . LEAND SUBTITLE S. FUNDING NUERS Spinfild VA2261 ThcCook Reservoir Water Quality Model...oxygen injected by the aeration system Manufacturers of diffusers supply OTE information specific to gas flow rate and depth. The depths at which most

76 FR 53454 - Exposure Modeling Public Meeting; Notice of Public Meeting

Federal Register 2010, 2011, 2012, 2013, 2014

2011-08-26

... ENVIRONMENTAL PROTECTION AGENCY [EPA-HQ-OPP-2009-0879; FRL-8885-9] Exposure Modeling Public...: An Exposure Modeling Public Meeting (EMPM) will be held for one day on September 20, 2011. This... Building), Fourth Floor Conference Center (S-4370-80), 2777 S. Crystal Drive, Arlington, VA 22202. FOR...

2. Oblique view of west portion of hospital complex showing ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

2. Oblique view of west portion of hospital complex showing in foreground, from left to right, Recreation Building (HABS No. VA-1287-N), shower room and swimming pool (HABS No. VA-1287-M); and in right middle ground, from front to rear, carpenter & paint shop (HABS No. VA-1287-L), medical storage building (HABS No. VA-1287-K), and central power house(HABS No. VA-1287-J), view to northwest from roof of 1960 high rise hospital - Portsmouth Naval Hospital, Bounded by Elizabeth River, Crawford Street, Portsmouth General Hospital, Parkview Avenue, & Scotts Creek, Portsmouth, Portsmouth, VA

Developing a Health Information Technology Systems Matrix: A Qualitative Participatory Approach

PubMed Central

Chavez, Margeaux; Nazi, Kim M; Antinori, Nicole

2016-01-01

Background The US Department of Veterans Affairs (VA) has developed various health information technology (HIT) resources to provide accessible veteran-centered health care. Currently, the VA is undergoing a major reorganization of VA HIT to develop a fully integrated system to meet consumer needs. Although extensive system documentation exists for various VA HIT systems, a more centralized and integrated perspective with clear documentation is needed in order to support effective analysis, strategy, planning, and use. Such a tool would enable a novel view of what is currently available and support identifying and effectively capturing the consumer’s vision for the future. Objective The objective of this study was to develop the VA HIT Systems Matrix, a novel tool designed to describe the existing VA HIT system and identify consumers’ vision for the future of an integrated VA HIT system. Methods This study utilized an expert panel and veteran informant focus groups with self-administered surveys. The study employed participatory research methods to define the current system and understand how stakeholders and veterans envision the future of VA HIT and interface design (eg, look, feel, and function). Directed content analysis was used to analyze focus group data. Results The HIT Systems Matrix was developed with input from 47 veterans, an informal caregiver, and an expert panel to provide a descriptive inventory of existing and emerging VA HIT in four worksheets: (1) access and function, (2) benefits and barriers, (3) system preferences, and (4) tasks. Within each worksheet is a two-axis inventory. The VA’s existing and emerging HIT platforms (eg, My HealtheVet, Mobile Health, VetLink Kiosks, Telehealth), My HealtheVet features (eg, Blue Button, secure messaging, appointment reminders, prescription refill, vet library, spotlight, vitals tracker), and non-VA platforms (eg, phone/mobile phone, texting, non-VA mobile apps, non-VA mobile electronic devices, non-VA websites) are organized by row. Columns are titled with thematic and functional domains (eg, access, function, benefits, barriers, authentication, delegation, user tasks). Cells for each sheet include descriptions and details that reflect factors relevant to domains and the topic of each worksheet. Conclusions This study provides documentation of the current VA HIT system and efforts for consumers’ vision of an integrated system redesign. The HIT Systems Matrix provides a consumer preference blueprint to inform the current VA HIT system and the vision for future development to integrate electronic resources within VA and beyond with non-VA resources. The data presented in the HIT Systems Matrix are relevant for VA administrators and developers as well as other large health care organizations seeking to document and organize their consumer-facing HIT resources. PMID:27713112

Numerical and experimental study of the 3D effect on connecting arm of vertical axis tidal current turbine

NASA Astrophysics Data System (ADS)

Guo, Wei; Kang, Hai-gui; Chen, Bing; Xie, Yu; Wang, Yin

2016-03-01

Vertical axis tidal current turbine is a promising device to extract energy from ocean current. One of the important components of the turbine is the connecting arm, which can bring about a significant effect on the pressure distribution along the span of the turbine blade, herein we call it 3D effect. However, so far the effect is rarely reported in the research, moreover, in numerical simulation. In the present study, a 3D numerical model of the turbine with the connecting arm was developed by using FLUENT software compiling the UDF (User Defined Function) command. The simulation results show that the pressure distribution along the span of blade with the connecting arm model is significantly different from those without the connecting arm. To facilitate the validation of numerical model, the laboratory experiment has been carried out by using three different types of NACA aerofoil connecting arm and circle section connecting arm. And results show that the turbine with NACA0012 connecting arm has the best start-up performance which is 0.346 m/s and the peak point of power conversion coefficient is around 0.33. A further study has been performed and a conclusion is drawn that the aerofoil and thickness of connecting arm are the most important factors on the power conversion coefficient of the vertical axis tidal current turbine.

Research on the Optimization Method of Arm Movement in the Assembly Workshop Based on Ergonomics

NASA Astrophysics Data System (ADS)

Hu, X. M.; Qu, H. W.; Xu, H. J.; Yang, L.; Yu, C. C.

2017-12-01

In order to improve the work efficiency and comfortability, Ergonomics is used to research the work of the operator in the assembly workshop. An optimization algorithm of arm movement in the assembly workshop is proposed. In the algorithm, a mathematical model of arm movement is established based on multi rigid body movement model and D-H method. The solution of inverse kinematics equation on arm movement is solved through kinematics theory. The evaluation functions of each joint movement and the whole arm movement are given based on the comfortability of human body joint. The solution method of the optimal arm movement posture based on the evaluation functions is described. The software CATIA is used to verify that the optimal arm movement posture is valid in an example and the experimental result show the effectiveness of the algorithm.

Analytic and simulation studies on the use of torque-wheel actuators for the control of flexible robotic arms

NASA Technical Reports Server (NTRS)

Montgomery, Raymond C.; Ghosh, Dave; Kenny, Sean

1991-01-01

This paper presents results of analytic and simulation studies to determine the effectiveness of torque-wheel actuators in suppressing the vibrations of two-link telerobotic arms with attached payloads. The simulations use a planar generic model of a two-link arm with a torque wheel at the free end. Parameters of the arm model are selected to be representative of a large space-based robotic arm of the same class as the Space Shuttle Remote Manipulator, whereas parameters of the torque wheel are selected to be similar to those of the Mini-Mast facility at the Langley Research Center. Results show that this class of torque-wheel can produce an oscillation of 2.5 cm peak-to-peak in the end point of the arm and that the wheel produces significantly less overshoot when the arm is issued an abrupt stop command from the telerobotic input station.

Comparison of Accessibility, Cost, and Quality of Elective Coronary Revascularization Between Veterans Affairs and Community Care Hospitals

PubMed Central

Hong, Juliette S.; Carey, Evan; Grunwald, Gary K.; Joynt Maddox, Karen; Maddox, Thomas M.

2018-01-01

Importance The Veterans Affairs (VA) Community Care (CC) Program supplements VA care with community-based medical services. However, access gains and value provided by CC have not been well described. Objectives To compare the access, cost, and quality of elective coronary revascularization procedures between VA and CC hospitals and to evaluate if procedural volume or publicly reported quality data can be used to identify high-value care. Design, Setting, and Participants Observational cohort study of veterans younger than 65 years undergoing an elective coronary revascularization, controlling for differences in risk factors using propensity adjustment. The setting was VA and CC hospitals. Participants were veterans undergoing elective percutaneous coronary intervention (PCI) and veterans undergoing coronary artery bypass graft (CABG) procedures between October 1, 2008, and September 30, 2011. The analysis was conducted between July 2014 and July 2017. Exposures Receipt of an elective coronary revascularization at a VA vs CC facility. Main Outcomes and Measures Access to care as measured by travel distance, 30-day mortality, and costs. Results In the 3 years ending on September 30, 2011, a total of 13 237 elective PCIs (79.1% at the VA) and 5818 elective CABG procedures (83.6% at the VA) were performed in VA or CC hospitals among veterans meeting study inclusion criteria. On average, use of CC was associated with reduced net travel by 53.6 miles for PCI and by 73.3 miles for CABG surgery compared with VA-only care. Adjusted 30-day mortality after PCI was higher in CC compared with VA (1.54% for CC vs 0.65% for VA, P < .001) but was similar after CABG surgery (1.33% for CC vs 1.51% for VA, P = .74). There were no differences in adjusted 30-day readmission rates for PCI (7.04% for CC vs 7.73% for VA, P = .66) or CABG surgery (8.13% for CC vs 7.00% for VA, P = .28). The mean adjusted PCI cost was higher in CC ($22 025 for CC vs $15 683 for VA, P < .001). The mean adjusted CABG cost was lower in CC ($55 526 for CC vs $63 144 for VA, P < .01). Neither procedural volume nor publicly reported mortality data identified hospitals that provided higher-value care with the exception that CABG mortality was lower in small-volume CC hospitals. Conclusions and Relevance In this veteran cohort, PCIs performed in CC hospitals were associated with shorter travel distance but with higher mortality, higher costs, and minimal travel savings compared with VA hospitals. The CABG procedures performed in CC hospitals were associated with shorter travel distance, similar mortality, and lower costs. As the VA considers expansion of the CC program, ongoing assessments of value and access gains are essential to optimize veteran outcomes and VA spending. PMID:29299607

Comparison of Accessibility, Cost, and Quality of Elective Coronary Revascularization Between Veterans Affairs and Community Care Hospitals.

PubMed

Barnett, Paul G; Hong, Juliette S; Carey, Evan; Grunwald, Gary K; Joynt Maddox, Karen; Maddox, Thomas M

2018-02-01

The Veterans Affairs (VA) Community Care (CC) Program supplements VA care with community-based medical services. However, access gains and value provided by CC have not been well described. To compare the access, cost, and quality of elective coronary revascularization procedures between VA and CC hospitals and to evaluate if procedural volume or publicly reported quality data can be used to identify high-value care. Observational cohort study of veterans younger than 65 years undergoing an elective coronary revascularization, controlling for differences in risk factors using propensity adjustment. The setting was VA and CC hospitals. Participants were veterans undergoing elective percutaneous coronary intervention (PCI) and veterans undergoing coronary artery bypass graft (CABG) procedures between October 1, 2008, and September 30, 2011. The analysis was conducted between July 2014 and July 2017. Receipt of an elective coronary revascularization at a VA vs CC facility. Access to care as measured by travel distance, 30-day mortality, and costs. In the 3 years ending on September 30, 2011, a total of 13 237 elective PCIs (79.1% at the VA) and 5818 elective CABG procedures (83.6% at the VA) were performed in VA or CC hospitals among veterans meeting study inclusion criteria. On average, use of CC was associated with reduced net travel by 53.6 miles for PCI and by 73.3 miles for CABG surgery compared with VA-only care. Adjusted 30-day mortality after PCI was higher in CC compared with VA (1.54% for CC vs 0.65% for VA, P < .001) but was similar after CABG surgery (1.33% for CC vs 1.51% for VA, P = .74). There were no differences in adjusted 30-day readmission rates for PCI (7.04% for CC vs 7.73% for VA, P = .66) or CABG surgery (8.13% for CC vs 7.00% for VA, P = .28). The mean adjusted PCI cost was higher in CC ($22 025 for CC vs $15 683 for VA, P < .001). The mean adjusted CABG cost was lower in CC ($55 526 for CC vs $63 144 for VA, P < .01). Neither procedural volume nor publicly reported mortality data identified hospitals that provided higher-value care with the exception that CABG mortality was lower in small-volume CC hospitals. In this veteran cohort, PCIs performed in CC hospitals were associated with shorter travel distance but with higher mortality, higher costs, and minimal travel savings compared with VA hospitals. The CABG procedures performed in CC hospitals were associated with shorter travel distance, similar mortality, and lower costs. As the VA considers expansion of the CC program, ongoing assessments of value and access gains are essential to optimize veteran outcomes and VA spending.

Model surgery with a passive robot arm for orthognathic surgery planning.

PubMed

Theodossy, Tamer; Bamber, Mohammad Anwar

2003-11-01

The aims of the study were to assess the degree of accuracy of model surgery performed manually using the Eastman technique and to compare it with model surgery performed with the aid of a robot arm. Twenty-one patients undergoing orthognathic surgery gave consent for this study. They were divided into 2 groups based on the model surgery technique used. Group A (52%) had model surgery performed manually, whereas group B (48%) had their model surgery performed using the robot arm. Patients' maxillary casts were measured before and after model surgery, and results were compared with those for the original treatment plan in horizontal (x-axis), vertical (y-axis), and transverse (z-axis) planes. Statistical analysis using Mann-Whitney U test for x- and y-axis and independent sample t test for z-axis have shown significant differences between both groups in x-axis (P =.024) and y-axis (P =.01) but not in z-axis (P =.776). Model surgery performed with the aid of a robot arm is significantly more accurate in anteroposterior and vertical planes than is manual model surgery. Robot arm has an important role to play in orthognathic surgery planning and in determining the biometrics of orthognathic surgical change at the model surgery stage.

Evaluating diagnosis-based case-mix measures: how well do they apply to the VA population?

