USSR Report, Military Affairs, No. 1807.

DTIC Science & Technology

1983-10-25

INFORMATION SERVICE REPRODUCED BY NATIONAL TECHNICAL INFORMATION SERVICE U.S. DEPARTMENT OF COMMERCE SPRINGFIELD, VA . 22161 5? 70 f JPRS...military horizon. The youths listen to lectures by Heroes of the Soviet Union K. Suraganov, D. Moroz , P. Blinov, T. Azhimov, and V. Krechetov, twice Hero

32 CFR 395.6 - Authorities.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 32 National Defense 2 2010-07-01 2010-07-01 false Authorities. 395.6 Section 395.6 National Defense Department of Defense (Continued) OFFICE OF THE SECRETARY OF DEFENSE (CONTINUED) ORGANIZATIONAL..., Springfield, VA 22161. (b) Communicate directly with the heads of the DoD Components. Communications to the...

Daily Report, Supplement, East Europe

DTIC Science & Technology

1993-06-30

REPRODUCED BY U.S. DEPARTMENT OF COMMERCE NATIONAL TECHNICAL INFORMATION SERVICE SPRINGFIELD, VA 22161 East Europe SUPPLEMENT JPRS-EER-93-060-S...appointed deputy director of the National Agency for Protection of the Constitution. Traditionally there were Turks in the division. My teacher was a... nation . This is accomplished through consistent policy, while ours has been exactly the opposite: incon- sistent. The generation of Turkish intelligence

JPRS Report, Proliferation Issues

DTIC Science & Technology

1992-09-23

reactor with earlier United Nations specialists arriving into the dis- limited capability from an Argentine specialist company puted area had found no...DEPARTMENT OF COMMERCE NATIONAL TECHNICAL INFORMATION SERVICE SPRINGFIELD, VA 22161 PROLIFERATION ISSUES JPRS-TND-92-035 CONTENTS 23 September 1992...thought that joining this treaty would constitute a sort of given national resource. impediment to the commercialization of Niger’s ura- [Ouhoumoudou

33 CFR 241.3 - References.

Code of Federal Regulations, 2010 CFR

2010-07-01

... Information Services, 5285 Port Royal Road, Springfield, VA 22161. References (a), (b) and (c) may be reviewed... 33 Navigation and Navigable Waters 3 2010-07-01 2010-07-01 false References. 241.3 Section 241.3... CONTROL COST-SHARING REQUIREMENTS UNDER THE ABILITY TO PAY PROVISION § 241.3 References. References cited...

77 FR 59120 - Butylate, Clethodim, Dichlorvos, Dicofol, Isopropyl Carbanilate, et al.; Tolerance Actions

Federal Register 2010, 2011, 2012, 2013, 2014

2012-09-26

... National Technical Information Service (NTIS), 5285 Port Royal Rd., Springfield, VA 22161; telephone number... established a MRL for methomyl in or on grapes at 5 milligrams/kilogram (mg/kg). This MRL is the same as the... dicofol in or on cattle meat at 3 mg/kg, eggs at 0.05 mg/kg, poultry meat and cottonseed at 0.1 mg/kg, and...

Application of DNA Profiling in Resolving Aviation Forensic Toxicology Issues

DTIC Science & Technology

2009-10-01

National Technical Information Service, Springfield, VA 22161 19. Security Classif. (of this report) 20. Security Classif. (of this page) 21 ...J,. Schumm. JW ..Development. of. highly. polymorphic.pentanucleotide.tandem.repeat.loci. with.low.stutter ..Profiles in DNA ..1998;2:3–6 . 21 ... PowerPlex ™ 16 System, Technical Manual No. D012 ..Madison,.WI:.Promega.Cor- poration;. 2000. (Available. at:. www .cstl .nist .gov/ strbase/images

Financial Management Regulation. Volume 1. General Financial Management Information, Systems, and Requirements

DTIC Science & Technology

1993-05-01

20301-1100 DoD Components will be provided copies of this Volume of the Regulation through normal publication channels. Other Federal Agencies and the... public may obtain copies of this Volume from the National Technical Information Service, 5285 Port Royal Road, Springfield, VA 22161, (703) 487- 4650...SECTION 1 PARAGRAPH 1 SUtHI’ARAGRAIlTS ii DoD Financial Management Regulation Volume 1, Introductionp PUBLICATIONS SUPERSEDED This Volume of the

Near East/South Asia Report

DTIC Science & Technology

1987-03-26

percent, 134 percent for cassette tapes, 96 percent for color televisions. Al- Halal Industrial Company implemented its marketing contracts for...fresn ahd salt water fish and using crop protection methods. The intermediate term projects include: breeding cows, the industrialization of their meat ...SERVICE SPRINGFIELD, VA 22161 riyne QDÄurr EHSEJCTED I 3 US NOTE JPRS publications contain information primarily from foreign newspapers

East Europe Report.

DTIC Science & Technology

1986-09-12

widespread introduction of waste-free technologies or technologies producing small amounts of waste, and there are still serious things to be done also...19980729 041 FBIS FOREIGN BROADCAST INFORMATION SERVICE REPRODUCED BY U.S. DEPARTMENT OF COMMERCE NATIONAL TECHNICAL INFORMATION SERVICE SPRINGFIELD...VA. 22161 107 NOTE JPRS publications contain information primarily from foreign newspapers, periodicals and books, but also from news agency

32 CFR Appendix E to Subpart M of... - References

Code of Federal Regulations, 2010 CFR

2010-07-01

... 32 National Defense 3 2010-07-01 2010-07-01 true References E Appendix E to Subpart M of Part 552... Training Center, and Camp Bonneville Pt. 552, Subpt. M, App. E Appendix E to Subpart M of Part 552... Services, U.S. Department of Commerce, 5285 Port Royal Road, Springfield, VA 22161. Fort Lewis Regulations...

Perspectives on Archeological Site Protection and Preservation

DTIC Science & Technology

1991-06-01

the West Malpais, created with the establishment of the El Malpais National Conservation Area, have been the scene of intensive loot- ing and...Available from National Technical Information Service, 5285 Port Royal Road, Springfield, VA 22161 i2a. DISTRIBUTION /AVAILABILITY STATEMENT 12b...Peter J. Pilles, Jr ........ ...................... .... 67 The Status of Archeological Site Preservation in the National Park Service--Mark J. Lynott

500 MHz Analog-to-Digital Converter Development Program

DTIC Science & Technology

1972-03-01

marginal level digital input signals. At these encoding speeds, quasi -stable non -digital voltage levels at their outputs still resulted. Further...OF COMMERCE SPRINGFIELD, VA. 22161 Radar Division AEROSPACE GROUP Hughes Aircraft Company * Culver City, California / .A CONTFNTS Page INTRODUCTION...sec. The experimental data also indicated that the short time stability of the timing reference generator caused most of the time jitter associated

Sub-Saharan Africa Report, No. 2869.

DTIC Science & Technology

1983-11-10

QUui-r^^ 33D< FBiS FOREIGN BROADCAST INFORMATION SERVICE REPRODUCED BY NATIONAL TECHNICAL INFORMATION SERVICE U.S. DEPARTMENT OF COMMERCE...8217 SPRINGFIELD, VA. 22161 / 6? 1^ NOTE JPRS publications contain information primarily from foreign newspapers, periodicals and books, but also from...indicate how the original information was processed. Where no processing indicator is given, the infor- mation was summarized or extracted. Unfamiliar

China Report, Political, Sociological and Military Affairs

DTIC Science & Technology

1985-03-07

DISTRIBUTION STATEMENT A yyyUjiy fl/fi Approved for Public Release i///V*U/ ULÜ Distribution Unlimited FBIS FOREIGN BROADCAST INFORMATION SERVICE...REPRODUCED BV _ NATIONAL TECHNICAL Q INFORMATION SERVICE 0 US. DEPARTMENT OF COMMERCE , / , SPRMSf IE10, VA. 22161 f hZ hoj NOTE JPRS...publications contain information primarily from foreign newspapers, periodicals and books, but also from news agency transmissions and broadcasts

FY 2001 Scientific and Technical Reports, Articles, Papers, and Presentations

NASA Technical Reports Server (NTRS)

Waits, J. E. Turner (Compiler)

2002-01-01

This Technical Memorandum (TM) presents formal NASA technical reports, papers published in technical journals, and presentations by MSFC personnel in FY 2001. It also includes papers of MSFC contractors. After being announced in STAR, all NASA series reports may be obtained from the National Technical Information Service, 5285 Port Royal Road, Springfield, VA 22161. The information in this TM may be of value to the scientific and engineering community in determining what information has been published and what is available.

Proceedings of Workshop on Expert Systems for Construction Scheduling Held in Champaign, Illinois on 23-24 March 1987.

DTIC Science & Technology

1987-08-01

TO 8/87 68 6 CUPPEIFMyTARY 0A,()N Copies are available from,. the National Technical Information Service Springfield, VA 22161 *COSATI CODES 18 SUBJECT... information . The first exploratory research step was to determine the breath and depth of the construction schedule analysis domain. This step defined...ADDITIONAL INFORMATION REGARDING THIS RESEARCIH I. O’Connor, Michael J., Jesus M. Dc La Garza, and C. William Ibbs, "An Expert Systcm for Construction

FY 2004 Scientific and Technical Reports, Articles, Papers, and Presentations

NASA Technical Reports Server (NTRS)

Fowler, B. A. (Compiler)

2006-01-01

This Technical Memorandum (TM) presents formal NASA technical reports, papers published in technical journals, and presentations by Marshall Space Flight Center (MSFC) personnel FY 2004. It also includes papers of MSFC contractors. After being announced in STAR, all NASA series reports may be obtained from the National Technical Information Service, 5285 Port Royal Road, Springfield, VA 22161. The information in this TM maybe of value to the scientific and engineering community in determining what information has been published and what is available.

FY 2003 Scientific and Technical Reports, Articles, Papers, and Presentations

NASA Technical Reports Server (NTRS)

Fowler, B. A. (Compiler)

2004-01-01

This Technical Memorandum (TM) presents formal NASA technical reports, papers published in technical journals, and presentations by Marshall Space Flight Center (MSFC) personnel in FY 2003. It also includes papers of MSFC contractors. After being announced in STAR, all NASA series reports may be obtained from the National Technical Information Service, 5285 Port Royal Road, Spring.eld, VA 22161. The information in this TM may be of value to the scientific and engineering community in determining what information has been published and what is available.

Financial Management Regulation. Volume 4. Accounting Policy and Procedures. Department of Defense.

DTIC Science & Technology

1995-01-01

Port Royal Road, Springfield, VA 22161; telephone (703) 487-4650. __ Accesion For NTIS CRA&I WI .. TAB Unannounced Q Justific tior1 By Disiribotion...for environmental response actions 2854 Restoration or replacement of damaged or destroyed facilities 4540 Architectural and engineering services 7212...Employment of outside architects and engineers 񕕤 Architectural and engineering services 21. Public Law 99-500, "Making continuing appropriations

Annual Data Summary for 1986 CERC (Coastal Engineering Research Center) Field Research Facility. Volume 1. Main Text and Appendix A

DTIC Science & Technology

1988-08-01

Waterways Experiment Station, Corps of Engineers PO Box 631, Vicksburg, Mississippi 39180-0631 DTI ~;~c~v ~ jAUG 291988 : H Ke August 1988 Final Report...PART I: INTRODUCTION ................................................ 3 Background ........................................................ 3...Information Service, 5285 Port Royal Road, Springfield, VA. 22161. 2 ANNUAL DATA SUMMARY FOR 1986 CERC FIELD RESEARCH FACILITY PART I: INTRODUCTION

JPRS Report, Science & Technology, USSR: Science & Technology Policy

DTIC Science & Technology

1990-05-31

SERVICE SPRINGFIELD, VA. 22161 DTTC QUALITY INSPECTED t Science & Technology USSR: Science & Technology Policy JPRS-UST-90-006 CONTENTS 31 May...64 Uzbek Central Committee Examines S& T Cadre Problem [PRAVDA VOSTOKA, 27Feb 90] 65 Miscellaneous Scientists Comment on Compensation, Contract...Expositions POISK Commentary on February S& T Conference [V. Oshchenko, Ye. Ponarina; POISK, 22-28 Feb 90] 77 Conference Sets Policy for Future S& T

Worldwide Report, Telecommunications Policy, Research, and Development

DTIC Science & Technology

1985-10-25

Available Copy REPRODUCED BY NATIONAL TECHNICAL INFORMATION SERVICE U.S. DEPARTMENT OF COMMERCE SPRINGFIELD, VA. 22161 o so MS NOTE JPRS...publications contain information primarily from foreign newspapers, periodicals and books, but also from news agency transmissions and broadcasts. Materials...base band transmission method, the structure of which is shown in figure 1. Under the conditions of a given transmitted optic pulse wave form and

JPRS Report, China.

DTIC Science & Technology

1991-01-16

JPRS-CAR-91-002 16 JANUARY 1991, FOREIGN BROADCAST INFORMATION SERVICE -’PRS Report-- I p~provd t•= p,,.• :i..SU China REPRODUCED BY U.S. DEPARTMENT...OF COMMERCE NATIONAL TECHNICAL INFORMATION SERVICE SPRINGFIELD, VA. 22161 China JPRS-CAR-91-002 CONTENTS 16 January 1991 INTERNATIONAL 19th-Century...disasters; delegated to and retrieved from the localities arbitrarily coordination, organization, arbitration, and resolution without benefit of a legal

76 FR 56648 - Atrazine, Chloroneb, Chlorpyrifos, Clofencet, Endosulfan, et al.; Tolerance Actions

Federal Register 2010, 2011, 2012, 2013, 2014

2011-09-14

... Technical Information Service (NTIS), 5285 Port Royal Rd., Springfield, VA 22161; telephone number: 1-800... at 2 mg/kg and tea, green, black at 30 mg/kg. These MRLs are different than the tolerances... apple at 0.5 mg/kg; cherries at 0.2 mg/kg; cottonseed at 1 mg/kg; nectarine at 0.2 mg/kg; olives at 1 mg...

Southeast Asia Report.

DTIC Science & Technology

1987-05-26

INFORMATIONSERVICE SPRINGFIELD, VA 22161 3/ M7 SPECIAL NOTICE Effective 1 June 1987 JPRS reports will have a new cover design and color, and some...nominate and designate Soeharto as Indonesian president for the 1988-93 term. They said in their statement that making the elections a success is the...Although the MI had made an equivalent statement last September, it did not evoke much response because only Ridwan Saidi had signed it. At that

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

Crew Escape Technologies (CREST) Mission Area Requirements Study Current and Future Crew Escape Requirements

DTIC Science & Technology

1992-02-01

purchased from: National Tecnical Information Service 5285 Port Royal Road Springfield VA 22161 Federal Governmet agencies and their contractors registered...Engineering Incpora:ted (IME) to organize and executi a tecnical approach to the QP= 14. SUIUECT TERMS Mission Area Requiremts, REST Escape SystM IS...the aerodynamic stabilization subsystems to become effective (drogue parachutes, or fins for the S4S), and the time required for the recovery parachute

Investigation of the Relationship between Land Use and Wildlife Abundance. Volume I. Literature Survey.

DTIC Science & Technology

1980-06-01

Grazing and the Livestock Industry. In: Brokaw, Howard P. Wildlife and America. Council on Environmental Quality, U.S. Fish and Wildlife Service...Environmental Impact Studies of the Navajo and Kaiparowits Power Plants. Second Annual Report. 1 June 1972 - 31 May 1973. National Technical Information Service... Navajo and Kaiparowits Power Plants. Fourth Annual Report. 1 June 1974 - 31 May 1975. National Technical Information Service, Springfield, VA 22161. L

JPRS Report, Science & Technology. USSR: Science & Technology Policy

DTIC Science & Technology

1987-08-05

of Sciences. 138 ~ T i Vladimir Ivanovich Bakhutashvili—deputy director of the Institute of Experimental Morphology imeni A.N. Natishvili of the...INFORMATIONSERVICE SPRINGFIELD, VA 22161 I IS JPRS-UST-87-014 5 AUGUST 1987 Soviet books and journal articles displaying a copyright notice are...Congress and the inplementation of the decree of the annual General Assemblly of the USSR Academy of Sciences, which was held on 19-21 March 1986, was i

JPRS Report, Soviet Union, World Economy & International Relations, No. 3, March 1988.

DTIC Science & Technology

1989-06-14

JPRS-UWE-89-008 14 JUNE 1989 JPRS Report— Soviet Union WORLD ECONOMY & INTERNATIONAL RELATIONS No 3, March 1988 MBTltlBOTION STATEMENT A...SERVICE SPRINGFIELD, VA. 22161 \\*2 Soviet Union WORLD ECONOMY & INTERNATIONAL RELATIONS No 3, March 1988 JPRS-UWE-89-008 CONTENTS 14 JUNE 1989...Institute of World Economy and International Relations of the USSR Academy of Sciences. Refer to the table of contents for a listing of any articles

Southeast Asia Report

DTIC Science & Technology

1987-02-27

REPRODUCED BY U.S. DEPARTMENT OF COMMERCE NATIONAL TECHNICAL INFORMATION SERVICE SPRINGFIELD, VA. 22161 DUC QUALITY INSPECTED Q 6> 1X1 M/1 NOTE...food supply for the whole population; the buffalo and cattle are used as draft animals and for trans - portation because Sekong Province is a new...of Ben- guet Exploration took place at the Manila Stock Exchange. The P15-million trans - action occurred at the time when rumors of a buy-in by

JPRS Report, East Asia, Korea: Kulloja, Issue No. 12, December 1986.

DTIC Science & Technology

1987-06-25

DiGlrib-uliori Unlimited East Asia Korea: KULLOJA ISSUE No 12 , DECEMBER 1986 REPRODUCED BY U S DEPARTMENT OF COMMERCE NATIONAL TECHNICAL...INFORMATIONSERVICE SPRINGFIELD, VA 22161 .MIC QUALITY msp&JnsD i ro 10 JPRS-AKU-87-003 25 JUNE 1987 KOREAN AFFAIRS REPORT KULLOJA No 12 , DECEMBER...KULLOJA in Korean No 12 , Dec 86 pp 3-16 [Text] Recently, our people’s interest in sports and athletic activities has evermore been intensifying. I think

JPRS Report, Soviet Union, Military Affairs.