PubMed

Rosen, A K; Loveland, S; Anderson, J J; Rothendler, J A; Hankin, C S; Rakovski, C C; Moskowitz, M A; Berlowitz, D R

2001-07-01

Diagnosis-based case-mix measures are increasingly used for provider profiling, resource allocation, and capitation rate setting. Measures developed in one setting may not adequately capture the disease burden in other settings. To examine the feasibility of adapting two such measures, Adjusted Clinical Groups (ACGs) and Diagnostic Cost Groups (DCGs), to the Department of Veterans Affairs (VA) population. A 60% random sample of veterans who used health care services during FY 1997 was obtained from VA inpatient and outpatient administrative databases. A split-sample technique was used to obtain a 40% sample (n = 1,046,803) for development and a 20% sample (n = 524,461) for validation. Concurrent ACG and DCG risk adjustment models, using 1997 diagnoses and demographics to predict FY 1997 utilization (ambulatory provider encounters, and service days-the sum of a patient's inpatient and outpatient visit days), were fitted and cross-validated. Patients were classified into groupings that indicated a population with multiple psychiatric and medical diseases. Model R-squares explained between 6% and 32% of the variation in service utilization. Although reparameterized models did better in predicting utilization than models with external weights, none of the models was adequate in characterizing the entire population. For predicting service days, DCGs were superior to ACGs in most categories, whereas ACGs did better at discriminating among veterans who had the lowest utilization. Although "off-the-shelf" case-mix measures perform moderately well when applied to another setting, modifications may be required to accurately characterize a population's disease burden with respect to the resource needs of all patients.

Vascular access in patients receiving hemodialysis in Libya.

PubMed

Alashek, Wiam A; McIntyre, Christopher W; Taal, Maarten W

2012-01-01

A native arteriovenous fistula (AVF) represents the optimal form of Vascular Access (VA) for patients receiving hemodialysis (HD). In Libya there are several barriers to AVF creation including lack of adequate preparation for dialysis and surgical services. We aimed to conduct the first comprehensive study of VA utilisation in HD patients in Libya. A prospective observational study included all adult patients receiving HD treatment in 25 HD facilities in Libya from May 2009 to Nov 2011. Researchers gathered data regarding VA through interviews with staff and patients as well as medical records. Patients with definitive VA were re-interviewed after 1 year. At baseline the majority of patients (91.9%; n=1573) were using permanent VA in the form of AVF or arteriovenous graft. Patients with permanent VA were more likely to be male and less likely to be diabetic than those with CVCs. Most patients had commenced HD using a temporary CVC (91.8%). VA-related complications were: thrombosis (46.7%), aneurysm (22.6%), infection (11.5%) and haemorrhage (10.2%). Incident VA thrombosis was reported by 14.7% in 1 year. Independent risk factors for incident thrombosis were female gender and diabetes. Hospitalisation for VA related complications was reported by 31.4%. Few patients in Libya initiate HD with definitive VA, but most achieve it thereafter. Improved dialysis preparation and increased provision of surgical services are required to increase the proportion of patients initiating HD with definitive VA and should be a priority in rebuilding health services in Libya after the recent conflict.

Recovery of Ventriculo-Atrial Conduction after Adrenaline in Patients Implanted with Pacemakers.

PubMed

Cismaru, Gabriel; Gusetu, Gabriel; Muresan, Lucian; Rosu, Radu; Andronache, Marius; Matuz, Roxana; Puiu, Mihai; Mester, Petru; Miclaus, Maria; Pop, Dana; Mircea, Petru Adrian; Zdrenghea, Dumitru

2015-07-01

Ventriculo-atrial (VA) conduction can have negative consequences for patients with implanted pacemakers and defibrillators. There is concern whether impaired VA conduction could recover during stressful situations. Although the influence of isoproterenol and atropine are well established, the effect of adrenaline has not been studied systematically. The objective of this study was to determine if adrenaline can facilitate recovery of VA conduction in patients implanted with pacemakers. A prospective study was conducted on 61 consecutive patients during a 4-month period (April-July 2014). The presence of VA conduction was assessed during the pacemaker implantation procedure. In case of an impaired VA conduction, adrenaline infusio was used as a stress surrogate to test conduction recovery. The indications for pacemaker implantation were: sinus node dysfunction in 18 patients, atrioventricular (AV) block in 40 patients, binodal dysfunction (sinus node+ AV node) in two patients and other (carotid sinus syndrome) in one patient. In the basal state, 15/61 (24.6%) presented spontaneous VA conduction and 46/61 (75.4%) had no VA conduction. After administration of adrenaline, there was VA conduction recovery in 5/46 (10.9%) patients. Adrenaline infusion produced recovery of VA conduction in 10.9% of patients with absent VA conduction in a basal state. Recovery of VA conduction during physiological or pathological stresses could be responsible for the pacemaker syndrome, PMT episodes, or certain implantable cardiac defibrillator detection issues. © 2015 Wiley Periodicals, Inc.

76 FR 40453 - Agency Information Collection (Application for VA Education Benefits) Activity Under OMB Review

Federal Register 2010, 2011, 2012, 2013, 2014

2011-07-08

... (Application for VA Education Benefits) Activity Under OMB Review AGENCY: Veterans Benefits Administration... Education Benefits, VA Form 22-1990. b. Application for Family Member to Use Transferred Benefits, VA Form 22-1990E. [[Page 40454

2. Perspective Map of Buena Vista (In Buena Vista, VA, ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

2. Perspective Map of Buena Vista (In Buena Vista, VA, NY:South Publishing Co., 1891 n.p.) (copy on file at Virginia State Library, Richmond, VA) - North River Canal System, West side of Buena Vista, Buena Vista, Roanoke City, VA

Hearing aid effectiveness after aural rehabilitation - individual versus group (HEARING) trial: RCT design and baseline characteristics

PubMed Central

2009-01-01

Background Hearing impairment is the most common body system disability in veterans. In 2008, nearly 520,000 veterans had a disability for hearing loss through the Department of Veterans Affairs (VA). Changes in eligibility for hearing aid services, along with the aging population, contributed to a greater than 300% increase in the number of hearing aids dispensed from 1996 to 2006. In 2006, the VA committed to having no wait times for patient visits while providing quality clinically-appropriate care. One approach to achieving this goal is the use of group visits as an alternative to individual visits. We sought to determine: 1) if group hearing aid fitting and follow-up visits were at least as effective as individual visits, and 2) whether group visits lead to cost savings through the six month period after the hearing aid fitting. We describe the rationale, design, and characteristics of the baseline cohort of the first randomized clinical trial to study the impact of group versus individual hearing aid fitting and follow-up visits. Methods Participants were recruited from the VA Puget Sound Health Care System Audiology Clinic. Eligible patients had no previous hearing aid use and monaural or binaural air-conduction hearing aids were ordered at the evaluation visit. Participants were randomized to receive the hearing aid fitting and the hearing aid follow-up in an individual or group visit. The primary outcomes were hearing-related function, measured with the first module of the Effectiveness of Aural Rehabilitation (Inner EAR), and hearing aid adherence. We tracked the total cost of planned and unplanned audiology visits over the 6-month interval after the hearing aid fitting. Discussion A cohort of 659 participants was randomized to receive group or individual hearing aid fitting and follow-up visits. Baseline demographic and self-reported health status and hearing-related measures were evenly distributed across the treatment arms. Outcomes after the 6-month follow-up period are needed to determine if group visits were as least as good as those for individual visits and will be reported in subsequent publication. Trial Registration NCT00260663 PMID:20003515

Does Motivation Matter? Analysis of a Randomized Trial of Proactive Outreach to VA Smokers.

PubMed

Danan, Elisheva R; Joseph, Anne M; Sherman, Scott E; Burgess, Diana J; Noorbaloochi, Siamak; Clothier, Barbara; Japuntich, Sandra J; Taylor, Brent C; Fu, Steven S

2016-08-01

Current guidelines advise providers to assess smokers' readiness to quit, then offer cessation therapies to smokers planning to quit and motivational interventions to smokers not planning to quit. We examined the relationship between baseline stage of change (SOC), treatment utilization, and smoking cessation to determine whether the effect of a proactive smoking cessation intervention was dependent on smokers' level of motivation to quit. Secondary analysis of a multicenter randomized controlled trial. A total of 3006 current smokers, aged 18-80 years, at four Veterans Affairs (VA) medical centers. Proactive care included proactive outreach (mailed invitation followed by telephone outreach), offer of smoking cessation services (telephone or face-to-face), and access to pharmacotherapy. Usual care participants had access to VA smoking cessation services and state telephone quitlines. Baseline SOC measured with Readiness to Quit Ladder, and 6-month prolonged abstinence self-reported at 1 year. At baseline, 35.8 % of smokers were in preparation, 38.2 % in contemplation, and 26.0 % in precontemplation. The overall interaction between SOC and treatment arm was not statistically significant (p = 0.30). Among smokers in preparation, 21.1 % of proactive care participants achieved 6-month prolonged abstinence, compared to 13.1 % of usual care participants (OR, 1.8 [95 % CI, 1.2-2.6]). Similarly, proactive care increased abstinence among smokers in contemplation (11.0 % vs. 6.5 %; OR, 1.8 [95 % CI, 1.1-2.8]). Smokers in precontemplation quit smoking at similar rates (5.3 % vs. 5.6 %; OR, 0.9 [95 % CI, 0.5-1.9]). Within each stage, uptake of smoking cessation treatments increased with higher SOC and with proactive care as compared with usual care. Mostly male participants limits generalizability. Randomization was not stratified by SOC. Proactive care increased treatment uptake compared to usual care across all SOC. Proactive care increased smoking cessation among smokers in preparation and contemplation but not in precontemplation. Proactively offering cessation therapies to smokers at all SOC will increase treatment utilization and population-level smoking cessation.

Use of the Blue Button Online Tool for Sharing Health Information: Qualitative Interviews With Patients and Providers.

PubMed

Klein, Dawn M; Fix, Gemmae M; Hogan, Timothy P; Simon, Steven R; Nazi, Kim M; Turvey, Carolyn L

2015-08-18

Information sharing between providers is critical for care coordination, especially in health systems such as the United States Department of Veterans Affairs (VA), where many patients also receive care from other health care organizations. Patients can facilitate this sharing by using the Blue Button, an online tool that promotes patients' ability to view, print, and download their health records. The aim of this study was to characterize (1) patients' use of Blue Button, an online information-sharing tool in VA's patient portal, My HealtheVet, (2) information-sharing practices between VA and non-VA providers, and (3) how providers and patients use a printed Blue Button report during a clinical visit. Semistructured qualitative interviews were conducted with 34 VA patients, 10 VA providers, and 9 non-VA providers. Interviews focused on patients' use of Blue Button, information-sharing practices between VA and non-VA providers, and how patients and providers use a printed Blue Button report during a clinical visit. Qualitative themes were identified through iterative rounds of coding starting with an a priori schema based on technology adoption theory. Information sharing between VA and non-VA providers relied primarily on the patient. Patients most commonly used Blue Button to access and share VA laboratory results. Providers recognized the need for improved information sharing, valued the Blue Button printout, and expressed interest in a way to share information electronically across settings. Consumer-oriented technologies such as Blue Button can facilitate patients sharing health information with providers in other health care systems; however, more education is needed to inform patients of this use to facilitate care coordination. Additional research is needed to explore how personal health record documents, such as Blue Button reports, can be easily shared and incorporated into the clinical workflow of providers.

Impact of Multisystem Health Care on Readmission and Follow-up Among Veterans Hospitalized for Chronic Obstructive Pulmonary Disease.

PubMed

Rinne, Seppo T; Elwy, Anashua R; Bastian, Lori A; Wong, Edwin S; Wiener, Renda S; Liu, Chuan-Fen

2017-07-01

Chronic obstructive pulmonary disease (COPD) is one of the most common causes of readmission at Veterans Affairs (VA) hospitals. Previous studies demonstrate worse outcomes for veterans with multisystem health care, though the impact of non-VA care on COPD readmissions is unknown. To examine the association of use of non-VA outpatient care with 30-day readmission and 30-day follow-up among veterans admitted to the VA for COPD. This is a retrospective cohort study using VA administrative data and Medicare claims. In total, 20,472 Medicare-eligible veterans who were admitted to VA hospitals for COPD during October 1, 2008 and September 30, 2011. We identified the source of outpatient care during the year before the index hospitalization as VA-only, dual-care (VA and Medicare), and Medicare-only. Outcomes of interest included any-cause 30-day readmission, COPD-specific 30-day readmission and follow-up visit within 30 days of discharge. We used mixed-effects logistic regression, controlling for baseline severity of illness, to examine the association between non-VA care and postdischarge outcomes. There was no association between non-VA care and any-cause readmission. We did identify an increased COPD-specific readmission risk with both dual-care [odds ratio (OR)=1.20; 95% confidence interval (CI), 1.02-1.40] and Medicare-only (OR=1.41; 95% CI, 1.15-1.75). Medicare-only outpatient care was also associated with significantly lower rates of follow-up (OR=0.81; 95% CI, 0.72-0.91). Differences in disease-specific readmission risk may reflect differences in disease management between VA and non-VA providers. Further research is needed to understand how multisystem care affects coordination and other measures of quality for veterans with COPD.

Comparing Catheter-Associated Urinary Tract Infection Prevention Programs Between Veterans Affairs Nursing Homes and Non-Veterans Affairs Nursing Homes.

PubMed

Mody, Lona; Greene, M Todd; Saint, Sanjay; Meddings, Jennifer; Trautner, Barbara W; Wald, Heidi L; Crnich, Christopher; Banaszak-Holl, Jane; McNamara, Sara E; King, Beth J; Hogikyan, Robert; Edson, Barbara S; Krein, Sarah L

2017-03-01

OBJECTIVE The impact of healthcare system integration on infection prevention programs is unknown. Using catheter-associated urinary tract infection (CAUTI) prevention as an example, we hypothesize that US Department of Veterans Affairs (VA) nursing homes have a more robust infection prevention infrastructure due to integration and centralization compared with non-VA nursing homes. SETTING VA and non-VA nursing homes participating in the AHRQ Safety Program for Long-Term Care collaborative. METHODS Nursing homes provided baseline information about their infection prevention programs to assess strengths and gaps related to CAUTI prevention via a needs assessment questionnaire. RESULTS A total of 353 of 494 nursing homes from 41 states (71%; 47 VA and 306 non-VA facilities) responded. VA nursing homes reported more hours per week devoted to infection prevention-related activities (31 vs 12 hours; P<.001) and were more likely to have committees that reviewed healthcare-associated infections. Compared with non-VA facilities, a higher percentage of VA nursing homes reported tracking CAUTI rates (94% vs 66%; P<.001), sharing CAUTI data with leadership (94% vs 70%; P=.014) and with nursing personnel (85% vs 56%, P=.003). However, fewer VA nursing homes reported having policies for appropriate catheter use (64% vs 81%; P=.004) and catheter insertion (83% vs 94%; P=.004). CONCLUSIONS Among nursing homes participating in an AHRQ-funded collaborative, VA and non-VA nursing homes differed in their approach to CAUTI prevention. Best practices from both settings should be applied universally to create an optimal infection prevention program within emerging integrated healthcare systems. Infect Control Hosp Epidemiol 2017;38:287-293.