DTIC Science & Technology

1988-05-03

JPRS-UMA-88-008 1 ö U ü / b 3 MAY 1988 !■■■■■ «■■■If FOREIGN BROADCAST INFORMATION SERVICE JP/? S Report— Soviet Union Military Affairs...Appro-rod for pab&e miaä^T REPRODUCED BY U S . DEPARTMENTOFCOMMERCE i NATIONAL TECHNICAL INFORMATIONSERVICE SPRINGFIELD, VA 22161 (Q...Agencies [Lt Gen Justice S . Maksimov; Moscow KRASNAYA ZVEZDA, 4 Dec 87] 13 Col Gen Babyev on Afghan Veterans’ Benefits [Col Gen VBabyev; Moscow

JPRS Report, East Europe, Oblasts: Bulgaria’s New Administrative Units

DTIC Science & Technology

1988-03-29

SPRINGFIELD, VA 22161 DTIC QUALITY INSPECTED 6 4-9 East Europe OBLASTS: Bulgaria’s New Administrative Units JPRS-EER-88-025 CONTENTS 29 MARCH...With Oblast Official [ Rumen Yanev; NARODNA MLADEZH, 27 Sep 87] 4 Comments by Oblast Party Leader [Nikolay Zhishev Interview; RABOTNICHESKO DELO...municipalities that will imple- ment the new content and new functions of self-govern- ment and rule by the people. There are eight oblasts described in eight

Species Profiles: Life Histories and Environmental Requirements of Coastal Vertebrates and Invertebrates Pacific Ocean Region. Report 2. Humpback Whale, Megaptera novaeangliae

DTIC Science & Technology

1989-11-01

from National Technical Information Service , 5285 Port Royal Road, Springfield, VA 22161. 17. COSATI CODES 16 SUBJECT TERMS (Continue on reverse if...National Marine Fisheries Service , NOAA Southwest Region Honolulu, HI 96822-2396 19. ABSTRACT (Continued). world. The major environmental impact facing...Nitta and John J. Naughton of the Southwest Region, National Marine Fisheries Service (NMFS), under support agreement WESCW88-241. Dr. C. Scott Baker

JPRS Report China

DTIC Science & Technology

1988-03-29

131079 JPRS-CAR-88-016 29 MARCH 1988 !■■■■■ ■«■■■I FOREIGN BROADCAST INFORMATION SERVICE -/P/? S Report— China \\0$^ P L «2 ptSTKBimÖN...SPRINGFIELD, VA 22161 imc*»u"I1𔄂PECB5D6 -f/ S JPRS-CAR-88-016 CONTENTS 29 MARCH 1988 POLITICAL CYL First Secretary Discusses CYL Structural...building socialism with distinctive Chinese characteristics into a new generation of people who have ideals, morality, cultural knowledge , and a good

Future Research Needs for Dredgeability of Rock: Rock Dredging Workshop Held in Jacksonville, Florida on 25-26 July 1985.

DTIC Science & Technology

1986-09-01

ORGANIZATION Gjeoteehnical Laborator WESGR-M 6c ADDRESS (City, Slate, and ZIP Code ) 7b ADDRESS(City, State. and ZIP Code ) PO Box 631 Vicksburg, MS 39180...of Engineers 8< ADDRESS(City, State, and ZIP Code ) 10 SOURCE OF FUNDING NUMBERS PROGRAM PROJECT TASK WORK UNIT.. ", 1 :, • ; I, - u It ., " ’ ~f...Springfield, VA 22161 17 COSATI CODES 18 SUBJECT TERMS (Continue-On revprse of necessary and identify by block number) " FIELD GROUP SUB GROUP

27 CFR 22.161 - Records.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 27 Alcohol, Tobacco Products and Firearms 1 2014-04-01 2014-04-01 false Records. 22.161 Section 22... TREASURY ALCOHOL DISTRIBUTION AND USE OF TAX-FREE ALCOHOL Records of Transactions § 22.161 Records. (a) General. All persons qualified under this part shall keep accurate records of all receipts, shipments...

32 CFR Appendix C to Part 290 - For Official Use Only

Code of Federal Regulations, 2010 CFR

2010-07-01

... 32 National Defense 2 2010-07-01 2010-07-01 false For Official Use Only C Appendix C to Part 290.... 290, App. C Appendix C to Part 290—For Official Use Only (a) General. Information that has not been... 22161. (c) Markings. (1) Location of Markings. (i) An unclassified document containing FOUO information...

Worldwide Report, Nuclear Development and Proliferation

DTIC Science & Technology

1984-05-14

PROLIFERATION IMC QUALITY: 19980729 081 FBIS FOREIGN BROADCAST INFORMATION SERVICE REPRODUCED BY NATIONAL TECHNICAL INFORMATION SERVICE U.S...Information Service , Springfield, Virginia 22161. In order- ing, it is recommended that the JPRS number, title, date and author, if applicable, of...Information Service , and are listed in the Monthly Catalog of U.S. Government Publications issued by the Superintendent of Documents, U.S. Government

Special Aviation Fire and Explosion Reduction (SAFER) Advisory Committee. Volume IIB.

DTIC Science & Technology

1980-06-26

Virginia 22161. ". iIf NOTICE This document is disseminated under the sponsorship of the Department of Transportation in the interest of information...7inal Report Office of Aviation Safety 1nt, 26, l78 - ’t::L Federal Aviation Administration U.S. Department of Transportation t. Spo-o.rng A-ge-,co L...members, oroposea the following scope for the Committee’s activities: * That the Committee confine izself to transport category airplanes. * That, with

Probabilistic oil Outflow Analysis of Alternative Tanker Designs. Addendum 1.

DTIC Science & Technology

1992-10-01

National Technical Information Service, Springfield, Virginia 22161 Prepared for: U.S. Coast Guard Research and Development Center 1082 Shennecossett...Center 1082 Shennecossett Road Groton, CT 06340-6096 ±i Technical Report Documentation Page 1. Report No. 2. Government Accession No. 3. Recipient’s...Code Research and Development Center U.S. Coast Guard 1082 Shennecossett Road Office of Engineering, Logistics, Groton, Connecticut 06340-6096 and

Automatic Traffic Advisory and Resolution Service (ATARS) Algorithms Including Resolution-Advisory-Register Logic. Volume 2. Sections 12 through 19. Appendices,

DTIC Science & Technology

1981-06-01

pairwise conflict or an indication of BCAS control . A Pair Record is also created when an aircraft receives a resolution advisory from BCAS or from a non ...replying site: Update track numbers: ILS!I’ (pair record shows a non -connected site in control ) T"_N CALL AI!CPAFTPAIRriwTIFICRTaOI: ( both aircraft...Springfield, Virginia 22161 a>- U S Department of Transportain Systems Research & Development Service LWashington, D.C. 20590 94 This document is

Research Methods to Develop Measures of Effectiveness of the United States Coast Guard’s Vessel Inspection and Boarding Program. Executive Summary - Volume I

DTIC Science & Technology

1995-05-01

Service, Springfield, Virginia 22161 Prepared for: LJCý U.S. Coast Guard Research and Development Center 1082 Shennecossett Road < Groton, Connecticut...States Coast Guard Research & Development Center 1082 Shennecossett Road Groton, CT 06340-6096 ii Technical Report Documentation Paae 1. Report No. 2...U.S. Coast Guard 14. Sponsoring Agency Code Research and Development Center Office of Engineering, Logistics, 1082 Shennecossett Road and Development

Cf-252 Characterization Documents

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

Feldman, Alexander

2014-03-14

Six documents were written by Vance and Associates under contract to the Off-Site Source Recovery Project of Los Alamos National Laboratory. These Six documents provided the basis for characterization of Californium-252 sealed sources and for the packaging and manifesting of this material for disposal at the Waste Isolation Pilot Project. The Six documents are: 1. VA-OSR-10, Development of radionuclide distributions for Cf-252 sealed sources. 2. VA-OSR-11, Uncertainty analysis for Cf-252 sealed sources. 3. VA-OSR-12, To determine the radionuclides in the waste drums containing Cf-252 sealed source waste that are required to be reported under the requirements of the WIPP WACmore » and the TRAMPAC. 4. VA-OSR-13, Development of the spreadsheet for the radiological calculations for the characterization of Cf-252 sources. 5. VA-OSR-14, Relative importance of neutron-induced fission in Cf-252 sources. 6. VA-OSR-15, Determine upper bound of decay product inventories from a drum of Cf-252 sources. These six documents provide the technical basis for the characterization of Cf-252 sources and will be part of the AK documentation required for submittal to the Central Characterization Project (CCP) of WIPP.« less

38 CFR 26.7 - VA environmental decision making and documents.

Code of Federal Regulations, 2010 CFR

2010-07-01

... environmental decision making and documents. (a) Relevant environmental documents shall accompany other decision documents as they proceed through the decision-making process. (b) The major decision points for VA actions... 38 Pensions, Bonuses, and Veterans' Relief 2 2010-07-01 2010-07-01 false VA environmental decision...

Assessments of the Veteran Medication Allergy Knowledge Gap and Potential Safety Improvements with the Veteran Health Information Exchange (VHIE).

PubMed

Pan, Eric; Botts, Nathan; Jordan, Harmon; Olinger, Lois; Donahue, Margaret; Hsing, Nelson

2016-01-01

The U.S. Department of Veterans Affairs (VA) Veteran Health Information Exchange (VHIE, formerly Virtual Lifetime Electronic Record, or VLER) had been deployed at all VA sites and used to exchange clinical information with private sector healthcare partners nationally. This paper examined VHIE's effect on allergy documentation. Review of all inbound VHIE transactions in FY14 showed that VHIE use was associated with a nearly eight-fold increase in allergy documentation rate. Preliminary manual document review further showed that VA and partners had shared knowledge of only 38% ofpatient allergies, while VA had exclusive knowledge of another 58% ofpatient allergies, and partners had exclusive knowledge of the last 5% of patient allergies. To our knowledge, this is the first study that examined the effect of HIE on allergy documentation.

Assessments of the Veteran Medication Allergy Knowledge Gap and Potential Safety Improvements with the Veteran Health Information Exchange (VHIE)

PubMed Central

Pan, Eric; Botts, Nathan; Jordan, Harmon; Olinger, Lois; Donahue, Margaret; Hsing, Nelson

2016-01-01

The U.S. Department of Veterans Affairs (VA) Veteran Health Information Exchange (VHIE, formerly Virtual Lifetime Electronic Record, or VLER) had been deployed at all VA sites and used to exchange clinical information with private sector healthcare partners nationally. This paper examined VHIE’s effect on allergy documentation. Review of all inbound VHIE transactions in FY14 showed that VHIE use was associated with a nearly eight-fold increase in allergy documentation rate. Preliminary manual document review further showed that VA and partners had shared knowledge of only 38% ofpatient allergies, while VA had exclusive knowledge of another 58% ofpatient allergies, and partners had exclusive knowledge of the last 5% of patient allergies. To our knowledge, this is the first study that examined the effect of HIE on allergy documentation. PMID:28269897

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.

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

None

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

Traylor, T.D.; Hicks, S.C.

1994-03-01

Transportation Energy Research announces on a monthly basis the current worldwide research and development information available on energy-efficient, environmentally sound transportation technologies. Its purpose is to enhance the technology transfer efforts of the Department of Energy. This publication contains the abstracts of DOE reports, journal articles, conference papers, patents, theses, and monographs added to the Energy Science and Technology Database during the past month. Also included are US information obtained through acquisition programs or interagency agreements and international information obtained through the International Energy Agency`s Energy Technology Data Exchange or government-to-government agreements. The DOE Office of Transportation Technologies (OTT) managesmore » federal R&D programs aimed at improving transportation-sector energy efficiency. OTT currently supports activities in four major program areas: Electric and Hybrid Vehicles; Advanced Propulsion Systems; and magnetic levitation technology; Advanced Materials. DOE and DOE contractors can obtain copies for $4.00 per issue by using VISA, MasterCard, or OSTI deposit accounts. Contact the Office of Scientific and Technical Information, P.O. Box 62, Oak Ridge, TN 37831, Attention: Information Services. For further information, call (615) 576-8401. Public availability is by subscription from the US Department of Commerce, Technology Administration, National Technical Information Service, Springfield, VA 22161. Order PB94-900900.« less

32 CFR 299.1 - Purpose.

Code of Federal Regulations, 2013 CFR

2013-07-01

... PROGRAM NATIONAL SECURITY AGENCY/CENTRAL SECURITY SERVICE (NSA/CSS) FREEDOM OF INFORMATION ACT PROGRAM... 22161. 2 See footnote 1 to this section. (b) This part applies to all NSA/CSS elements, field activities...

32 CFR 299.1 - Purpose.

Code of Federal Regulations, 2014 CFR

2014-07-01

... PROGRAM NATIONAL SECURITY AGENCY/CENTRAL SECURITY SERVICE (NSA/CSS) FREEDOM OF INFORMATION ACT PROGRAM... 22161. 2 See footnote 1 to this section. (b) This part applies to all NSA/CSS elements, field activities...

32 CFR 299.1 - Purpose.

Code of Federal Regulations, 2012 CFR

2012-07-01

... PROGRAM NATIONAL SECURITY AGENCY/CENTRAL SECURITY SERVICE (NSA/CSS) FREEDOM OF INFORMATION ACT PROGRAM... 22161. 2 See footnote 1 to this section. (b) This part applies to all NSA/CSS elements, field activities...

32 CFR 299.1 - Purpose.

Code of Federal Regulations, 2011 CFR

2011-07-01

... PROGRAM NATIONAL SECURITY AGENCY/CENTRAL SECURITY SERVICE (NSA/CSS) FREEDOM OF INFORMATION ACT PROGRAM... 22161. 2 See footnote 1 to this section. (b) This part applies to all NSA/CSS elements, field activities...

Disclosure of information to organ, tissue and eye procurement organizations. Final rule.

PubMed

2008-11-03

This document adopts, with changes, a Department of Veterans Affairs (VA) interim final rule that implemented provisions of the Veterans Benefits, Health Care, and Information Technology Act of 2006 concerning disclosure of information to organ, tissue and eye procurement organizations. The regulation will provide authority for VA to provide individually-identifiable VA medical records of veterans or dependents of veterans who are deceased or whose death is imminent to representatives of organ procurement organizations, eye banks, and tissue banks to determine whether the patients are suitable potential donors. This document modifies the interim final rule to clarify the definition of "near death" and to correct a grammatical error in the definition of "procurement organization." This document also clarifies that eye bank and tissue bank registration with FDA must have an active status.

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

78 FR 52085 - VA Veteran-Owned Small Business Verification Guidelines

Federal Register 2010, 2011, 2012, 2013, 2014

2013-08-22

... DEPARTMENT OF VETERANS AFFAIRS 38 CFR Part 74 RIN 2900-AO49 VA Veteran-Owned Small Business Verification Guidelines AGENCY: Department of Veterans Affairs. ACTION: Final rule. SUMMARY: This document... Domestic Assistance This final rule affects the verification guidelines of veteran- owned small businesses...

78 FR 18425 - Proposed Information Collection VA Police Officer Pre-Employment Screening Checklist); Comment...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-03-26

... enhance the quality, utility, and clarity of the information to be collected; and (4) ways to minimize the... approved collection. Abstract: VA personnel complete VA Form 0120 to document pre- employment history and...

Comparison of provider-documented and patient-reported brief intervention for unhealthy alcohol use in VA outpatients.

PubMed

Lapham, Gwen T; Rubinsky, Anna D; Shortreed, Susan M; Hawkins, Eric J; Richards, Julie; Williams, Emily C; Berger, Douglas; Chavez, Laura J; Kivlahan, Daniel R; Bradley, Katharine A

2015-08-01

Performance measures for brief alcohol interventions (BIs) are currently based on provider documentation of BI. However, provider documentation may not be a reliable measure of whether or not patients are offered clinically meaningful BIs. In particular, BI documented with clinical decision support in an electronic medical record (EMR) could appear identical irrespective of the quality of BI provided. We hypothesized that differences in how BI was implemented across health systems could lead to differences in the proportion of documented BI recalled and reported by patients across health systems. Male outpatients with unhealthy alcohol use identified by confidential satisfaction surveys (2009-2012) were assessed for whether they reported receiving BI in the past year (patient-reported BI) and whether they had BI documented in the EMR during the same period (documented BI). We evaluated and compared the prevalence of documented BI to patient-reported BI across 21 VA networks to determine whether documented BI had a variable association with patient-reported BI across the networks. Of 9896 eligible male outpatients with unhealthy alcohol use, 59.0% (95% CI 57.4-60.5%) reported BI (50.4-64.9% across networks) and 37.4% (95% CI 36.0-38.9%) had BI documented in the EMR (28.0-44.2% across networks). Overall, 72.9% (95% CI 70.8-75.5%) of patients with documented BI also reported BI. The association between documented BI and patient-reported BI did not vary across VA networks in adjusted logistic regression models. Performance measures of BI that rely on provider documentation in EMRs appear comparable to patient report for comparing care across VA networks. Published by Elsevier Ireland Ltd.

Contraceptive Provision in the VA Healthcare System to Women Who Report Military Sexual Trauma

PubMed Central

Mattocks, Kristin; Schwarz, Eleanor Bimla; Borrero, Sonya; Skanderson, Melissa; Zephyrin, Laurie; Brandt, Cynthia; Haskell, Sally

2014-01-01

Abstract Background: Women Veterans who suffered military sexual trauma (MST) may be at high risk for unintended pregnancy and benefit from contraceptive services. The objective of this study is to compare documented provision of contraceptives to women Veterans using the Department of Veterans Affairs (VA) health system who report or deny MST. Methods: This retrospective cohort study included women Veterans aged 18–45 years who served in Operation Enduring or Iraqi Freedom and had at least one visit to a VA medical center between 2002 and 2010. Data were obtained from VA administrative and clinical databases. Chi-squared tests and logistic regression were conducted to evaluate the association between MST, ascertained by routine clinical screening, and first documented receipt of hormonal or long-acting contraception. Results: Of 68,466 women Veterans, 13% reported, 59% denied and 28% had missing data for the MST screen. Among the entire study cohort, 30% of women had documented receipt of a contraceptive method. Women reporting MST were significantly more likely than those denying MST to receive a method of contraception (adjusted odds ratio [aOR] 1.12, 95% confidence interval [CI] 1.07–1.18) including an intrauterine device (odds ratio [OR] 1.29, 95% CI 1.17–1.41) or contraceptive injection (OR 1.17, 95% CI 1.05–1.29). Women who were younger, unmarried, seen at a women's health clinic, or who had more than one visit were more likely to receive contraception. Conclusions: A minority of women Veterans of reproductive age receive contraceptive services from the VA. Women Veterans who report MST, and particularly those who seek care at VA women's health clinics, are more likely to receive contraception. PMID:24787680

38 CFR 26.8 - Assistance to applicants.

Code of Federal Regulations, 2010 CFR

2010-07-01

... improvement of state veterans' health care facilities or cemeteries. (c) Public notices or other means used to... provided to non-VA groups, VA element affected will initiate the NEPA process pursuant to these regulations... process and ensure compliance with VA environmental program. The environmental documents prepared by the...

Rehabilitation and Prosthetic Services

MedlinePlus

... VA Learning University (VALU) SimLearn Libraries (VALNET) VA Software Documentation Library (VDL) About VHA Learn about VHA Forms & ... & Sensory Aids Service (PSAS) Our Mission The mission of the Prosthetic & ...

Disclosure of information to organ procurement organizations. Interim final rule.

PubMed

2007-08-23

This document amends the Department of Veterans Affairs (VA) regulations to implement section 204 of the Veterans Benefits, Health Care, and Information Technology Act of 2006. This regulatory change will provide authority for VA to provide individually-identifiable VA medical records of veterans or dependents of veterans who are deceased or whose death is imminent to representatives of organ procurement organizations (OPOs) as defined in section 371(b) of the Public Health Service Act (PHS Act), eye banks, and tissue banks to determine whether the patients are suitable potential donors.

48 CFR 833.103 - Protests to VA.

Code of Federal Regulations, 2011 CFR

2011-10-01

... encouraged to use alternative dispute resolution (ADR) procedures to resolve protests at any stage in the protest process. If ADR is used, VA will not furnish any documentation in an ADR proceeding beyond what is...

SmokefreeVET Partner Toolkit | SmokefreeVET

Cancer.gov

SmokefreeVET has a variety of documents to help Veterans and health care providers better understand the resources that VA and the National Cancer Institute have developed to support Veterans in VA care to quit tobacco.

Suicide Risk Documented During Veterans' Last Veterans Affairs Health Care Contacts Prior to Suicide.