Physicians' Perspectives Regarding Prescription Drug Monitoring Program Use Within the Department of Veterans Affairs: a Multi-State Qualitative Study.

PubMed

Radomski, Thomas R; Bixler, Felicia R; Zickmund, Susan L; Roman, KatieLynn M; Thorpe, Carolyn T; Hale, Jennifer A; Sileanu, Florentina E; Hausmann, Leslie R M; Thorpe, Joshua M; Suda, Katie J; Stroupe, Kevin T; Gordon, Adam J; Good, Chester B; Fine, Michael J; Gellad, Walid F

2018-03-08

The Department of Veterans Affairs (VA) has implemented robust strategies to monitor prescription opioid dispensing, but these strategies have not accounted for opioids prescribed by non-VA providers. State-based prescription drug monitoring programs (PDMPs) are a potential tool to identify VA patients' receipt of opioids from non-VA prescribers, and recent legislation requires their use within VA. To evaluate VA physicians' perspectives and experiences regarding use of PDMPs to monitor Veterans' receipt of opioids from non-VA prescribers. Qualitative study using semi-structured interviews. Forty-two VA primary care physicians who prescribed opioids to 15 or more Veterans in 2015. We sampled physicians from two states with PDMPs (Massachusetts and Illinois) and one without prescriber access to a PDMP at the time of the interviews (Pennsylvania). From February to August 2016, we conducted semi-structured telephone interviews that addressed the following topics regarding PDMPs: overall experiences, barriers to optimal use, and facilitators to improve use. VA physicians broadly supported use of PDMPs or desired access to one, while exhibiting varying patterns of PDMP use dictated by state laws and their clinical judgment. Physicians noted administrative burdens and incomplete or unavailable prescribing data as key barriers to PDMP use. To facilitate use, physicians endorsed (1) linking PDMPs with the VA electronic health record, (2) using templated notes to document PDMP use, and (3) delegating routine PDMP queries to ancillary staff. Despite the time and administrative burdens associated with their use, VA physicians in our study broadly supported PDMPs. The application of our findings to ongoing PDMP implementation efforts may strengthen PDMP use both within and outside VA and improve the safe prescribing of opioids.

Value-at-Risk forecasts by a spatiotemporal model in Chinese stock market

NASA Astrophysics Data System (ADS)

Gong, Pu; Weng, Yingliang

2016-01-01

This paper generalizes a recently proposed spatial autoregressive model and introduces a spatiotemporal model for forecasting stock returns. We support the view that stock returns are affected not only by the absolute values of factors such as firm size, book-to-market ratio and momentum but also by the relative values of factors like trading volume ranking and market capitalization ranking in each period. This article studies a new method for constructing stocks' reference groups; the method is called quartile method. Applying the method empirically to the Shanghai Stock Exchange 50 Index, we compare the daily volatility forecasting performance and the out-of-sample forecasting performance of Value-at-Risk (VaR) estimated by different models. The empirical results show that the spatiotemporal model performs surprisingly well in terms of capturing spatial dependences among individual stocks, and it produces more accurate VaR forecasts than the other three models introduced in the previous literature. Moreover, the findings indicate that both allowing for serial correlation in the disturbances and using time-varying spatial weight matrices can greatly improve the predictive accuracy of a spatial autoregressive model.

Volatile anesthetic binding to proteins is influenced by solvent and aliphatic residues.

PubMed

Streiff, John H; Jones, Keith A

2008-10-01

The main objective of this work was to characterize VA binding sites in multiple anesthetic target proteins. A computational algorithm was used to quantify the solvent exclusion and aliphatic character of amphiphilic pockets in the structures of VA binding proteins. VA binding sites in the protein structures were defined as the pockets with solvent exclusion and aliphatic character that exceeded minimum values observed in the VA binding sites of serum albumin, firefly luciferase, and apoferritin. We found that the structures of VA binding proteins are enriched in these pockets and that the predicted binding sites were consistent with experimental determined binding locations in several proteins. Autodock3 was used to dock the simulated molecules of 1,1,1,2,2-pentafluoroethane, difluoromethyl 1,1,1,2-tetrafluoroethyl ether, and sevoflurane and the isomers of halothane and isoflurane into these potential binding sites. We found that the binding of the various VA molecules to the amphiphilic pockets is driven primarily by VDW interactions and to a lesser extent by weak hydrogen bonding and electrostatic interactions. In addition, the trend in Delta G binding values follows the Meyer-Overton rule. These results suggest that VA potencies are related to the VDW interactions between the VA ligand and protein target. It is likely that VA bind to sites with a high degree of solvent exclusion and aliphatic character because aliphatic residues provide favorable VDW contacts and weak hydrogen bond donors. Water molecules occupying these sites maintain pocket integrity, associate with the VA ligand, and diminish the unfavorable solvation enthalpy of the VA. Water molecules displaced into the bulk by the VA ligand may provide an additional favorable enthalpic contribution to VA binding. Anesthesia is a component of many health related procedures, the outcomes of which could be improved with a better understanding of the molecular targets and mechanisms of anesthetic action.

Vitamin A Status of Women and Children in Yaoundé and Douala, Cameroon, is Unchanged One Year after Initiation of a National Vitamin A Oil Fortification Program

PubMed Central

Engle-Stone, Reina; Nankap, Martin; Ndjebayi, Alex; Gimou, Marie-Madeleine; Friedman, Avital; Haskell, Marjorie J.; Tarini, Ann; Brown, Kenneth H.

2017-01-01

Vitamin A (VA) fortification of cooking oil is considered a cost-effective strategy for increasing VA status, but few large-scale programs have been evaluated. We conducted representative surveys in Yaoundé and Douala, Cameroon, 2 years before and 1 year after the introduction of a mandatory national program to fortify cooking oil with VA. In each survey, 10 different households were selected within each of the same 30 clusters (n = ~300). Malaria infection and plasma indicators of inflammation and VA (retinol-binding protein, pRBP) status were assessed among women aged 15–49 years and children aged 12–59 months, and casual breast milk samples were collected for VA and fat measurements. Refined oil intake was measured by a food frequency questionnaire, and VA was measured in household oil samples post-fortification. Pre-fortification, low inflammation-adjusted pRBP was common among children (33% <0.83 µmol/L), but not women (2% <0.78 µmol/L). Refined cooking oil was consumed by >80% of participants in the past week. Post-fortification, only 44% of oil samples were fortified, but fortified samples contained VA concentrations close to the target values. Controlling for age, inflammation, and other covariates, there was no difference in the mean pRBP, mean breast milk VA, prevalence of low pRBP, or prevalence of low milk VA between the pre- and post-fortification surveys. The frequency of refined oil intake was not associated with VA status indicators post-fortification. In sum, after a year of cooking oil fortification with VA, we did not detect evidence of increased plasma RBP or milk VA among urban women and preschool children, possibly because less than half of the refined oil was fortified. The enforcement of norms should be strengthened, and the program should be evaluated in other regions where the prevalence of VA deficiency was greater pre-fortification. PMID:28531099

Dream Chaser Model Being Tested at Langley Research Center (LaRC

NASA Image and Video Library

2013-07-11

NASA's Langley Research Center in Hampton, Va., recently conducted hypersonic testing of Dream Chaser models for SNC as part of the agency's Commercial Crew Program in order to obtain necessary data for the material selection and design of the TPS

Adapting the multifamily group model for treating veterans with posttraumatic stress disorder.

PubMed

Sherman, Michelle D; Perlick, Deborah A; Straits-Tröster, Kristy

2012-11-01

The Department of Veterans Affairs (VA) health care system's leadership has endorsed family involvement in veterans' mental health care as an important component of treatment. Both veterans and families describe family participation as highly desirable, and research has documented that having healthy social support is a strong protective factor for posttraumatic stress disorder (PTSD). Family psychoeducation has been shown to be effective in preventing relapse among severely mentally ill, and preliminary evidence suggests that family interventions for PTSD may improve veteran and family outcomes. The multifamily group (MFG) treatment model incorporates psychoeducation, communication training, and problem-solving skill building, and it increases social support through its group format. This article describes the rationale for further adaptation of the MFG model for PTSD, and it reviews issues related to its implementation as a promising adjunctive treatment as part of the continuum of PTSD services available in VA.

Predicting Directly Measured Trunk and Upper Arm Postures in Paper Mill Work From Administrative Data, Workers' Ratings and Posture Observations.

PubMed

Heiden, Marina; Garza, Jennifer; Trask, Catherine; Mathiassen, Svend Erik

2017-03-01

A cost-efficient approach for assessing working postures could be to build statistical models for predicting results of direct measurements from cheaper data, and apply these models to samples in which only the latter data are available. The present study aimed to build and assess the performance of statistical models predicting inclinometer-assessed trunk and arm posture among paper mill workers. Separate models were built using administrative data, workers' ratings of their exposure, and observations of the work from video recordings as predictors. Trunk and upper arm postures were measured using inclinometry on 28 paper mill workers during three work shifts each. Simultaneously, the workers were video filmed, and their postures were assessed by observation of the videos afterwards. Workers' ratings of exposure, and administrative data on staff and production during the shifts were also collected. Linear mixed models were fitted for predicting inclinometer-assessed exposure variables (median trunk and upper arm angle, proportion of time with neutral trunk and upper arm posture, and frequency of periods in neutral trunk and upper arm inclination) from administrative data, workers' ratings, and observations, respectively. Performance was evaluated in terms of Akaike information criterion, proportion of variance explained (R2), and standard error (SE) of the model estimate. For models performing well, validity was assessed by bootstrap resampling. Models based on administrative data performed poorly (R2 ≤ 15%) and would not be useful for assessing posture in this population. Models using workers' ratings of exposure performed slightly better (8% ≤ R2 ≤ 27% for trunk posture; 14% ≤ R2 ≤ 36% for arm posture). The best model was obtained when using observational data for predicting frequency of periods with neutral arm inclination. It explained 56% of the variance in the postural exposure, and its SE was 5.6. Bootstrap validation of this model showed similar expected performance in other samples (5th-95th percentile: R2 = 45-63%; SE = 5.1-6.2). Observational data had a better ability to predict inclinometer-assessed upper arm exposures than workers' ratings or administrative data. However, observational measurements are typically more expensive to obtain. The results encourage analyses of the cost-efficiency of modeling based on administrative data, workers' ratings, and observation, compared to the performance and cost of measuring exposure directly. © The Author 2017. Published by Oxford University Press on behalf of the British Occupational Hygiene Society.

Duplicate Federal Payments for Dual Enrollees in Medicare Advantage Plans and the Veterans Affairs Health Care System

PubMed Central

Trivedi, Amal N.; Grebla, Regina C.; Jiang, Lan; Yoon, Jean; Mor, Vincent; Kizer, Kenneth W.

2013-01-01

Context Some veterans are eligible to enroll simultaneously in a Medicare Advantage (MA) plan and the Veterans Affairs health care system (VA). This scenario produces the potential for redundant federal spending because MA plans would receive payments to insure veterans who receive care from the VA, another taxpayer-funded health plan. Objective To quantify the prevalence of dual enrollment in VA and MA, the concurrent use of health services in each setting, and the estimated costs of VA care provided to MA enrollees. Design Retrospective analysis of 1 245 657 veterans simultaneously enrolled in the VA and an MA plan between 2004–2009. Main Outcome Measures Use of health services and inflation-adjusted estimated VA health care costs. Results Among individuals who were eligible to enroll in the VA and in an MA plan, the number of persons dually enrolled increased from 485 651 in 2004 to 924 792 in 2009. In 2009, 8.3% of the MA population was enrolled in the VA and 5.0% of MA beneficiaries were VA users. The estimated VA health care costs for MA enrollees totaled $13.0 billion over 6 years, increasing from $1.3 billion in 2004 to $3.2 billion in 2009. Among dual enrollees, 10% exclusively used the VA for outpatient and acute inpatient services, 35% exclusively used the MA plan, 50% used both the VA and MA, and 4% received no services during the calendar year. The VA financed 44% of all outpatient visits (n=21 353 841), 15% of all acute medical and surgical admissions (n=177 663), and 18% of all acute medical and surgical inpatient days (n=1 106 284) for this dually enrolled population. In 2009, the VA billed private insurers $52.3 million to reimburse care provided to MA enrollees and collected $9.4 million (18% of the billed amount; 0.3% of the total cost of care). Conclusions The federal government spends a substantial and increasing amount of potentially duplicative funds in 2 separate managed care programs for the care of same individuals. PMID:22735360

PTSD risk and mental health care engagement in a multi-war era community sample of women veterans.