PubMed

Denneson, Lauren M; Kovas, Anne E; Britton, Peter C; Kaplan, Mark S; McFarland, Bentson H; Dobscha, Steven K

2016-06-01

A total of 295 veterans who died by suicide in 2009 across 11 states and received Veterans Affairs (VA) health care in the 6 months prior to death were identified. The suicide risk factors documented and the care received at these veterans' last VA contacts are described, and the study explores whether veterans present differently to VA care (i.e., different risk factors documented or different care settings accessed) based on the proximity of their last contact to suicide. Many veterans were seen in primary care (n = 136; 46%) for routine follow-up (n = 168; 57%). Fifty-three (18%) were assessed for suicidal thoughts; 20 (38%) of whom endorsed such thoughts. Although higher frequencies of some risk factors at last contacts more proximal to suicide compared to those more distal were observed, findings overall highlight the challenges clinicians face detecting enhanced risk prior to suicide. © Published 2016. This article is a U.S. Government work and is in the public domain in the USA.

Municipal solid waste management: A bibliography of US Department of Energy contractor reports through 1993

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

Shepherd, P

1994-07-01

US Department of Energy contractors continue to conduct research targeting the productive and responsible use of the more than 536,000 tons of municipal solid waste (MSW) that is generated each day in the United States. It is becoming more and more prudent to improve current methods of MSW management and to continue to search for additional cost-effective, energy-efficient means to manage our MSW resource. This bibliography is an updated version of Municipal Waste to Energy: An Annotated Bibliography of US Department of Energy Contractor Reports, by Caroline Brooks, published in 1987. Like its predecessor, this bibliography provides information about technicalmore » reports on energy from municipal waste that were prepared under grants or contracts from the US Department of Energy. The reports listed focus on energy from municipal waste technologies and energy conservation in wastewater treatment. The bibliography contains three indexes -- an author index, a subject index, and a title index. The reports are listed alphabetically in the subject areas and may appear under more than one subject. All of the reports cited in the original MSW bibliography are also included in this update. The number of copies of each report originally published varied according to anticipated public demand. However, all reports are available in either microfiche or hard copy form and may be ordered from the National Technical Information Service (NTIS), US Department of Commerce, Springfield, VA 22161. Explicit information on ordering reports is included in Appendix A.« less

76 FR 22161 - Second Meeting: RTCA Special Committee 225: Rechargeable Lithium Batteries and Battery Systems...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-04-20

... Committee 225: Rechargeable Lithium Batteries and Battery Systems--Small and Medium Sizes AGENCY: Federal... Lithium Batteries and Battery Systems--Small and Medium Sizes. SUMMARY: The FAA is issuing this notice to advise the public of a meeting of RTCA Special Committee 225: Rechargeable Lithium Batteries and Battery...

Documented Brief Intervention Not Associated with Resolution of Unhealthy Alcohol Use One Year Later among VA Patients Living with HIV

PubMed Central

Williams, Emily C.; Lapham, Gwen T.; Bobb, Jennifer F.; Rubinsky, Anna D.; Catz, Sheryl L.; Shortreed, Susan M.; Bensley, Kara M.; Bradley, Katharine A.

2017-01-01

Objective Unhealthy alcohol use is particularly risky for patients living with HIV (PLWH). Brief interventions reduce drinking among patients with unhealthy alcohol use, but whether its receipt in routine outpatient settings is associated with reduced drinking among PLWH with unhealthy alcohol use is unknown. We assessed whether PLWH who screened positive for unhealthy alcohol use were more likely to resolve unhealthy drinking one year later if they had brief alcohol intervention (BI) documented in their electronic health record in a national sample of PLWH from the Veterans Health Administration. Methods Secondary VA clinical and administrative data from the electronic medical record (EMR) were used to identify all positive alcohol screens (AUDIT-C score ≥ 5) documented among PLWH (10/01/09-5/30/13) followed by another alcohol screen documented 9–15 months later. Unadjusted and adjusted Poisson regression models assessed the association between brief intervention (advice to reduce drinking or abstain documented in EMR) and resolution of unhealthy alcohol use (follow-up AUDIT-C <5 with ≥ 2 point reduction). Results Overall 2,101 PLWH with unhealthy drinking (10/01/09-5/30/13) had repeat alcohol screens 9–15 months later. Of those, 77% had brief intervention documented after their first screen, and 61% resolved unhealthy alcohol use at follow-up. Documented brief intervention was not associated with resolution [Adjusted incidence rate ratio 0.96, (95% CI 0.90–1.02)]. Conclusions Documented brief intervention was not associated with resolving unhealthy alcohol use at follow-up screening among VA PLWH with unhealthy alcohol use. Effective methods of resolving unhealthy alcohol use in this vulnerable population are needed. PMID:28554608

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.

U.S. Department of Energy Hydrogen and Fuel Cells Program 2012 Annual Merit Review and Peer Evaluation Report: May 14-18, 2012, Arlington, VA

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

Not Available

2012-09-01

This document summarizes the comments provided by peer reviewers on hydrogen and fuel cell projects presented at the fiscal year (FY) 2012 U.S. Department of Energy (DOE) Hydrogen and Fuel Cells Program and Vehicle Technologies Program Annual Merit Review and Peer Evaluation Meeting (AMR), held May 14-18, 2012, in Arlington, VA.

Technical Reference Manual to Allied Medical Publication 7.5 (AMedP 7.5) NATO Planning Guide for the Estimation of CBRN Casualties

DTIC Science & Technology

2016-10-01

Response Subject Matter Expert Review Meeting, 23-25 June 2008, Albuquerque, New Mexico , United States of America, IDA Document D-3884 (Alexandria, VA...Meeting, 26 June 2008, Albuquerque, New Mexico , United States of America, IDA Document D-3885 (Alexandria, VA: Institute for Defense Analyses, August...26 June 2008 radiological human response meetings in Albuquerque, New Mexico :  Canada – Commander Ian Torrie, CFHSG-DHSO – Diana Wilkinson, DRDC

An Expert System for Restructurable Control

DTIC Science & Technology

1988-01-01

CONTROL INITIAL REALIZATION PHYSICAL L UY -DSIGN AND IS " 1 TUNING IDNIY YTMNEEDED?/ CURRENT A B8 I IMPLEMENT NO PAT? YES CONTROLESITN i_ AB ITUNE ...For sale by the National Technical Information Service, Springfield, Virginia 22161

Initial Results from the Survey of Organizational Research Climates (SOuRCe) in the U.S. Department of Veterans Affairs Healthcare System.

PubMed

Martinson, Brian C; Nelson, David; Hagel-Campbell, Emily; Mohr, David; Charns, Martin P; Bangerter, Ann; Thrush, Carol R; Ghilardi, Joseph R; Bloomfield, Hanna; Owen, Richard; Wells, James A

2016-01-01

In service to its core mission of improving the health and well-being of veterans, Veterans Affairs (VA) leadership is committed to supporting research best practices in the VA. Recognizing that the behavior of researchers is influenced by the organizational climates in which they work, efforts to assess the integrity of research climates and share such information with research leadership in VA may be one way to support research best practices. The Survey of Organizational Research Climate (SOuRCe) is the first validated survey instrument specifically designed to assess the organizational climate of research integrity in academic research organizations. The current study reports on an initiative to use the SOuRCe in VA facilities to characterize the organizational research climates and pilot test the effectiveness of using SOuRCe data as a reporting and feedback intervention tool. We administered the SOuRCe using a cross-sectional, online survey, with mailed follow-up to non-responders, of research-engaged employees in the research services of a random selection of 42 VA facilities (e.g., Hospitals/Stations) believed to employ 20 or more research staff. We attained a 51% participation rate, yielding more than 5,200 usable surveys. We found a general consistency in organizational research climates across a variety of sub-groups in this random sample of research services in the VA. We also observed similar SOuRCe scale score means, relative rankings of these scales and their internal reliability, in this VA-based sample as we have previously documented in more traditional academic research settings. Results also showed more substantial variability in research climate scores within than between facilities in the VA research service as reflected in meaningful subgroup differences. These findings suggest that the SOuRCe is suitable as an instrument for assessing the research integrity climates in VA and that the tool has similar patterns of results that have been observed in more traditional academic research settings. The local and specific nature of organizational climates in VA research services, as reflected in variability across sub-groups within individual facilities, has important policy implications. Global, "one-size-fits-all" type initiatives are not likely to yield as much benefit as efforts targeted to specific organizational units or sub-groups and tailored to the specific strengths and weaknesses documented in those locations.

76 FR 22161 - Fifty Seventh Meeting: RTCA Special Committee 135, Environmental Conditions and Test Procedures...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-04-20

... Committee 135, Environmental Conditions and Test Procedures for Airborne Equipment AGENCY: Federal Aviation...: Environmental Conditions and Test Procedures for Airborne Equipment. SUMMARY: The FAA is issuing this notice to... Procedures for Airborne Equipment. DATES: The meeting will be held May 11-12, 2011 from 9 a.m.-5 p.m...

National Dam Safety Program. Lake Monocan Dam (ID VA-12502), James River Basin, Allen Creek. Nelson County, Virginia. Phase I Inspection Report.

DTIC Science & Technology

1980-04-01

P 114 June 1978 Mr. W. Douglas Wright *Wiley and Wilson, Inc. 2310 Langhorne Road ’ :5 1973 Lvnchburg, Virginia 24505 & LSON, INC. LYNCHF.U1G. VA. Dv...CLASSIFICATION OF THIS P Dat Entered)’ " ’ READ INSTRUCTIO)NS REPORT DOCUMENTATION PAGE BEFORE COMPLETING FORM . REPORT NUMBER - 12. GOVT ACCESSION...OBSOLETE Unclassified -SECUnclassified OI P nd SECURITY CLASSIFICATION OF THIS PAGE (Wfen Dis Entered) SECURITY CLASSIFICATION OF INIS PAOE(Whe Data

Environmental and Water Quality Operational Studies. Environmental Features for Streambank Protection Projects.

DTIC Science & Technology

1984-11-01

Port Royal Road, Springfield, Virginia 22161. 19. KEY WORDS (Conltinue an, reverse olde It necessemy and Identify by block imbr) Bank protection (WES...20. AmT-RAcT (cothwe areyee &M ffneeeeiny ge Identify by block nmmber) This report provides guidance for incorporating environmental consid- erations...Environmental Effects ....................... 16 * PART IV: STRUCTURAL DESIGNS ..................... 24 4 Composite Revetment ........................ 249

Automated extraction of ejection fraction for quality measurement using regular expressions in Unstructured Information Management Architecture (UIMA) for heart failure.

PubMed

Garvin, Jennifer H; DuVall, Scott L; South, Brett R; Bray, Bruce E; Bolton, Daniel; Heavirland, Julia; Pickard, Steve; Heidenreich, Paul; Shen, Shuying; Weir, Charlene; Samore, Matthew; Goldstein, Mary K

2012-01-01

Left ventricular ejection fraction (EF) is a key component of heart failure quality measures used within the Department of Veteran Affairs (VA). Our goals were to build a natural language processing system to extract the EF from free-text echocardiogram reports to automate measurement reporting and to validate the accuracy of the system using a comparison reference standard developed through human review. This project was a Translational Use Case Project within the VA Consortium for Healthcare Informatics. We created a set of regular expressions and rules to capture the EF using a random sample of 765 echocardiograms from seven VA medical centers. The documents were randomly assigned to two sets: a set of 275 used for training and a second set of 490 used for testing and validation. To establish the reference standard, two independent reviewers annotated all documents in both sets; a third reviewer adjudicated disagreements. System test results for document-level classification of EF of <40% had a sensitivity (recall) of 98.41%, a specificity of 100%, a positive predictive value (precision) of 100%, and an F measure of 99.2%. System test results at the concept level had a sensitivity of 88.9% (95% CI 87.7% to 90.0%), a positive predictive value of 95% (95% CI 94.2% to 95.9%), and an F measure of 91.9% (95% CI 91.2% to 92.7%). An EF value of <40% can be accurately identified in VA echocardiogram reports. An automated information extraction system can be used to accurately extract EF for quality measurement.

Electronic Health Records: DOD and VA Should Remove Barriers and Improve Efforts to Meet Their Common System Needs

DTIC Science & Technology

2011-02-01

and develop joint information technology (IT) capabilities for the James A. Lovell Federal Health Care Center ( FHCC ). In light of these efforts...Center to form the James A. Lovell Federal Health Care Center ( FHCC ) has prompted the departments to work toward implementing electronic health...information needs for the FHCC . To do this, GAO analyzed departmental reviews and other documentation and interviewed DOD and VA officials. What

Couple/family therapy for posttraumatic stress disorder: review to facilitate interpretation of VA/DOD Clinical Practice Guideline.

PubMed

Monson, Candice M; Macdonald, Alexandra; Brown-Bowers, Amy

2012-01-01

A well-documented association exists among Veterans' posttraumatic stress disorder (PTSD) symptoms, family relationship problems, and mental health problems in partners and children of Veterans. This article reviews the recommendations regarding couple/family therapy offered in the newest version of the Department of Veterans Affairs (VA)/Department of Defense (DOD) VA/DOD Clinical Practice Guideline for Management of Post-Traumatic Stress. We then provide a heuristic for clinicians, researchers, and policy makers to consider when incorporating couple/family interventions into Veterans' mental health services. The range of research that has been conducted on couple/family therapy for Veterans with PTSD is reviewed using this heuristic, and suggestions for clinical practice are offered.

A graph algebra for scalable visual analytics.

PubMed

Shaverdian, Anna A; Zhou, Hao; Michailidis, George; Jagadish, Hosagrahar V

2012-01-01

Visual analytics (VA), which combines analytical techniques with advanced visualization features, is fast becoming a standard tool for extracting information from graph data. Researchers have developed many tools for this purpose, suggesting a need for formal methods to guide these tools' creation. Increased data demands on computing requires redesigning VA tools to consider performance and reliability in the context of analysis of exascale datasets. Furthermore, visual analysts need a way to document their analyses for reuse and results justification. A VA graph framework encapsulated in a graph algebra helps address these needs. Its atomic operators include selection and aggregation. The framework employs a visual operator and supports dynamic attributes of data to enable scalable visual exploration of data.

Initial Results from the Survey of Organizational Research Climates (SOuRCe) in the U.S. Department of Veterans Affairs Healthcare System

PubMed Central

Martinson, Brian C.; Nelson, David; Hagel-Campbell, Emily; Mohr, David; Charns, Martin P.; Bangerter, Ann; Thrush, Carol R.; Ghilardi, Joseph R.; Bloomfield, Hanna; Owen, Richard; Wells, James A.

2016-01-01

Background In service to its core mission of improving the health and well-being of veterans, Veterans Affairs (VA) leadership is committed to supporting research best practices in the VA. Recognizing that the behavior of researchers is influenced by the organizational climates in which they work, efforts to assess the integrity of research climates and share such information with research leadership in VA may be one way to support research best practices. The Survey of Organizational Research Climate (SOuRCe) is the first validated survey instrument specifically designed to assess the organizational climate of research integrity in academic research organizations. The current study reports on an initiative to use the SOuRCe in VA facilities to characterize the organizational research climates and pilot test the effectiveness of using SOuRCe data as a reporting and feedback intervention tool. Methods We administered the SOuRCe using a cross-sectional, online survey, with mailed follow-up to non-responders, of research-engaged employees in the research services of a random selection of 42 VA facilities (e.g., Hospitals/Stations) believed to employ 20 or more research staff. We attained a 51% participation rate, yielding more than 5,200 usable surveys. Results We found a general consistency in organizational research climates across a variety of sub-groups in this random sample of research services in the VA. We also observed similar SOuRCe scale score means, relative rankings of these scales and their internal reliability, in this VA-based sample as we have previously documented in more traditional academic research settings. Results also showed more substantial variability in research climate scores within than between facilities in the VA research service as reflected in meaningful subgroup differences. These findings suggest that the SOuRCe is suitable as an instrument for assessing the research integrity climates in VA and that the tool has similar patterns of results that have been observed in more traditional academic research settings. Conclusions The local and specific nature of organizational climates in VA research services, as reflected in variability across sub-groups within individual facilities, has important policy implications. Global, “one-size-fits-all” type initiatives are not likely to yield as much benefit as efforts targeted to specific organizational units or sub-groups and tailored to the specific strengths and weaknesses documented in those locations. PMID:26967736

38 CFR 39.19 - General requirements for site selection and construction of veterans' cemeteries.

Code of Federal Regulations, 2010 CFR

2010-07-01

... Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS (CONTINUED) AID TO STATES FOR ESTABLISHMENT, EXPANSION, AND... VA should be documented and justified in the application. (d) The space criteria and area... requirements of the project but are subject to approval by VA. Substantial deviation from the space or area...

75 FR 1120 - Agency Information Collection (Health-Care Use Survey for Enduring Freedom and Operation Iraqi...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-01-08

... (Health-Care Use Survey for Enduring Freedom and Operation Iraqi Freedom (OEF/OIF) Veterans) Activity...-New (10-0478).'' SUPPLEMENTARY INFORMATION: Title: Health-Care Use Survey for Enduring Freedom and... VA health care; (2) document unique barriers to VA care for women and men; and (3) provide reliable...

Perspective on 2015 DoD Cyber Strategy

DTIC Science & Technology

2015-09-29

Testimony View document details Support RAND Browse Reports & Bookstore Make a charitable contribution Limited Electronic Distribution Rights This...AGING PUBLIC SAFETY SCIENCE AND TECHNOLOGY TERRORISM AND HOMELAND SECURITY Report Documentation Page Form ApprovedOMB No. 0704-0188 Public reporting ...Directorate for Information Operations and Reports , 1215 Jefferson Davis Highway, Suite 1204, Arlington VA 22202-4302. Respondents should be aware

July 2, 2002 Petition for the Administrator to Object to Title V Permit for Solite Corp. in Cascade, VA

EPA Pesticide Factsheets

This document may be of assistance in applying the Title V air operating permit regulations. This document is part of the Title V Petition Database available at www2.epa.gov/title-v-operating-permits/title-v-petition-database. Some documents in the database are a scanned or retyped version of a paper photocopy of the original. Although we have taken considerable effort to quality assure the documents, some may contain typographical errors. Contact the office that issued the document if you need a copy of the original.

Use of the Blue Button Online Tool for Sharing Health Information: Qualitative Interviews With Patients and Providers

PubMed Central

Fix, Gemmae M; Hogan, Timothy P; Simon, Steven R; Nazi, Kim M; Turvey, Carolyn L

2015-01-01

Background 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. Objective 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. Methods 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. Results 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. Conclusions 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. PMID:26286139

Intelligence and Electronic Warfare (IEW) Streamlining Project. Volume 2. Directives and Related Study Documents. Revision

DTIC Science & Technology

1992-11-18

CDR INSCOM FT BELVOIR VA//IACG/IALOfa// INfO Nd DA WASH DC// DAHO -FDZ/DALO-SNIC/DANI-PI// CDR AMC ALEXANDRIA VA//AIICLG/AHCLG-SID// CDR CECON FT...Nondevelopmental Items (COTS/NDI) communications for more than 22 years. The explosion of technology has provided new capabilities and has challenged the

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.