PubMed

Washington, Donna L; Davis, Teri D; Der-Martirosian, Claudia; Yano, Elizabeth M

2013-07-01

Post-traumatic stress disorder (PTSD) is common in women veterans (WVs), and associated with significant co-morbidity. Effective treatment is available; however, PTSD is often unrecognized. Identify PTSD prevalence and mental healthcare (MHC) use in a representative national WV sample. Cross-sectional, population-based 2008-2009 national survey of 3,611 WVs, weighted to the population. We screened for PTSD using a validated instrument, and also assessed demographic characteristics, health characteristics, and MHC use in the prior 12 months. Among those screening positive, we conducted multivariate logistic regression to identify independent predictors of MHC use. Overall, 13.0 % (95 % confidence interval [CI] 9.8-16.2) of WVs screened PTSD-positive. Veterans Health Administration (VA) healthcare was used by 31.1 % of PTSD-positives and 11.4 % of PTSD-negatives (p<0.001). Among those screening positive, 48.7 % (95 % CI 35.9-61.6) used MHC services (66.3 % of VA-users, 40.8 % of VA-nonusers; p<0.001). Having a diagnosis of depression (OR=8.6; 95 % CI 1.5-48.9) and VA healthcare use (OR=2.7; 95 % CI 1.1-7.0) predicted MHC use, whereas lacking a regular provider for health care (OR=0.2; 95 % CI 0.1-0.4) and household income below the federal poverty level (OR=0.2; 95 % CI 0.1-0.5) predicted nonuse. More than one in eight WVs screened positive for PTSD. Though a majority of VA-users received MHC, low income predicted nonuse. Only a minority of VA-nonusers received MHC. The majority of WVs use non-VA healthcare providers, who may be unaware of their veteran status and PTSD risk. VA outreach to educate VA-nonusers and their healthcare providers about WVs' PTSD risk and available evidence-based VA treatment options is one approach to extend the reach of VA MHC. Research to characterize barriers to VA MHC use for VA-nonusers and low income VA-users is warranted to better understand low service utilization, and to inform program development to engage more WVs in needed MHC.

Visual Impairment and Blindness Avoided with Ranibizumab in Hispanic and Non-Hispanic Whites with Diabetic Macular Edema in the United States.

PubMed

Varma, Rohit; Bressler, Neil M; Doan, Quan V; Danese, Mark; Dolan, Chantal M; Lee, Abraham; Turpcu, Adam

2015-05-01

To estimate visual impairment (VI) and blindness avoided with intravitreal ranibizumab 0.3 mg treatment for central-involved diabetic macular edema (DME) among Hispanic and non-Hispanic white individuals in the United States. Population-based model simulating visual acuity (VA) outcomes over 2 years after diagnosis and treatment of DME. Visual acuity changes with and without ranibizumab were based on data from the RISE, RIDE, and DRCR Network trials. For the better-seeing eye, VA outcomes included VI, defined as worse than 20/40 in the better-seeing eye, and blindness, defined as VA of 20/200 or worse in the better-seeing eye. Incidence of 1 or both eyes with central-involved DME in 2010 were estimated based on the 2010 United States population, prevalence of diabetes mellitus, and 1-year central-involved DME incidence rate. Sixty-one percent of incident individuals had bilateral DME and 39% had unilateral DME, but DME could develop in the fellow eye. Cases of VI and blindness avoided with ranibizumab treatment. Among approximately 102 million Hispanic and non-Hispanic white individuals in the United States 45 years of age and older in 2010, an estimated 37 274 had central-involved DME and VI eligible for ranibizumab treatment. Compared with no ranibizumab treatment, the model predicted that ranibizumab 0.3 mg every 4 weeks would reduce the number of individuals with VI from 11 438 (95% simulation interval [SI], 7249-16 077) to 6304 (95% SI, 3921-8981), a 45% (95% SI, 36%-53%) reduction at 2 years. Ranibizumab would reduce the number of incident eyes with VA worse than 20/40 from 16 910 (95% SI, 10 729-23 577) to 9361 (95% SI, 5839-13 245), a 45% (95% SI, 38%-51%) reduction. Ranibizumab was estimated to reduce the number of individuals with legal blindness by 75% (95% SI, 58%-88%) and the number of incident eyes with VA of 20/200 or worse by 76% (95% SI, 63%-87%). This model suggests that ranibizumab 0.3 mg every 4 weeks substantially reduces prevalence of VI and legal blindness 2 years after initiating treatment among Hispanic and non-Hispanic white individuals in the United States with central-involved DME that has caused vision loss. Copyright © 2015 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.

Mechanical Impedance Modeling of Human Arm: A survey

NASA Astrophysics Data System (ADS)

Puzi, A. Ahmad; Sidek, S. N.; Sado, F.

2017-03-01

Human arm mechanical impedance plays a vital role in describing motion ability of the upper limb. One of the impedance parameters is stiffness which is defined as the ratio of an applied force to the measured deformation of the muscle. The arm mechanical impedance modeling is useful in order to develop a better controller for system that interacts with human as such an automated robot-assisted platform for automated rehabilitation training. The aim of the survey is to summarize the existing mechanical impedance models of human upper limb so to justify the need to have an improved version of the arm model in order to facilitate the development of better controller of such systems with ever increase in complexity. In particular, the paper will address the following issue: Human motor control and motor learning, constant and variable impedance models, methods for measuring mechanical impedance and mechanical impedance modeling techniques.

Semiparametric Identification of Human Arm Dynamics for Flexible Control of a Functional Electrical Stimulation Neuroprosthesis

PubMed Central

Schearer, Eric M.; Liao, Yu-Wei; Perreault, Eric J.; Tresch, Matthew C.; Memberg, William D.; Kirsch, Robert F.; Lynch, Kevin M.

2016-01-01

We present a method to identify the dynamics of a human arm controlled by an implanted functional electrical stimulation neuroprosthesis. The method uses Gaussian process regression to predict shoulder and elbow torques given the shoulder and elbow joint positions and velocities and the electrical stimulation inputs to muscles. We compare the accuracy of torque predictions of nonparametric, semiparametric, and parametric model types. The most accurate of the three model types is a semiparametric Gaussian process model that combines the flexibility of a black box function approximator with the generalization power of a parameterized model. The semiparametric model predicted torques during stimulation of multiple muscles with errors less than 20% of the total muscle torque and passive torque needed to drive the arm. The identified model allows us to define an arbitrary reaching trajectory and approximately determine the muscle stimulations required to drive the arm along that trajectory. PMID:26955041

A method for removing arm backscatter from EPID images

DOE Office of Scientific and Technical Information (OSTI.GOV)

King, Brian W.; Greer, Peter B.; School of Mathematical and Physical Sciences, University of Newcastle, Newcastle, New South Wales 2308

2013-07-15

Purpose: To develop a method for removing the support arm backscatter from images acquired using current Varian electronic portal imaging devices (EPIDs).Methods: The effect of arm backscatter on EPID images was modeled using a kernel convolution method. The parameters of the model were optimized by comparing on-arm images to off-arm images. The model was used to develop a method to remove the effect of backscatter from measured EPID images. The performance of the backscatter removal method was tested by comparing backscatter corrected on-arm images to measured off-arm images for 17 rectangular fields of different sizes and locations on the imager.more » The method was also tested using on- and off-arm images from 42 intensity modulated radiotherapy (IMRT) fields.Results: Images generated by the backscatter removal method gave consistently better agreement with off-arm images than images without backscatter correction. For the 17 rectangular fields studied, the root mean square difference of in-plane profiles compared to off-arm profiles was reduced from 1.19% (standard deviation 0.59%) on average without backscatter removal to 0.38% (standard deviation 0.18%) when using the backscatter removal method. When comparing to the off-arm images from the 42 IMRT fields, the mean {gamma} and percentage of pixels with {gamma} < 1 were improved by the backscatter removal method in all but one of the images studied. The mean {gamma} value (1%, 1 mm) for the IMRT fields studied was reduced from 0.80 to 0.57 by using the backscatter removal method, while the mean {gamma} pass rate was increased from 72.2% to 84.6%.Conclusions: A backscatter removal method has been developed to estimate the image acquired by the EPID without any arm backscatter from an image acquired in the presence of arm backscatter. The method has been shown to produce consistently reliable results for a wide range of field sizes and jaw configurations.« less

Verbal autopsy: current practices and challenges.

PubMed Central

Soleman, Nadia; Chandramohan, Daniel; Shibuya, Kenji

2006-01-01

Cause-of-death data derived from verbal autopsy (VA) are increasingly used for health planning, priority setting, monitoring and evaluation in countries with incomplete or no vital registration systems. In some regions of the world it is the only method available to obtain estimates on the distribution of causes of death. Currently, the VA method is routinely used at over 35 sites, mainly in Africa and Asia. In this paper, we present an overview of the VA process and the results of a review of VA tools and operating procedures used at demographic surveillance sites and sample vital registration systems. We asked for information from 36 field sites about field-operating procedures and reviewed 18 verbal autopsy questionnaires and 10 cause-of-death lists used in 13 countries. The format and content of VA questionnaires, field-operating procedures, cause-of-death lists and the procedures to derive causes of death from VA process varied substantially among sites. We discuss the consequences of using varied methods and conclude that the VA tools and procedures must be standardized and reliable in order to make accurate national and international comparisons of VA data. We also highlight further steps needed in the development of a standard VA process. PMID:16583084

Determination of the electrical resistivity of vertically aligned carbon nanotubes by scanning probe microscopy

NASA Astrophysics Data System (ADS)

Ageev, O. A.; Il'in, O. I.; Rubashkina, M. V.; Smirnov, V. A.; Fedotov, A. A.; Tsukanova, O. G.

2015-07-01

Techniques are developed to determine the resistance per unit length and the electrical resistivity of vertically aligned carbon nanotubes (VA CNTs) using atomic force microscopy (AFM) and scanning tunneling microscopy (STM). These techniques are used to study the resistance of VA CNTs. The resistance of an individual VA CNT calculated with the AFM-based technique is shown to be higher than the resistance of VA CNTs determined by the STM-based technique by a factor of 200, which is related to the influence of the resistance of the contact of an AFM probe to VA CNTs. The resistance per unit length and the electrical resistivity of an individual VA CNT 118 ± 39 nm in diameter and 2.23 ± 0.37 μm in height that are determined by the STM-based technique are 19.28 ± 3.08 kΩ/μm and 8.32 ± 3.18 × 10-4 Ω m, respectively. The STM-based technique developed to determine the resistance per unit length and the electrical resistivity of VA CNTs can be used to diagnose the electrical parameters of VA CNTs and to create VA CNT-based nanoelectronic elements.

Increasing the ranks of academic researchers in mental health: a multisite approach to postdoctoral fellowship training.

PubMed

O'Hara, Ruth; Cassidy-Eagle, Erin L; Beaudreau, Sherry A; Eyler, Lisa T; Gray, Heather L; Giese-Davis, Janine; Hubbard, Jeffrey; Yesavage, Jerome A

2010-01-01

This report highlights the use of multisite training for psychiatry and psychology postdoctoral fellows developing careers in academic clinical research in the field of mental health. The objective is to describe a model of training for young investigators to establish independent academic clinical research careers, including (1) program structure and eligibility, (2) program goals and development of a multisite curriculum, (3) use of technology for implementing the program across multiple sites, and (4) advantages and challenges of this multisite approach. In 2000, in collaboration with the Veterans Affairs (VA) Mental Illness Research, Education and Clinical Centers (MIRECCs), the VA Office of Academic Affiliations launched the Special Fellowship Program in Advanced Psychiatry and Psychology. Each of the 10 currently participating VA sites across the United States is affiliated with a MIRECC and an academic medical institution. In the first five years of this fellowship program, 83 fellows (34 psychiatrists and 49 psychologists) have participated. The success of this multisite approach is evidenced by the 58 fellows who have already graduated from the program: 70% have entered academic clinical research positions, and over 25 have obtained independent extramural grant support from the VA or the National Institutes of Health. Multisite training results in a greater transfer of knowledge and capitalizes on the nationwide availability of experts, creating unique networking and learning opportunities for trainees. The VA's multisite fellowship program plays a valuable role in preparing substantial numbers of psychiatry and psychology trainees for a range of academic clinical research and leadership positions in the field of mental health.

A 3D musculoskeletal model of the western lowland gorilla hind limb: moment arms and torque of the hip, knee and ankle.

PubMed

Goh, Colleen; Blanchard, Mary L; Crompton, Robin H; Gunther, Michael M; Macaulay, Sophie; Bates, Karl T

2017-10-01

Three-dimensional musculoskeletal models have become increasingly common for investigating muscle moment arms in studies of vertebrate locomotion. In this study we present the first musculoskeletal model of a western lowland gorilla hind limb. Moment arms of individual muscles around the hip, knee and ankle were compared with previously published data derived from the experimental tendon travel method. Considerable differences were found which we attribute to the different methodologies in this specific case. In this instance, we argue that our 3D model provides more accurate and reliable moment arm data than previously published data on the gorilla because our model incorporates more detailed consideration of the 3D geometry of muscles and the geometric constraints that exist on their lines-of-action about limb joints. Our new data have led us to revaluate the previous conclusion that muscle moment arms in the gorilla hind limb are optimised for locomotion with crouched or flexed limb postures. Furthermore, we found that bipedalism and terrestrial quadrupedalism coincided more regularly with higher moment arms and torque around the hip, knee and ankle than did vertical climbing. This indicates that the ability of a gorilla to walk bipedally is not restricted by musculoskeletal adaptations for quadrupedalism and vertical climbing, at least in terms of moment arms and torque about hind limb joints. © 2017 The Authors. Journal of Anatomy published by John Wiley & Sons Ltd on behalf of Anatomical Society.

Finger muscle attachments for an OpenSim upper-extremity model.

PubMed

Lee, Jong Hwa; Asakawa, Deanna S; Dennerlein, Jack T; Jindrich, Devin L

2015-01-01

We determined muscle attachment points for the index, middle, ring and little fingers in an OpenSim upper-extremity model. Attachment points were selected to match both experimentally measured locations and mechanical function (moment arms). Although experimental measurements of finger muscle attachments have been made, models differ from specimens in many respects such as bone segment ratio, joint kinematics and coordinate system. Likewise, moment arms are not available for all intrinsic finger muscles. Therefore, it was necessary to scale and translate muscle attachments from one experimental or model environment to another while preserving mechanical function. We used a two-step process. First, we estimated muscle function by calculating moment arms for all intrinsic and extrinsic muscles using the partial velocity method. Second, optimization using Simulated Annealing and Hooke-Jeeves algorithms found muscle-tendon paths that minimized root mean square (RMS) differences between experimental and modeled moment arms. The partial velocity method resulted in variance accounted for (VAF) between measured and calculated moment arms of 75.5% on average (range from 48.5% to 99.5%) for intrinsic and extrinsic index finger muscles where measured data were available. RMS error between experimental and optimized values was within one standard deviation (S.D) of measured moment arm (mean RMS error = 1.5 mm < measured S.D = 2.5 mm). Validation of both steps of the technique allowed for estimation of muscle attachment points for muscles whose moment arms have not been measured. Differences between modeled and experimentally measured muscle attachments, averaged over all finger joints, were less than 4.9 mm (within 7.1% of the average length of the muscle-tendon paths). The resulting non-proprietary musculoskeletal model of the human fingers could be useful for many applications, including better understanding of complex multi-touch and gestural movements.

Finger Muscle Attachments for an OpenSim Upper-Extremity Model

PubMed Central

Lee, Jong Hwa; Asakawa, Deanna S.; Dennerlein, Jack T.; Jindrich, Devin L.

2015-01-01

We determined muscle attachment points for the index, middle, ring and little fingers in an OpenSim upper-extremity model. Attachment points were selected to match both experimentally measured locations and mechanical function (moment arms). Although experimental measurements of finger muscle attachments have been made, models differ from specimens in many respects such as bone segment ratio, joint kinematics and coordinate system. Likewise, moment arms are not available for all intrinsic finger muscles. Therefore, it was necessary to scale and translate muscle attachments from one experimental or model environment to another while preserving mechanical function. We used a two-step process. First, we estimated muscle function by calculating moment arms for all intrinsic and extrinsic muscles using the partial velocity method. Second, optimization using Simulated Annealing and Hooke-Jeeves algorithms found muscle-tendon paths that minimized root mean square (RMS) differences between experimental and modeled moment arms. The partial velocity method resulted in variance accounted for (VAF) between measured and calculated moment arms of 75.5% on average (range from 48.5% to 99.5%) for intrinsic and extrinsic index finger muscles where measured data were available. RMS error between experimental and optimized values was within one standard deviation (S.D) of measured moment arm (mean RMS error = 1.5 mm < measured S.D = 2.5 mm). Validation of both steps of the technique allowed for estimation of muscle attachment points for muscles whose moment arms have not been measured. Differences between modeled and experimentally measured muscle attachments, averaged over all finger joints, were less than 4.9 mm (within 7.1% of the average length of the muscle-tendon paths). The resulting non-proprietary musculoskeletal model of the human fingers could be useful for many applications, including better understanding of complex multi-touch and gestural movements. PMID:25853869

Muscle short-range stiffness can be used to estimate the endpoint stiffness of the human arm

PubMed Central

Hu, Xiao; Murray, Wendy M.

2011-01-01

The mechanical properties of the human arm are regulated to maintain stability across many tasks. The static mechanics of the arm can be characterized by estimates of endpoint stiffness, considered especially relevant for the maintenance of posture. At a fixed posture, endpoint stiffness can be regulated by changes in muscle activation, but which activation-dependent muscle properties contribute to this global measure of limb mechanics remains unclear. We evaluated the role of muscle properties in the regulation of endpoint stiffness by incorporating scalable models of muscle stiffness into a three-dimensional musculoskeletal model of the human arm. Two classes of muscle models were tested: one characterizing short-range stiffness and two estimating stiffness from the slope of the force-length curve. All models were compared with previously collected experimental data describing how endpoint stiffness varies with changes in voluntary force. Importantly, muscle properties were not fit to the experimental data but scaled only by the geometry of individual muscles in the model. We found that force-dependent variations in endpoint stiffness were accurately described by the short-range stiffness of active arm muscles. Over the wide range of evaluated arm postures and voluntary forces, the musculoskeletal model incorporating short-range stiffness accounted for 98 ± 2, 91 ± 4, and 82 ± 12% of the variance in stiffness orientation, shape, and area, respectively, across all simulated subjects. In contrast, estimates based on muscle force-length curves were less accurate in all measures, especially stiffness area. These results suggest that muscle short-range stiffness is a major contributor to endpoint stiffness of the human arm. Furthermore, the developed model provides an important tool for assessing how the nervous system may regulate endpoint stiffness via changes in muscle activation. PMID:21289133

Pharmacy benefits management in the Veterans Health Administration: 1995 to 2003.

PubMed

Sales, Mariscelle M; Cunningham, Francesca E; Glassman, Peter A; Valentino, Michael A; Good, Chester B

2005-02-01

The Department of Veterans Affairs (VA) Pharmacy Benefits Management Strategic Healthcare Group (VA PBM) oversees the formulary for the entire VA system, which serves more than 4 million veterans and provides more than 108 million prescriptions per year. Since its establishment in 1995, the VA PBM has managed pharmaceuticals and pharmaceutical-related policies, including drug safety and efficacy evaluations, pharmacologic management algorithms, and criteria for drug use. These evidence-based practices promote, optimize, and assist VA providers with the safe and appropriate use of pharmaceuticals while allowing for formulary decisions that can result in substantial cost savings. The VA PBM also has utilized various contracting techniques to standardize generic agents as well as specific drugs and drug classes (eg, antihistamines, angiotensin-converting enzyme inhibitors, alpha-blockers, and 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors [statins]). These methods have enabled the VA to save approximately dollar 1.5 billion since 1996 even as drug expenditures continued to rise from roughly dollar 1 billion in fiscal year (FY) 1996 to more than dollar 3 billion in FY 2003. Furthermore, the VA PBM has established an outcomes research section to undertake quality-improvement and safety initiatives that ultimately monitor and determine the clinical impact of formulary decisions on the VA system nationwide. The experiences of this pharmacy benefits program, including clinical and contracting processes/procedures and their impact on the VA healthcare system, are described.

Loss of Drosophila pheromone reverses its role in sexual communication in Drosophila suzukii

PubMed Central

Dekker, Teun; Revadi, Santosh; Mansourian, Suzan; Ramasamy, Sukanya; Lebreton, Sebastien; Becher, Paul G.; Angeli, Sergio; Rota-Stabelli, Omar; Anfora, Gianfranco

2015-01-01

The Drosophila pheromone cis-11-octadecenyl acetate (cVA) is used as pheromone throughout the melanogaster group and fulfils a primary role in sexual and social behaviours. Here, we found that Drosophila suzukii, an invasive pest that oviposits in undamaged ripe fruit, does not produce cVA. In fact, its production site, the ejaculatory bulb, is atrophied. Despite loss of cVA production, its receptor, Or67d, and cognate sensillum, T1, which are essential in cVA-mediated behaviours, were fully functional. However, T1 expression was dramatically reduced in D. suzukii, and the corresponding antennal lobe glomerulus, DA1, minute. Behavioural responses to cVA depend on the input balance of Or67d neurons (driving cVA-mediated behaviours) and Or65a neurons (inhibiting cVA-mediated behaviours). Accordingly, the shifted input balance in D. suzukii has reversed cVA's role in sexual behaviour: perfuming D. suzukii males with Drosophila melanogaster equivalents of cVA strongly reduced mating rates. cVA has thus evolved from a generic sex pheromone to a heterospecific signal that disrupts mating in D. suzukii, a saltational shift, mediated through offsetting the input balance that is highly conserved in congeneric species. This study underlines that dramatic changes in a species' sensory preference can result from rather ‘simple’ numerical shifts in underlying neural circuits. PMID:25716789

VA Caregiver Support

MedlinePlus

... Performance VA Plans, Budget, & Performance VA Center for Innovation (VACI) Agency Financial Report ... Management Services Veterans Service Organizations Office of Accountability & Whistleblower ...

Identification of QTL and Qualitative Trait Loci for Agronomic Traits Using SNP Markers in the Adzuki Bean.

PubMed

Li, Yuan; Yang, Kai; Yang, Wei; Chu, Liwei; Chen, Chunhai; Zhao, Bo; Li, Yisong; Jian, Jianbo; Yin, Zhichao; Wang, Tianqi; Wan, Ping

2017-01-01

The adzuki bean ( Vigna angularis ) is an important grain legume. Fine mapping of quantitative trait loci (QTL) and qualitative trait genes plays an important role in gene cloning, molecular-marker-assisted selection (MAS), and trait improvement. However, the genetic control of agronomic traits in the adzuki bean remains poorly understood. Single-nucleotide polymorphisms (SNPs) are invaluable in the construction of high-density genetic maps. We mapped 26 agronomic QTLs and five qualitative trait genes related to pigmentation using 1,571 polymorphic SNP markers from the adzuki bean genome via restriction-site-associated DNA sequencing of 150 members of an F 2 population derived from a cross between cultivated and wild adzuki beans. We mapped 11 QTLs for flowering time and pod maturity on chromosomes 4, 7, and 10. Six 100-seed weight (SD100WT) QTLs were detected. Two major flowering time QTLs were located on chromosome 4, firstly VaFld4.1 (PEVs 71.3%), co-segregating with SNP marker s690-144110, and VaFld4.2 (PEVs 67.6%) at a 0.974 cM genetic distance from the SNP marker s165-116310. Three QTLs for seed number per pod ( Snp3.1, Snp3.2 , and Snp4.1 ) were mapped on chromosomes 3 and 4. One QTL VaSdt4.1 of seed thickness (SDT) and three QTLs for branch number on the main stem were detected on chromosome 4. QTLs for maximum leaf width (LFMW) and stem internode length were mapped to chromosomes 2 and 9, respectively. Trait genes controlling the color of the seed coat, pod, stem and flower were mapped to chromosomes 3 and 1. Three candidate genes, VaAGL, VaPhyE , and VaAP2 , were identified for flowering time and pod maturity. VaAGL encodes an agamous-like MADS-box protein of 379 amino acids. VaPhyE encodes a phytochrome E protein of 1,121 amino acids. Four phytochrome genes ( VaPhyA1, VaPhyA2, VaPhyB , and VaPhyE ) were identified in the adzuki bean genome. We found candidate genes VaAP2/ERF.81 and VaAP2/ERF.82 of SD100WT, VaAP2-s4 of SDT, and VaAP2/ERF.86 of LFMW. A candidate gene VaUGT related to black seed coat color was identified. These mapped QTL and qualitative trait genes provide information helpful for future adzuki bean candidate gene cloning and MAS breeding to improve cultivars with desirable growth periods, yields, and seed coat color types.

Helix-coil transition of a four-way DNA junction observed by multiple fluorescence parameters.

PubMed

Vámosi, György; Clegg, Robert M

2008-10-16

The thermal denaturation of immobile four-way DNA ("Holliday-") junctions with 17 base pair arms was studied via fluorescence spectroscopic measurements. Two arms of the molecule were labeled at the 5'-end with fluorescein and tetramethylrhodamine, respectively. Melting was monitored by the fluorescence intensity of the dyes, the fluorescence anisotropy of tetramethylrhodamine, and Forster resonance energy transfer (FRET) between fluorescein and rhodamine. To fit the thermal denaturation curves of the four-way junctions, two basic thermodynamic models were tested: (1) all-or-none transitions assuming a molecularity of one, two, or four and (2) a statistical "zipper" model. The all-or-none models correspond to reaction mechanisms assuming that the cooperative melting unit (that is, the structure changing from complete helix to complete coil) consists of (1) one arm, (2) two neighboring arms (which have one continuous strand common to the two arms), or (3) all four arms. In each case, the melting of the cooperative unit takes place in a single step. The tetramolecular reaction model (four-arm melting) yielded unrealistically low van't Hoff enthalpy and entropy values, whereas the monomolecular model (one-arm melting) resulted in a poor fit to the experimental data. The all-or-none bimolecular (two neighboring arm model) fit gave intermediate standard enthalpy change (Delta H) values between those expected for the melting of a duplex with a total length between the helix lengths of one and two arms (17 and 34 base pairs). Simulations according to the zipper model fit the experimental curves best when the length of the simulated duplex was assumed to be 34 base pairs, the length of a single strand. This suggests that the most important parameter determining the melting behavior of the molecule is the end-to-end distance of the strands (34 bases) rather than the length of the individual arms (17 base pairs) and that the equilibrium concentration of partially denatured intermediate states has to be taken into account. These findings are in good agreement with results obtained for three-way DNA junctions ( Stuhmeier, F. ; Lilley, D. M. ; Clegg, R. M. Biochemistry 1997, 36, 13539 ). An interesting result is that the extent-of-melting curves derived from the fluorescence intensity and anisotropy nearly agree, whereas the curve derived from the FRET data shows a change prior to the melting. This may be an indication of a conformational change leaving the double-stranded structure intact but changing the end-to-end distance of the different arms in a way consistent with the transition to the extended square configuration ( Clegg, R. M. ; Murchie, A. I. ; Lilley, D. M. Biophys. J. 1994, 66, 99 ) of this branched molecule.

Night-shift work and risk of compromised visual acuity among the workers in an electronics manufacturing company.

PubMed

Lin, Yu-Cheng; Ho, Kuo-Jung

2018-01-01

To evaluate the association between night-shift work exposure and visual health, this cross-sectional study utilized visual acuity, a surrogate measure for visual function, as a parameter, and performed an analysis comparing visual acuity between daytime and nighttime employees in an electronics manufacturing company. Data of personal histories, occupational records, physical examinations and blood tests was obtained from the electronic health records of workers. The total of 8280 workers including 3098 women and 5182 men, wearing their own daily used eyeglasses, were included in the final analysis. The mean age of the sample population was 34.7 years old (standard deviation = 5.4 years). All workers were divided into 3 work categories - consistent daytime worker (CDW), day-shift worker (DSW) and night-shift worker (NSW). The check-up results of glasses-corrected visual acuity (c-VA) were utilized to classify individuals as good (≥ 1.2, both eyes) and inadequate (< 0.8, the better eye) c-VA. Consistent daytime workers had the highest rate of good c-VA (42.5% vs. 25.1% DSW and 21.1% NSW, p = 0.047). Night-shift workers had the highest rate of inadequate c-VA (CDW, DSW and NSW: 2.6%, 6.2%, and 7.6%, p = 0.03) among all employees. After controlling for covariates, NSW were found at an increased risk for inadequate c-VA (adjusted odds ratio (ORa) = 2.7, 95% confidence interval (CI): 2.0-3.6, vs. CDW), and less likely to have good c-VA (ORa = 0.4, 95% CI: 0.4-0.5, vs. CDW). Night-shift work is moderately associated with compromised visual acuity of employees in this electronics manufacturing company. Int J Occup Med Environ Health 2018;31(1):71-79. This work is available in Open Access model and licensed under a CC BY-NC 3.0 PL license.