Automated extraction of ejection fraction for quality measurement using regular expressions in Unstructured Information Management Architecture (UIMA) for heart failure

PubMed Central

DuVall, Scott L; South, Brett R; Bray, Bruce E; Bolton, Daniel; Heavirland, Julia; Pickard, Steve; Heidenreich, Paul; Shen, Shuying; Weir, Charlene; Samore, Matthew; Goldstein, Mary K

2012-01-01

Objectives Left ventricular ejection fraction (EF) is a key component of heart failure quality measures used within the Department of Veteran Affairs (VA). Our goals were to build a natural language processing system to extract the EF from free-text echocardiogram reports to automate measurement reporting and to validate the accuracy of the system using a comparison reference standard developed through human review. This project was a Translational Use Case Project within the VA Consortium for Healthcare Informatics. Materials and methods We created a set of regular expressions and rules to capture the EF using a random sample of 765 echocardiograms from seven VA medical centers. The documents were randomly assigned to two sets: a set of 275 used for training and a second set of 490 used for testing and validation. To establish the reference standard, two independent reviewers annotated all documents in both sets; a third reviewer adjudicated disagreements. Results System test results for document-level classification of EF of <40% had a sensitivity (recall) of 98.41%, a specificity of 100%, a positive predictive value (precision) of 100%, and an F measure of 99.2%. System test results at the concept level had a sensitivity of 88.9% (95% CI 87.7% to 90.0%), a positive predictive value of 95% (95% CI 94.2% to 95.9%), and an F measure of 91.9% (95% CI 91.2% to 92.7%). Discussion An EF value of <40% can be accurately identified in VA echocardiogram reports. Conclusions An automated information extraction system can be used to accurately extract EF for quality measurement. PMID:22437073

Comparison of Grouping Methods for Template Extraction from VA Medical Record Text.

PubMed

Redd, Andrew M; Gundlapalli, Adi V; Divita, Guy; Tran, Le-Thuy; Pettey, Warren B P; Samore, Matthew H

2017-01-01

We investigate options for grouping templates for the purpose of template identification and extraction from electronic medical records. We sampled a corpus of 1000 documents originating from Veterans Health Administration (VA) electronic medical record. We grouped documents through hashing and binning tokens (Hashed) as well as by the top 5% of tokens identified as important through the term frequency inverse document frequency metric (TF-IDF). We then compared the approaches on the number of groups with 3 or more and the resulting longest common subsequences (LCSs) common to all documents in the group. We found that the Hashed method had a higher success rate for finding LCSs, and longer LCSs than the TF-IDF method, however the TF-IDF approach found more groups than the Hashed and subsequently more long sequences, however the average length of LCSs were lower. In conclusion, each algorithm appears to have areas where it appears to be superior.

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

The Veteran-Initiated Electronic Care Coordination: A Multisite Initiative to Promote and Evaluate Consumer-Mediated Health Information Exchange.

PubMed

Klein, Dawn M; Pham, Kassi; Samy, Leila; Bluth, Adam; Nazi, Kim M; Witry, Matthew; Klutts, J Stacey; Grant, Kathleen M; Gundlapalli, Adi V; Kochersberger, Gary; Pfeiffer, Laurie; Romero, Sergio; Vetter, Brian; Turvey, Carolyn L

2017-04-01

Information continuity is critical to person-centered care when patients receive care from multiple healthcare systems. Patients can access their electronic health record data through patient portals to facilitate information exchange. This pilot was developed to improve care continuity for rural Veterans by (1) promoting the use of the Department of Veterans Affairs (VA) patient portal to share health information with non-VA providers, and (2) evaluating the impact of health information sharing at a community appointment. Veterans from nine VA healthcare systems were trained to access and share their VA Continuity of Care Document (CCD) with their non-VA providers. Patients and non-VA providers completed surveys on their experiences. Participants (n = 620) were primarily older, white, and Vietnam era Veterans. After training, 78% reported the CCD would help them be more involved in their healthcare and 86% planned to share it regularly with non-VA providers. Veterans (n = 256) then attended 277 community appointments. Provider responses from these appointments (n = 133) indicated they were confident in the accuracy of the information (97%) and wanted to continue to receive the CCD (96%). Ninety percent of providers reported the CCD improved their ability to have an accurate medication list and helped them make medication treatment decisions. Fifty percent reported they did not order a laboratory test or another procedure because of information available in the CCD. This pilot demonstrates feasibility and value of patient access to a CCD to facilitate information sharing between VA and non-VA providers. Outreach and targeted education are needed to promote consumer-mediated health information exchange.

Rationale for a Threshold Limit Value (TLV)R for JP-4/Jet B Wide Cut Aviation Turbine Fuel.

DTIC Science & Technology

1983-04-01

Additional copies may be purchased from: National Technical Information Service 5285 Port Royal Road Springfield, Virginia 22161 Government agencies...Cameron Station Alexandria, Virginia 22314 This report has been reviewed by the Public Affairs Office and is releasable to the National Technical...Information Service (NTIS). At NTIS, it will be available to the general public, including foreign nations . This technical report has been reviewed and is

Strategic plan for the Turner-Fairbank Highway Research Center.

DOT National Transportation Integrated Search

2014-01-01

Located in McLean, VA, the Turner-Fairbank Highway Research Center (TFHRC), is the Federal Highway Administrations (FHWA) core facility for research, development, and technology within the broader transportation research community. This document d...

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

Ada (Trade Name) Bibliography. Volume 2.

DTIC Science & Technology

1984-03-01

for every journal. The publisher information V,.0 appears if the document is a textbook. N % Xle r , , % 1= &-6 Ada Bibliography Volume 11 9 3. DOCUMENT...THE ADA LkNGUAGE SYSTEM PROJECT RAKITIN. STEVEN R . 6TH INT’L CONF ON SOFTWARE ENGINEERING: POSTER SESSION, PP. 49-50. 09/16/82 This paper discusses...VALIDATION AVAILABLE FROM: NATL.TECHNCL INF.SVC.5285 PORT ROYAL RD,SPRINGFIELD.VA SPONSORS: U.S.ARMY,COMMUNICATIONS R & D COMND, FT.MONMOUTH, NJ DOCUMENT

27 CFR 22.134 - Records of shipment.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 27 Alcohol, Tobacco Products and Firearms 1 2010-04-01 2010-04-01 false Records of shipment. 22.134 Section 22.134 Alcohol, Tobacco Products and Firearms ALCOHOL AND TOBACCO TAX AND TRADE BUREAU... § 22.161. (Approved by the Office of Management and Budget under control number 1512-0334) ...

27 CFR 22.134 - Records of shipment.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 27 Alcohol, Tobacco Products and Firearms 1 2011-04-01 2011-04-01 false Records of shipment. 22.134 Section 22.134 Alcohol, Tobacco Products and Firearms ALCOHOL AND TOBACCO TAX AND TRADE BUREAU... § 22.161. (Approved by the Office of Management and Budget under control number 1512-0334) ...

Using the cost distribution report in estimating private sector payments: what adjustments should researchers make?

PubMed

Nugent, Gary; Grippen, Glen; Parris, Y C; Mitchell, Mary

2003-06-01

To reapportion Veterans Health Administration (VA) annual expenditures into benefit categories for comparison with estimated payments by private sector providers. Total expenditures for six VA medical centers for federal fiscal year 1999 were reapportioned by benefit category using the cost distribution report (CDR). Health benefit categories were based on those of health care insurers. Cost reapportionment was based on CDR data and reviews of source accounting and payroll documents. Actual expenditures for many benefits can be accurately identified and reapportioned using CDR data, but other expenditures were not identifiable in the CDR and required inspection of source documents. Inpatient expenditures amounting to $75,110,094 US dollars and outpatient expenditures amounting to $73,594,284 US dollars were reapportioned into other benefit categories, primarily professional fees. Expenditures for some VA benefits could not be identified because of differences in accounting and clinical practice between the VA and the community. Revisions to bring the CDR more in line with private sector payment categories would improve effectiveness for internal VA analyses and external expenditure comparisons. CDR revisions would require changes in recording some clinical workload (eg, rehabilitation and extended care) and classifying residential and domiciliary programs separate from inpatient care. Benefits that were not assigned expenditures for comparison with payments represent a potential liability if the VA were to purchase health care services in the marketplace. Variation among hospitals on expenditures not clearly identified in the CDR was significant and raises questions about the effectiveness of capitated budget methodologies using either the CDR or the decision support system.

JFACC Information Management (IM) Capability: Operational Concept

DTIC Science & Technology

2006-01-01

designated by other documentation. ©2006 The MITRE Corporation. All Rights Reserved. Langley Site Operations Hampton, Virginia Report...1204, Arlington VA 22202-4302. Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to a penalty...ORGANIZATION NAME(S) AND ADDRESS(ES) MITRE Corporation,Langley Site Operations,Hampton,VA,23666 8. PERFORMING ORGANIZATION REPORT NUMBER 9. SPONSORING

Using policy to increase prescribing of smoking cessation medications in the VA healthcare system.

PubMed

Smith, Mark W; Chen, Shuo; Siroka, Andrew M; Hamlett-Berry, Kim

2010-12-01

Since 2002 the US Veterans Affairs (VA) healthcare system has initiated national policies and programmes to reduce smoking among its patients and to increase evidence-based treatment for smoking. To document changes in dispensing rates of cessation-related medications in VA from 2004 to 2008. Retrospective analysis of VA administrative data. Prescription fills for nicotine replacement therapy (NRT), and for bupropion among NRT users, each grew more than 60% in four years. The increase stemmed primarily from treating more people rather than from filling more prescriptions per person. The results provide strong support for the efficacy of these policies and illustrate how healthcare systems can successfully employ multiple strategies to increase evidence-based smoking-cessation treatment.

Report on Tick-Borne Disease and Integrated Pest Management Conference

EPA Pesticide Factsheets

The US Environmental Protection Agency (EPA) and the Centers for Disease Control and Prevention (CDC) co-hosted a conference on Tick-Borne Disease Integrated Pest Management on March 5-6, 2013, in Arlington, VA. This document summarizes this meeting.

One-year incidence and predictors of homelessness among 300,000 U.S. Veterans seen in specialty mental health care.