Effect of reverse shoulder design philosophy on muscle moment arms.

PubMed

Hamilton, Matthew A; Diep, Phong; Roche, Chris; Flurin, Pierre Henri; Wright, Thomas W; Zuckerman, Joseph D; Routman, Howard

2015-04-01

This study analyzes the muscle moment arms of three different reverse shoulder design philosophies using a previously published method. Digital bone models of the shoulder were imported into a 3D modeling software and markers placed for the origin and insertion of relevant muscles. The anatomic model was used as a baseline for moment arm calculations. Subsequently, three different reverse shoulder designs were virtually implanted and moment arms were analyzed in abduction and external rotation. The results indicate that the lateral offset between the joint center and the axis of the humerus specific to one reverse shoulder design increased the external rotation moment arms of the posterior deltoid relative to the other reverse shoulder designs. The other muscles analyzed demonstrated differences in the moment arms, but none of the differences reached statistical significance. This study demonstrated how the combination of variables making up different reverse shoulder designs can affect the moment arms of the muscles in different and statistically significant ways. The role of humeral offset in reverse shoulder design has not been previously reported and could have an impact on external rotation and stability achieved post-operatively. © 2015 Orthopaedic Research Society. Published by Wiley Periodicals, Inc.

Recommendations for the Implementation of the LASSO Workflow

DOE Office of Scientific and Technical Information (OSTI.GOV)

Gustafson, William I; Vogelmann, Andrew M; Cheng, Xiaoping

The U. S. Department of Energy (DOE) Atmospheric Radiation Measurement (ARM) Research Fa-cility began a pilot project in May 2015 to design a routine, high-resolution modeling capability to complement ARM’s extensive suite of measurements. This modeling capability, envisioned in the ARM Decadal Vision (U.S. Department of Energy 2014), subsequently has been named the Large-Eddy Simu-lation (LES) ARM Symbiotic Simulation and Observation (LASSO) project, and it has an initial focus of shallow convection at the ARM Southern Great Plains (SGP) atmospheric observatory. This report documents the recommendations resulting from the pilot project to be considered by ARM for imple-mentation into routinemore » operations. During the pilot phase, LASSO has evolved from the initial vision outlined in the pilot project white paper (Gustafson and Vogelmann 2015) to what is recommended in this report. Further details on the overall LASSO project are available at https://www.arm.gov/capabilities/modeling/lasso. Feedback regarding LASSO and the recommendations in this report can be directed to William Gustafson, the project principal investigator (PI), and Andrew Vogelmann, the co-principal investigator (Co-PI), via lasso@arm.gov.« less

Gaseous spiral structure and mass drift in spiral galaxies

NASA Astrophysics Data System (ADS)

Kim, Yonghwi; Kim, Woong-Tae

2014-05-01

We use hydrodynamic simulations to investigate non-linear gas responses to an imposed stellar spiral potential in disc galaxies. The gaseous medium is assumed to be infinitesimally thin, isothermal, and unmagnetized. We consider various spiral-arm models with differing strength and pattern speed. We find that the extent and shapes of gaseous arms as well as the related mass drift rate depend rather sensitively on the arm pattern speed. In models where the arm pattern is rotating slow, the gaseous arms extend across the corotation resonance (CR) all the way to the outer boundary, with a pitch angle slightly smaller than that of the stellar counterpart. In models with a fast rotating pattern, on the other hand, spiral shocks are much more tightly wound than the stellar arms, and cease to exist in the regions near and outside the CR where mathcal {M}_perp /sin p_* gtrsim 25-40, with mathcal {M}_perp denoting the perpendicular Mach number of a rotating gas relative to the arms with pitch angle p*. Inside the CR, the arms drive mass inflows at a rate of ˜0.05-3.0 M⊙ yr-1 to the central region, with larger values corresponding to stronger and slower arms. The contribution of the shock dissipation, external torque, and self-gravitational torque to the mass inflow is roughly 50, 40, and 10 per cent, respectively. We demonstrate that the distributions of line-of-sight velocities and spiral-arm densities can be a useful diagnostic tool to distinguish if the spiral pattern is rotating fast or slow.

Long-term effect of surface light scattering and glistenings of intraocular lenses on visual function.

PubMed

Hayashi, Ken; Hirata, Akira; Yoshida, Motoaki; Yoshimura, Koichi; Hayashi, Hideyuki

2012-08-01

To investigate the long-term effect of surface light scattering and glistenings of various intraocular lenses (IOLs) on visual function and optical aberrations after cataract surgery. Case-control study. Thirty-five eyes that underwent implantation of a hydrophobic acrylic, silicone, or polymethyl methacrylate (PMMA) IOL more than 10 years ago were recruited. The scattering light intensity of the surface and internal matrix of the optic was measured using Scheimpflug photography. Visual acuity (VA) was measured using VA charts, and contrast VA and that with glare (glare VA) were examined using a contrast sensitivity tester. Ocular higher-order aberrations (HOAs) were measured using a Hartmann-Shack aberrometer. Mean scattering light intensity of the surface and internal matrix of the optic was significantly higher in the acrylic group than in the silicone and PMMA groups (P < .0001). Mean uncorrected VA, photopic and mesopic contrast VA and glare VA, and HOAs did not differ significantly among groups, although mean corrected VA in the acrylic group was significantly better than that in the other groups (P = .0023). Scattering light intensity of the surface and internal matrix did not correlate with VA, contrast VA, or glare VA, and did not correlate with ocular and internal optic HOAs in the acrylic group. At more than 10 years postoperatively, visual function, including contrast sensitivity, and ocular HOAs were comparable among eyes that received acrylic, silicone, and PMMA IOLs. Surface scattering and glistenings with the acrylic IOLs were not significantly correlated with visual function and optical aberrations. Copyright © 2012 Elsevier Inc. All rights reserved.

The subatlantic triangle: gateway to early localization of the atlantoaxial vertebral artery.

PubMed

Tayebi Meybodi, Ali; Gandhi, Sirin; Preul, Mark C; Lawton, Michael T

2018-04-27

OBJECTIVE Exposure of the vertebral artery (VA) between C-1 and C-2 vertebrae (atlantoaxial VA) may be necessary in a variety of pathologies of the craniovertebral junction. Current methods to expose this segment of the VA entail sharp dissection of muscles close to the internal jugular vein and the spinal accessory nerve. The present study assesses the technique of exposing the atlantoaxial VA through a newly defined muscular triangle at the craniovertebral junction. METHODS Five cadaveric heads were prepared for surgical simulation in prone position, turned 30°-45° toward the side of exposure. The atlantoaxial VA was exposed through the subatlantic triangle after reflecting the sternocleidomastoid and splenius capitis muscles inferiorly. The subatlantic triangle was formed by 3 groups of muscles: 1) the levator scapulae and splenius cervicis muscles inferiorly and laterally, 2) the longissimus capitis muscle inferiorly and medially, and 3) the inferior oblique capitis superiorly. The lengths of the VA exposed through the triangle before and after unroofing the C-2 transverse foramen were measured. RESULTS The subatlantic triangle consistently provided access to the whole length of atlantoaxial VA. The average length of the VA exposed via the subatlantic triangle was 19.5 mm. This average increased to 31.5 mm after the VA was released at the C-2 transverse foramen. CONCLUSIONS The subatlantic triangle provides a simple and straightforward pathway to expose the atlantoaxial VA. The proposed method may be useful during posterior approaches to the craniovertebral junction should early exposure and control of the atlantoaxial VA become necessary.

Modification of Male Courtship Motivation by Olfactory Habituation via the GABAA Receptor in Drosophila melanogaster

PubMed Central

Tachibana, Shin-Ichiro; Touhara, Kazushige; Ejima, Aki

2015-01-01

A male-specific component, 11-cis-vaccenyl acetate (cVA) works as an anti-aphrodisiac pheromone in Drosophila melanogaster. The presence of cVA on a male suppresses the courtship motivation of other males and contributes to suppression of male-male homosexual courtship, while the absence of cVA on a female stimulates the sexual motivation of nearby males and enhances the male-female interaction. However, little is known how a male distinguishes the presence or absence of cVA on a target fly from either self-produced cVA or secondhand cVA from other males in the vicinity. In this study, we demonstrate that male flies have keen sensitivity to cVA; therefore, the presence of another male in the area reduces courtship toward a female. This reduced level of sexual motivation, however, could be overcome by pretest odor exposure via olfactory habituation to cVA. Real-time imaging of cVA-responsive sensory neurons using the neural activity sensor revealed that prolonged exposure to cVA decreased the levels of cVA responses in the primary olfactory center. Pharmacological and genetic screening revealed that signal transduction via GABAA receptors contributed to this olfactory habituation. We also found that the habituation experience increased the copulation success of wild-type males in a group. In contrast, transgenic males, in which GABA input in a small subset of local neurons was blocked by RNAi, failed to acquire the sexual advantage conferred by habituation. Thus, we illustrate a novel phenomenon in which olfactory habituation positively affects sexual capability in a competitive environment. PMID:26252206

"Where's My Choice?" An Examination of Veteran and Provider Experiences With Hepatitis C Treatment Through the Veteran Affairs Choice Program.

PubMed

Tsai, Jack; Yakovchenko, Vera; Jones, Natalie; Skolnik, Avy; Noska, Amanda; Gifford, Allen L; McInnes, D Keith

2017-07-01

The Department of Veterans Affairs (VA) is the country's largest provider for chronic hepatitis C virus (HCV) infection. The VA created the Choice Program, which allows eligible veterans to seek care from community providers, who are reimbursed by the VA. This study aimed to examine perspectives and experiences with the VA Choice Program among veteran patients and their HCV providers. Qualitative study based on semistructured interviews with veteran patients and VA providers. Interview transcripts were analyzed using rapid assessment procedures based in grounded theory. A total of 38 veterans and 10 VA providers involved in HCV treatment across 3 VA medical centers were interviewed. Veterans and providers were asked open-ended questions about their experiences with HCV treatment in the VA and through the Choice Program, including barriers and facilitators to treatment access and completion. Four themes were identified: (1) there were difficulties in enrollment, ongoing support, and billing with third-party administrators; (2) veterans experienced a lack of choice in location of treatment; (3) fragmented care led to coordination challenges between VA and community providers; and (4) VA providers expressed reservations about sending veterans to community providers. The Choice Program has the potential to increase veteran access to HCV treatment, but veterans and VA providers have described substantial problems in the initial years of the program. Enhancing care coordination, incorporating shared decision-making, and establishing a wide network of community providers may be important areas for further development in designing community-based specialist services for needy veterans.

Identifying Homelessness among Veterans Using VA Administrative Data: Opportunities to Expand Detection Criteria.

PubMed

Peterson, Rachel; Gundlapalli, Adi V; Metraux, Stephen; Carter, Marjorie E; Palmer, Miland; Redd, Andrew; Samore, Matthew H; Fargo, Jamison D

2015-01-01

Researchers at the U.S. Department of Veterans Affairs (VA) have used administrative criteria to identify homelessness among U.S. Veterans. Our objective was to explore the use of these codes in VA health care facilities. We examined VA health records (2002-2012) of Veterans recently separated from the military and identified as homeless using VA conventional identification criteria (ICD-9-CM code V60.0, VA specific codes for homeless services), plus closely allied V60 codes indicating housing instability. Logistic regression analyses examined differences between Veterans who received these codes. Health care services and co-morbidities were analyzed in the 90 days post-identification of homelessness. VA conventional criteria identified 21,021 homeless Veterans from Operations Enduring Freedom, Iraqi Freedom, and New Dawn (rate 2.5%). Adding allied V60 codes increased that to 31,260 (rate 3.3%). While certain demographic differences were noted, Veterans identified as homeless using conventional or allied codes were similar with regards to utilization of homeless, mental health, and substance abuse services, as well as co-morbidities. Differences were noted in the pattern of usage of homelessness-related diagnostic codes in VA facilities nation-wide. Creating an official VA case definition for homelessness, which would include additional ICD-9-CM and other administrative codes for VA homeless services, would likely allow improved identification of homeless and at-risk Veterans. This also presents an opportunity for encouraging uniformity in applying these codes in VA facilities nationwide as well as in other large health care organizations.

Cervical spondylosis: a rare and curable cause of vertebrobasilar insufficiency.

PubMed

Denis, Daniel J; Shedid, Daniel; Shehadeh, Mohammad; Weil, Alexander G; Lanthier, Sylvain

2014-05-01

Spondylotic vertebral artery (VA) compression is a rare cause of vertebrobasilar insufficiency and stroke. A 53-year-old man experienced multiple brief vertebrobasilar transient ischemic attacks (TIAs) and strokes, not apparently triggered by neck movements. Brain magnetic resonance imaging (MRI) documented consecutive infarcts, first in the left then right medial posterior inferior cerebellar artery (PICA) territories. Angiography showed two extracranial right vertebral artery (VA) stenoses, left VA hypoplasia, absence of left PICA and a dominant right PICA. Computed tomography angiography revealed right VA compression by osteophytes at C5-C6 and C6-C7 levels. No further vertebrobasilar insufficiency symptoms occurred in the 65 months following VA surgical decompression. Our literature review found 49 published surgical cases with vertebrobasilar symptoms caused by cervical spondylosis. Forty cases had one or more brief TIAs frequently triggered by neck movements. Three cases presented with stroke without prior TIA, with symptoms suggesting a top of the basilar artery embolic infarcts (one combined with a PICA infarct). Six cases had both TIAs and minor stroke. VA compression by uncovertebral osteophytes at the C5-C6 level was common. Dynamic angiography done in 38 cases systematically revealed worsening of VA stenosis or complete occlusion with either neck extension or rotation (ipsilateral when specified). Contralateral VA incompetence was found in 14 patients. Spondylotic VA stenosis can cause hemodynamic TIAs and watershed strokes, especially when contralateral VA insufficiency is combined to specific neck movements. Low-amplitude neck movement may suffice in severe cases. Embolic vertebrobasilar events are less frequent. VA decompression from spondylosis may prevent recurrent ischemic episodes.

A Changing Landscape for Vitamin A Programs: Implications for Optimal Intervention Packages, Program Monitoring, and Safety.

PubMed

Klemm, Rolf D W; Palmer, Amanda C; Greig, Alison; Engle-Stone, Reina; Dalmiya, Nita

2016-06-01

Vitamin A deficiency (VAD) remains a widespread public health problem in the developing world, despite changes in under-5 mortality rates, morbidity patterns, and intervention options. This article considers the implications of a changing epidemiologic and programmatic landscape for vitamin A (VA) programs. We review progress to prevent VAD and its health consequences, assess gaps in VA status and intervention coverage data, and assess data needed to guide decisions regarding the optimal mix, targeting, and dose of VA interventions to maximize benefit and minimize risk. Vitamin A supplementation programs have contributed to the reduction in under-5 mortality rates, but alone, do not address the underlying problem of inadequate dietary VA intakes and VAD among preschool-aged children in the developing world. A combination of VA interventions (eg, supplementation, fortified foods, multiple micronutrient powders, and lipid-based nutrient supplements) will be required to achieve VA adequacy in most settings. Current efforts to measure the coverage of multiple VA interventions, as well as whether and how much VA children are receiving, are few and fragmented. Where intervention overlap exists, further effort is needed to monitor VA intakes, ensuring that targeted groups are consuming adequate amounts but not exceeding the tolerable upper intake level. Vitamin A status data will also be critical for navigating the changing landscape of VA programs. Data from these monitoring efforts will help to guide decisions on the optimal mix, targeting, and exposure to VA interventions to maximize public health benefit while minimizing any potential risk. © The Author(s) 2016.

Pregnancy and maternal iron deficiency stimulate hepatic CRBPII expression in rats.

PubMed

Cottin, Sarah C; Gambling, Lorraine; Hayes, Helen E; Stevens, Valerie J; McArdle, Harry J

2016-06-01

Iron deficiency impairs vitamin A (VA) metabolism in the rat but the mechanisms involved are unknown and the effect during development has not been investigated. We investigated the effect of pregnancy and maternal iron deficiency on VA metabolism in the mother and fetus. 54 rats were fed either a control or iron deficient diet for 2weeks prior to mating and throughout pregnancy. Another 15 female rats followed the same diet and were used as non-pregnant controls. Maternal liver, placenta and fetal liver were collected at d21 for total VA, retinol and retinyl ester (RE) measurement and VA metabolic gene expression analysis. Iron deficiency increased maternal hepatic RE (P<.05) and total VA (P<.0001), fetal liver RE (P<.05), and decreased placenta total VA (P<.05). Pregnancy increased Cellular Retinol Binding Protein (CRBP)-II gene expression by 7 fold (P=.001), decreased VA levels (P=.0004) and VA metabolic gene expression (P<.0001) in the liver. Iron deficiency increased hepatic CRBPII expression by a further 2 fold (P=.044) and RBP4 by~20% (P=.005), increased RBPR2 and decreased CRBPII, LRAT, and TTR in fetal liver, while it had no effect on VA metabolic gene expression in the placenta. Hepatic CRBPII expression is increased by pregnancy and further increased by iron deficiency, which may play an important role in VA metabolism and homeostasis. Maternal iron deficiency also alters VA metabolism in the fetus, which is likely to have consequences for development. Copyright © 2016 Elsevier Inc. All rights reserved.

Identifying Homelessness among Veterans Using VA Administrative Data: Opportunities to Expand Detection Criteria

PubMed Central

Peterson, Rachel; Gundlapalli, Adi V.; Metraux, Stephen; Carter, Marjorie E.; Palmer, Miland; Redd, Andrew; Samore, Matthew H.; Fargo, Jamison D.

2015-01-01

Researchers at the U.S. Department of Veterans Affairs (VA) have used administrative criteria to identify homelessness among U.S. Veterans. Our objective was to explore the use of these codes in VA health care facilities. We examined VA health records (2002-2012) of Veterans recently separated from the military and identified as homeless using VA conventional identification criteria (ICD-9-CM code V60.0, VA specific codes for homeless services), plus closely allied V60 codes indicating housing instability. Logistic regression analyses examined differences between Veterans who received these codes. Health care services and co-morbidities were analyzed in the 90 days post-identification of homelessness. VA conventional criteria identified 21,021 homeless Veterans from Operations Enduring Freedom, Iraqi Freedom, and New Dawn (rate 2.5%). Adding allied V60 codes increased that to 31,260 (rate 3.3%). While certain demographic differences were noted, Veterans identified as homeless using conventional or allied codes were similar with regards to utilization of homeless, mental health, and substance abuse services, as well as co-morbidities. Differences were noted in the pattern of usage of homelessness-related diagnostic codes in VA facilities nation-wide. Creating an official VA case definition for homelessness, which would include additional ICD-9-CM and other administrative codes for VA homeless services, would likely allow improved identification of homeless and at-risk Veterans. This also presents an opportunity for encouraging uniformity in applying these codes in VA facilities nationwide as well as in other large health care organizations. PMID:26172386

Continuous Evaluation of Fast Processes in Climate Models Using ARM Measurements

DOE Office of Scientific and Technical Information (OSTI.GOV)

Li, Zhijin; Sha, Feng; Liu, Yangang

2016-02-02

This five-year award supports the project “Continuous Evaluation of Fast Processes in Climate Models Using ARM Measurements (FASTER)”. The goal of this project is to produce accurate, consistent and comprehensive data sets for initializing both single column models (SCMs) and cloud resolving models (CRMs) using data assimilation. A multi-scale three-dimensional variational data assimilation scheme (MS-3DVAR) has been implemented. This MS-3DVAR system is built on top of WRF/GSI. The Community Gridpoint Statistical Interpolation (GSI) system is an operational data assimilation system at the National Centers for Environmental Prediction (NCEP) and has been implemented in the Weather Research and Forecast (WRF) model.more » This MS-3DVAR is further enhanced by the incorporation of a land surface 3DVAR scheme and a comprehensive aerosol 3DVAR scheme. The data assimilation implementation focuses in the ARM SGP region. ARM measurements are assimilated along with other available satellite and radar data. Reanalyses are then generated for a few selected period of time. This comprehensive data assimilation system has also been employed for other ARM-related applications.« less

Modeling of two-hot-arm horizontal thermal actuator

NASA Astrophysics Data System (ADS)

Yan, Dong; Khajepour, Amir; Mansour, Raafat

2003-03-01

Electrothermal actuators have a very promising future in MEMS applications since they can generate large deflection and force with low actuating voltages and small device areas. In this study, a lumped model of a two-hot-arm horizontal thermal actuator is presented. In order to prove the accuracy of the lumped model, finite element analysis (FEA) and experimental results are provided. The two-hot-arm thermal actuator has been fabricated using the MUMPs process. Both the experimental and FEA results are in good agreement with the results of lumped modeling.

38 CFR 26.9 - Information on and public participation in VA environmental process.

Code of Federal Regulations, 2010 CFR

2010-07-01

... participation in VA environmental process. 26.9 Section 26.9 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS (CONTINUED) ENVIRONMENTAL EFFECTS OF THE DEPARTMENT OF VETERANS AFFAIRS (VA) ACTIONS § 26.9 Information on and public participation in VA environmental process. (a) During the...

75 FR 59800 - Privacy Act of 1974; Report of Matching Program

Federal Register 2010, 2011, 2012, 2013, 2014

2010-09-28

... beneficiaries who are receiving VA benefits, and to reduce or terminate benefits, if appropriate. The match will... beneficiaries and adjust VA benefit payments as prescribed by law. The proposed matching program will enable VA... matching Railroad Retirement Board (RRB), retirement and survivor benefits records with VA pension...

75 FR 7651 - Privacy Act of 1974; System of Records

Federal Register 2010, 2011, 2012, 2013, 2014

2010-02-22

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77 FR 76865 - Copayments for Medications in 2013

Federal Register 2010, 2011, 2012, 2013, 2014

2012-12-31

... increase. For 2012, VA ``froze'' the copayment amount for veterans in VA's health care system enrollment... each $1 increase in the copayment amount'' applicable to veterans enrolled in one of VA's health care... December 31, 2012, the copayment amount for veterans in priority categories 2 through 6 of VA's health care...

78 FR 62441 - VA Dental Insurance Program-Federalism

Federal Register 2010, 2011, 2012, 2013, 2014

2013-10-22

... DEPARTMENT OF VETERANS AFFAIRS 38 CFR Part 17 RIN 2900-AO85 VA Dental Insurance Program... Veterans Affairs (VA) is taking direct final action to amend its regulations related to the VA Dental Insurance Program (VADIP), a pilot program to offer premium-based dental insurance to enrolled veterans and...

78 FR 63143 - VA Dental Insurance Program-Federalism

Federal Register 2010, 2011, 2012, 2013, 2014

2013-10-23

... DEPARTMENT OF VETERANS AFFAIRS 38 CFR Part 17 RIN 2900-AO86 VA Dental Insurance Program... Affairs (VA) proposes to amend its regulations related to the VA Dental Insurance Program (VADIP), a pilot program to offer premium-based dental insurance to enrolled veterans and certain survivors and dependents...

76 FR 24570 - Proposed Information Collection (Application for VA Education Benefits) Activity; Comment Request

Federal Register 2010, 2011, 2012, 2013, 2014

2011-05-02

... (Application for VA Education Benefits) Activity; Comment Request AGENCY: Veterans Benefits Administration, Department of Veterans Affairs. ACTION: Notice. SUMMARY: The Veterans Benefits Administration (VBA... Under the Montgomery GI Bill, VA Form 22-1990E. c. Application for VA Education Benefits Under the...

76 FR 27386 - Agency Information Collection (Cooperative Studies Program (CSP): Site Survey and Meeting...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-05-11

... DEPARTMENT OF VETERANS AFFAIRS [OMB Control No. 2900-New (VA Form 10-0511)] Agency Information.... 2900-New (VA Form 10-0511).'' SUPPLEMENTARY INFORMATION: Titles: a. Cooperative Studies Program (CSP) Site Survey, VA Form 10-0511. b. Cooperative Studies Program (CSP) Meeting Evaluation, VA Form 10...

48 CFR 852.219-9 - VA Small business subcontracting plan minimum requirements.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 48 Federal Acquisition Regulations System 5 2010-10-01 2010-10-01 false VA Small business... Provisions and Clauses 852.219-9 VA Small business subcontracting plan minimum requirements. As prescribed in subpart 819.709, insert the following clause: VA Small Business Subcontracting Plan Minimum Requirements...

75 FR 24510 - Drug and Drug-Related Supply Promotion by Pharmaceutical Company Sales Representatives at VA...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-05-05

... VA facilities and the business relationships between VA staff and sales representatives promoting..., and provide sales representatives with a consistent standard of permissible business practice at VA... include suspension of a sales representative's access privileges, or, in extreme cases, denying access to...

48 CFR 852.219-9 - VA Small business subcontracting plan minimum requirements.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 48 Federal Acquisition Regulations System 5 2013-10-01 2013-10-01 false VA Small business... Provisions and Clauses 852.219-9 VA Small business subcontracting plan minimum requirements. As prescribed in subpart 819.709, insert the following clause: VA Small Business Subcontracting Plan Minimum Requirements...

48 CFR 852.219-9 - VA Small business subcontracting plan minimum requirements.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 48 Federal Acquisition Regulations System 5 2011-10-01 2011-10-01 false VA Small business... Provisions and Clauses 852.219-9 VA Small business subcontracting plan minimum requirements. As prescribed in subpart 819.709, insert the following clause: VA Small Business Subcontracting Plan Minimum Requirements...

48 CFR 852.219-9 - VA Small business subcontracting plan minimum requirements.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 48 Federal Acquisition Regulations System 5 2012-10-01 2012-10-01 false VA Small business... Provisions and Clauses 852.219-9 VA Small business subcontracting plan minimum requirements. As prescribed in subpart 819.709, insert the following clause: VA Small Business Subcontracting Plan Minimum Requirements...

48 CFR 852.219-9 - VA Small business subcontracting plan minimum requirements.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 48 Federal Acquisition Regulations System 5 2014-10-01 2014-10-01 false VA Small business... Provisions and Clauses 852.219-9 VA Small business subcontracting plan minimum requirements. As prescribed in subpart 819.709, insert the following clause: VA Small Business Subcontracting Plan Minimum Requirements...

Improved orthopedic arm joint

NASA Technical Reports Server (NTRS)

Dane, D. H.

1971-01-01

Joint permits smooth and easy movement of disabled arm and is smaller, lighter and less expensive than previous models. Device is interchangeable and may be used on either arm at the shoulder or at the elbow.

Stochastic estimation of human arm impedance under nonlinear friction in robot joints: a model study.

PubMed

Chang, Pyung Hun; Kang, Sang Hoon

2010-05-30

The basic assumption of stochastic human arm impedance estimation methods is that the human arm and robot behave linearly for small perturbations. In the present work, we have identified the degree of influence of nonlinear friction in robot joints to the stochastic human arm impedance estimation. Internal model based impedance control (IMBIC) is then proposed as a means to make the estimation accurate by compensating for the nonlinear friction. From simulations with a nonlinear Lugre friction model, it is observed that the reliability and accuracy of the estimation are severely degraded with nonlinear friction: below 2 Hz, multiple and partial coherence functions are far less than unity; estimated magnitudes and phases are severely deviated from that of a real human arm throughout the frequency range of interest; and the accuracy is not enhanced with an increase of magnitude of the force perturbations. In contrast, the combined use of stochastic estimation and IMBIC provides with accurate estimation results even with large friction: the multiple coherence functions are larger than 0.9 throughout the frequency range of interest and the estimated magnitudes and phases are well matched with that of a real human arm. Furthermore, the performance of suggested method is independent of human arm and robot posture, and human arm impedance. Therefore, the IMBIC will be useful in measuring human arm impedance with conventional robot, as well as in designing a spatial impedance measuring robot, which requires gearing. (c) 2010 Elsevier B.V. All rights reserved.

A robot arm simulation with a shared memory multiprocessor machine

NASA Technical Reports Server (NTRS)

Kim, Sung-Soo; Chuang, Li-Ping

1989-01-01

A parallel processing scheme for a single chain robot arm is presented for high speed computation on a shared memory multiprocessor. A recursive formulation that is derived from a virtual work form of the d'Alembert equations of motion is utilized for robot arm dynamics. A joint drive system that consists of a motor rotor and gears is included in the arm dynamics model, in order to take into account gyroscopic effects due to the spinning of the rotor. The fine grain parallelism of mechanical and control subsystem models is exploited, based on independent computation associated with bodies, joint drive systems, and controllers. Efficiency and effectiveness of the parallel scheme are demonstrated through simulations of a telerobotic manipulator arm. Two different mechanical subsystem models, i.e., with and without gyroscopic effects, are compared, to show the trade-off between efficiency and accuracy.

Toward a VA Women's Health Research Agenda: setting evidence-based priorities to improve the health and health care of women veterans.

PubMed

Yano, Elizabeth M; Bastian, Lori A; Frayne, Susan M; Howell, Alexandra L; Lipson, Linda R; McGlynn, Geraldine; Schnurr, Paula P; Seaver, Margaret R; Spungen, Ann M; Fihn, Stephan D

2006-03-01

The expansion of women in the military is reshaping the veteran population, with women now constituting the fastest growing segment of eligible VA health care users. In recognition of the changing demographics and special health care needs of women, the VA Office of Research & Development recently sponsored the first national VA Women's Health Research Agenda-setting conference to map research priorities to the needs of women veterans and position VA as a national leader in Women's Health Research. This paper summarizes the process and outcomes of this effort, outlining VA's research priorities for biomedical, clinical, rehabilitation, and health services research.

Toward a VA Women's Health Research Agenda: Setting Evidence-based Priorities to Improve the Health and Health Care of Women Veterans

PubMed Central

Yano, Elizabeth M; Bastian, Lori A; Frayne, Susan M; Howell, Alexandra L; Lipson, Linda R; McGlynn, Geraldine; Schnurr, Paula P; Seaver, Margaret R; Spungen, Ann M; Fihn, Stephan D

2006-01-01

The expansion of women in the military is reshaping the veteran population, with women now constituting the fastest growing segment of eligible VA health care users. In recognition of the changing demographics and special health care needs of women, the VA Office of Research & Development recently sponsored the first national VA Women's Health Research Agenda-setting conference to map research priorities to the needs of women veterans and position VA as a national leader in Women's Health Research. This paper summarizes the process and outcomes of this effort, outlining VA's research priorities for biomedical, clinical, rehabilitation, and health services research. PMID:16637953

76 FR 71920 - Payment for Home Health Services and Hospice Care by Non-VA Providers

Federal Register 2010, 2011, 2012, 2013, 2014

2011-11-21

... concerning the billing methodology for non-VA providers of home health services and hospice care. The proposed rulemaking would include home health services and hospice care under the VA regulation governing payment for other non-VA health care providers. Because the newly applicable methodology cannot supersede...

78 FR 30767 - Copayments for Medications in 2013

Federal Register 2010, 2011, 2012, 2013, 2014

2013-05-23

... 2 through 6 of VA's health care system is $8. 38 CFR 17.110(b)(1)(ii). Thereafter, the copayment... year for a veteran enrolled in one of VA's health care enrollment system priority categories 2 through... veterans enrolled in one of VA's health care enrollment system priority categories 2 through 6. VA invited...

76 FR 19524 - Privacy Act of 1974; Deletion of System of Records

Federal Register 2010, 2011, 2012, 2013, 2014

2011-04-07

... Affairs (VA) is deleting a system of records entitled ``PROS/KEYS User Permissions Database-VA'' (67VA30... requirement for VA to maintain this system of records no longer exists because the PROS/ KEYS Database was... DEPARTMENT OF VETERANS AFFAIRS Privacy Act of 1974; Deletion of System of Records AGENCY...

78 FR 6849 - Agency Information Collection (Verification of VA Benefits) Activity Under OMB Review

Federal Register 2010, 2011, 2012, 2013, 2014

2013-01-31

... (Verification of VA Benefits) Activity Under OMB Review AGENCY: Veterans Benefits Administration, Department of... ``OMB Control No. 2900-0406.'' SUPPLEMENTARY INFORMATION: Title: Verification of VA Benefits, VA Form 26... eliminate unlimited versions of lender- designed forms. The form also informs the lender whether or not the...

Adenovirus vectors lacking virus-associated RNA expression enhance shRNA activity to suppress hepatitis C virus replication

NASA Astrophysics Data System (ADS)

Pei, Zheng; Shi, Guoli; Kondo, Saki; Ito, Masahiko; Maekawa, Aya; Suzuki, Mariko; Saito, Izumu; Suzuki, Tetsuro; Kanegae, Yumi

2013-12-01

First-generation adenovirus vectors (FG AdVs) expressing short-hairpin RNA (shRNA) effectively downregulate the expressions of target genes. However, this vector, in fact, expresses not only the transgene product, but also virus-associated RNAs (VA RNAs) that disturb cellular RNAi machinery. We have established a production method for VA-deleted AdVs lacking expression of VA RNAs. Here, we showed that the highest shRNA activity was obtained when the shRNA was inserted not at the popularly used E1 site, but at the E4 site. We then compared the activities of shRNAs against hepatitis C virus (HCV) expressed from VA-deleted AdVs or conventional AdVs. The VA-deleted AdVs inhibited HCV production much more efficiently. Therefore, VA-deleted AdVs were more effective than the currently used AdVs for shRNA downregulation, probably because of the lack of competition between VA RNAs and the shRNAs. These VA-deleted AdVs might enable more effective gene therapies for chronic hepatitis C.

Balancing Demand and Supply for Veterans' Health Care: A Summary of Three RAND Assessments Conducted Under the Veterans Choice Act.

PubMed

Farmer, Carrie M; Hosek, Susan D; Adamson, David M

2016-06-20

In response to concerns that the Department of Veterans Affairs (VA) has faced about veterans' access to care and the quality of care delivered, Congress enacted the Veterans Access, Choice, and Accountability Act of 2014 ("Veterans Choice Act") in August 2014. The law was passed to help address access issues by expanding the criteria through which veterans can seek care from civilian providers. In addition, the law called for a series of independent assessments of the VA health care system across a broad array of topics related to the delivery of health care services to veterans in VA-owned and -operated facilities, as well as those under contract to VA. RAND conducted three of these assessments: Veteran demographics and health care needs (A), VA health care capabilities (B), and VA authorities and mechanisms for purchasing care (C). This article summarizes the findings of our assessments and includes recommendations from the reports for improving the match between veterans' needs and VA's capabilities, including VA's ability to purchase necessary care from the private sector.

Model of outgrowths in the spiral galaxies NGC 4921 and NGC 7049 and the origin of spiral arms

NASA Astrophysics Data System (ADS)

Carlqvist, Per

2013-02-01

NGC 4921 and 7049 are two spiral galaxies presenting narrow, distinct dust features. A detailed study of the morphology of those features has been carried out using Hubble Space Telescope archival images. NGC 4921 shows a few but well-defined dust arms midway to its centre while NGC 7049 displays many more dusty features, mainly collected within a ring-shaped formation. Numerous dark and filamentary structures, called outgrowths, are found to protrude from the dusty arms in both galaxies. The outgrowths point both outwards and inwards in the galaxies. Mostly they are found to be V-shaped or Y-shaped with the branches connected to dark arm filaments. Often the stem of the Y appears to consist of intertwined filaments. Remarkably, the outgrowths show considerable similarities to elephant trunks in H ii regions. A model of the outgrowths, based on magnetized filaments, is proposed. The model provides explanations of both the shapes and orientations of the outgrowths. Most important, it can also give an account for their intertwined structures. It is found that the longest outgrowths are confusingly similar to dusty spiral arms. This suggests that some of the outgrowths can develop into such arms. The time-scale of the development is estimated to be on the order of the rotation period of the arms or shorter. Similar processes may also take place in other spiral galaxies. If so, the model of the outgrowths can offer a new approach to the old winding problem of spiral arms.

Surgical resident supervision in the operating room and outcomes of care in Veterans Affairs hospitals.

PubMed

Itani, Kamal M F; DePalma, Ralph G; Schifftner, Tracy; Sanders, Karen M; Chang, Barbara K; Henderson, William G; Khuri, Shukri F

2005-11-01

There has been concern that a reduced level of surgical resident supervision in the operating room (OR) is correlated with worse patient outcomes. Until September 2004, Veterans' Affairs (VA) hospitals entered in the surgical record level 3 supervision on every surgical case when the attending physician was available but not physically present in the OR or the OR suite. In this study, we assessed the impact of level 3 on risk-adjusted morbidity and mortality in the VA system. Surgical cases entered into the National Surgical Quality Improvement Program database between 1998 and 2004, from 99 VA teaching facilities, were included in a logistic regression analysis for each year. Level 3 versus all other levels of supervision were forced into the model, and patient characteristics then were selected stepwise to arrive at a final model. Confidence limits for the odds ratios were calculated by profile likelihood. A total of 610,660 cases were available for analysis. Thirty-day mortality and morbidity rates were reported in 14,441 (2.36%) and 63,079 (10.33%) cases, respectively. Level 3 supervision decreased from 8.72% in 1998 to 2.69% in 2004. In the logistic regression analysis, the odds ratios for mortality for level 3 ranged from .72 to 1.03. Only in the year 2000 were the odds ratio for mortality statistically significant at the .05 level (odds ratio, .72; 95% confidence interval, .594-.858). For morbidity, the odds ratios for level 3 supervision ranged from .66 to 1.01, and all odds ratios except for the year 2004 were statistically significant. Between 1998 and 2004, the level of resident supervision in the OR did not affect clinical outcomes adversely for surgical patients in the VA teaching hospitals.

HIV/AIDS-related mortality in Africa and Asia: evidence from INDEPTH health and demographic surveillance system sites.

PubMed

Streatfield, P Kim; Khan, Wasif A; Bhuiya, Abbas; Hanifi, Syed M A; Alam, Nurul; Millogo, Ourohiré; Sié, Ali; Zabré, Pascal; Rossier, Clementine; Soura, Abdramane B; Bonfoh, Bassirou; Kone, Siaka; Ngoran, Eliezer K; Utzinger, Juerg; Abera, Semaw F; Melaku, Yohannes A; Weldearegawi, Berhe; Gomez, Pierre; Jasseh, Momodou; Ansah, Patrick; Azongo, Daniel; Kondayire, Felix; Oduro, Abraham; Amu, Alberta; Gyapong, Margaret; Kwarteng, Odette; Kant, Shashi; Pandav, Chandrakant S; Rai, Sanjay K; Juvekar, Sanjay; Muralidharan, Veena; Wahab, Abdul; Wilopo, Siswanto; Bauni, Evasius; Mochamah, George; Ndila, Carolyne; Williams, Thomas N; Khagayi, Sammy; Laserson, Kayla F; Nyaguara, Amek; Van Eijk, Anna M; Ezeh, Alex; Kyobutungi, Catherine; Wamukoya, Marylene; Chihana, Menard; Crampin, Amelia; Price, Alison; Delaunay, Valérie; Diallo, Aldiouma; Douillot, Laetitia; Sokhna, Cheikh; Gómez-Olivé, F Xavier; Mee, Paul; Tollman, Stephen M; Herbst, Kobus; Mossong, Joël; Chuc, Nguyen T K; Arthur, Samuelina S; Sankoh, Osman A; Byass, Peter

2014-01-01

As the HIV/AIDS pandemic has evolved over recent decades, Africa has been the most affected region, even though a large proportion of HIV/AIDS deaths have not been documented at the individual level. Systematic application of verbal autopsy (VA) methods in defined populations provides an opportunity to assess the mortality burden of the pandemic from individual data. To present standardised comparisons of HIV/AIDS-related mortality at sites across Africa and Asia, including closely related causes of death such as pulmonary tuberculosis (PTB) and pneumonia. Deaths related to HIV/AIDS were extracted from individual demographic and VA data from 22 INDEPTH sites across Africa and Asia. VA data were standardised to WHO 2012 standard causes of death assigned using the InterVA-4 model. Between-site comparisons of mortality rates were standardised using the INDEPTH 2013 standard population. The dataset covered a total of 10,773 deaths attributed to HIV/AIDS, observed over 12,204,043 person-years. HIV/AIDS-related mortality fractions and mortality rates varied widely across Africa and Asia, with highest burdens in eastern and southern Africa, and lowest burdens in Asia. There was evidence of rapidly declining rates at the sites with the heaviest burdens. HIV/AIDS mortality was also strongly related to PTB mortality. On a country basis, there were strong similarities between HIV/AIDS mortality rates at INDEPTH sites and those derived from modelled estimates. Measuring HIV/AIDS-related mortality continues to be a challenging issue, all the more so as anti-retroviral treatment programmes alleviate mortality risks. The congruence between these results and other estimates adds plausibility to both approaches. These data, covering some of the highest mortality observed during the pandemic, will be an important baseline for understanding the future decline of HIV/AIDS.