PubMed

Tsai, Jack; Hoff, Rani A; Harpaz-Rotem, Ilan

2017-05-01

The Department of Veterans Affairs (VA) is committed to preventing and ending homelessness among U.S. veterans, but there have been few estimates of the incidence of veteran homelessness and prospective studies to identify predictors of homelessness. This study examines the 1-year incidence of homelessness among veterans seen in VA specialty mental health clinics and identified sociodemographic and clinical predictors of homelessness. Using a retrospective cohort study design, data were extracted from the VA medical records of 306,351 veterans referred to anxiety and posttraumatic stress disorder clinics across 130 VA facilities from 2008-2012 and followed for 1 year after referral. Homeless incidence was defined as new use of any VA homeless services or a documented International Classification of Diseases (9th rev.) V60.0 (lack of housing) code during the year. Of the total sample, 5.6% (7.8% for women and 5.4% for men) experienced homelessness within 1 year after referral to VA specialty mental health care. Veterans who were unmarried or diagnosed with a drug use disorder were more than twice as likely to become homeless; those who were Black or had annual incomes less than $25,000 were more than one and a half times as likely to become homeless. Together, these findings suggest a notable and important percentage of veterans seen in VA specialty mental health clinics newly experience homelessness annually. Monitoring early signs of housing vulnerability and preventing homelessness in this vulnerable but treatment-engaged population may be important in the VA's efforts to end veteran homelessness. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

14 CFR 221.61 - Rules and regulations governing foreign air transportation.

Code of Federal Regulations, 2010 CFR

2010-01-01

... governing foreign air transportation. Instead of being included in the fares tariffs, the rules and regulations governing foreign air transportation required to be filed by §§ 221.20 and 221.30 and/or... 14 Aeronautics and Space 4 2010-01-01 2010-01-01 false Rules and regulations governing foreign air...

Poststroke Rehabilitation and Restorative Care Utilization: A Comparison Between VA Community Living Centers and VA-contracted Community Nursing Homes.

PubMed

Jia, Huanguang; Pei, Qinglin; Sullivan, Charles T; Cowper Ripley, Diane C; Wu, Samuel S; Bates, Barbara E; Vogel, W Bruce; Bidelspach, Douglas E; Wang, Xinping; Hoffman, Nannette

2016-03-01

Effective poststroke rehabilitation care can speed patient recovery and minimize patient functional disabilities. Veterans affairs (VA) community living centers (CLCs) and VA-contracted community nursing homes (CNHs) are the 2 major sources of institutional long-term care for Veterans with stroke receiving care under VA auspices. This study compares rehabilitation therapy and restorative nursing care among Veterans residing in VA CLCs versus those Veterans in VA-contracted CNHs. Retrospective observational. All Veterans diagnosed with stroke, newly admitted to the CLCs or CNHs during the study period who completed at least 2 Minimum Data Set assessments postadmission. The outcomes were numbers of days for rehabilitation therapy and restorative nursing care received by the Veterans during their stays in CLCs or CNHs as documented in the Minimum Data Set databases. For rehabilitation therapy, the CLC Veterans had lower user rates (75.2% vs. 76.4%, P=0.078) and fewer observed therapy days (4.9 vs. 6.4, P<0.001) than CNH Veterans. However, the CLC Veterans had higher adjusted odds for therapy (odds ratio=1.16, P=0.033), although they had fewer average therapy days (coefficient=-1.53±0.11, P<0.001). For restorative nursing care, CLC Veterans had higher user rates (33.5% vs. 30.6%, P<0.001), more observed average care days (9.4 vs. 5.9, P<0.001), higher adjusted odds (odds ratio=2.28, P<0.001), and more adjusted days for restorative nursing care (coefficient=5.48±0.37, P<0.001). Compared with their counterparts at VA-contracted CNHs, Veterans at VA CLCs had fewer average rehabilitation therapy days (both unadjusted and adjusted), but they were significantly more likely to receive restorative nursing care both before and after risk adjustment.

48 CFR 811.202 - Maintenance of standardization documents.

Code of Federal Regulations, 2014 CFR

2014-10-01

... standardization documents. 811.202 Section 811.202 Federal Acquisition Regulations System DEPARTMENT OF VETERANS... been developed by the U.S. Department of Agriculture. Purchase descriptions and specifications for... 89, Subsistence, must be used by VA only when purchasing such items of subsistence from the Defense...

48 CFR 811.202 - Maintenance of standardization documents.

Code of Federal Regulations, 2010 CFR

2010-10-01

... standardization documents. 811.202 Section 811.202 Federal Acquisition Regulations System DEPARTMENT OF VETERANS... been developed by the U.S. Department of Agriculture. Purchase descriptions and specifications for... 89, Subsistence, must be used by VA only when purchasing such items of subsistence from the Defense...

48 CFR 811.202 - Maintenance of standardization documents.

Code of Federal Regulations, 2013 CFR

2013-10-01

... standardization documents. 811.202 Section 811.202 Federal Acquisition Regulations System DEPARTMENT OF VETERANS... been developed by the U.S. Department of Agriculture. Purchase descriptions and specifications for... 89, Subsistence, must be used by VA only when purchasing such items of subsistence from the Defense...

48 CFR 811.202 - Maintenance of standardization documents.

Code of Federal Regulations, 2012 CFR

2012-10-01

... standardization documents. 811.202 Section 811.202 Federal Acquisition Regulations System DEPARTMENT OF VETERANS... been developed by the U.S. Department of Agriculture. Purchase descriptions and specifications for... 89, Subsistence, must be used by VA only when purchasing such items of subsistence from the Defense...

48 CFR 811.202 - Maintenance of standardization documents.

Code of Federal Regulations, 2011 CFR

2011-10-01

... standardization documents. 811.202 Section 811.202 Federal Acquisition Regulations System DEPARTMENT OF VETERANS... been developed by the U.S. Department of Agriculture. Purchase descriptions and specifications for... 89, Subsistence, must be used by VA only when purchasing such items of subsistence from the Defense...

Review and Evaluation of the VA Enrollee Health Care Projection Model

DTIC Science & Technology

2008-01-01

prohibited. RAND PDFs are protected under copyright law. Permission is required from RAND to reproduce, or reuse in another form, any of our research ...Visit RAND at www.rand.org Explore the RAND Center for Military Health Policy Research View document details For More Information This PDF document was...SUBSTANCE ABUSE TERRORISM AND HOMELAND SECURITY TRANSPORTATION AND INFRASTRUCTURE WORKFORCE AND WORKPLACE The RAND Corporation is a nonprofit research

2012 Review on the Extension of the AMedP-8(C) Methodology to New Agents, Materials, and Conditions

DTIC Science & Technology

2013-10-01

Atlantic Treaty Organization (NATO) to estimate casualties from chemical, biological , radiological, and nuclear (CBRN) weapons . The final draft...chemical, biological , radiological, and nuclear (CBRN) weapons . The final draft documenting this methodology was published by IDA in 2009 and was...from Battlefield Exposure to Chemical, Biological and Radiological Agents and Nuclear Weapon Effects. IDA Document D- 4465. Alexandria, VA: IDA

Standardized Verification, Validation, and Accreditation (VV&A) Documentation Schema Description Document

DTIC Science & Technology

2008-10-31

SSC Charleston; Mr. David Broyles, SSC Charleston; Dr. Richard Daehler-Wilking, SSC Charleston; Ms. Marcy Stutzman, Northrop Grumman ; and Tammie...PAGE Form Approved OMB No. 0704-0188 Public reporting burden for this collection of information is estimated to average 1 hour per response, including...1204, Arlington, VA 22202-4302, and to the Office of Management and Budget, Paperwork Reduction Project (0704-0188) Washington DC 20503. 1 . AGENCY

Applying Bioaugmentation to Treat DNAPL Sources in Fractured Rock

DTIC Science & Technology

2017-03-27

document has been cleared for public release REPORT DOCUMENTATION PAGE Form Approved OMB No. 0704-0188 Public reporting burden for this collection...Services, Directorate for Information Operations and Reports (0704-0188), 1215 Jefferson Davis Highway, Suite 1204, Arlington, VA 22202- 4302. Respondents...information if it does not display a currently valid OMB control number. PLEASE DO NOT RETURN YOUR FORM TO THE ABOVE ADDRESS. 1. REPORT DATE (DD

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.

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.

Integrated clinical workstations for image and text data capture, display, and teleconsultation.

PubMed

Dayhoff, R; Kuzmak, P M; Kirin, G

1994-01-01

The Department of Veterans Affairs (VA) DHCP Imaging System digitally records clinically significant diagnostic images selected by medical specialists in a variety of hospital departments, including radiology, cardiology, gastroenterology, pathology, dermatology, hematology, surgery, podiatry, dental clinic, and emergency room. These images, which include true color and gray scale images, scanned documents, and electrocardiogram waveforms, are stored on network file servers and displayed on workstations located throughout a medical center. All images are managed by the VA's hospital information system (HIS), allowing integrated displays of text and image data from all medical specialties. Two VA medical centers currently have DHCP Imaging Systems installed, and other installations are underway.

Determining Clinically Relevant Changes in Community Walking Metrics to Be Tracked by the VA as Part of Routine Care in Lower Limb Amputee Veterans

DTIC Science & Technology

2017-10-01

20007 REPORT DATE: October 2017 TYPE OF REPORT : Annual PREPARED FOR: U.S. Army Medical Research and Materiel Command Fort Detrick, Maryland...21702-5012 DISTRIBUTION STATEMENT: Approved for Public Release; Distribution Unlimited The views, opinions and/or findings contained in this report ...other documentation. REPORT DOCUMENTATION PAGE Form Approved OMB No. 0704-0188 Public reporting burden for this collection of information is

75 FR 32293 - Nonduplication; Pension, Compensation, and Dependency and Indemnity Compensation; Correction

Federal Register 2010, 2011, 2012, 2013, 2014

2010-06-08

... DEPARTMENT OF VETERANS AFFAIRS 38 CFR Part 21 Nonduplication; Pension, Compensation, and Dependency and Indemnity Compensation; Correction AGENCY: Department of Veterans Affairs. ACTION: Correcting amendment. SUMMARY: This document corrects the Department of Veterans Affairs (VA) regulation that governs...

Department of Transportation Data Communications Requirements Analysis.

DTIC Science & Technology

1981-07-01

National Technical Information Service, Springfield, Virginia 22161. CJ0 us Department of Transportation FdeWAtcMk Adl*lt,. and Systems Research...General Administrative System . .. ................. 4.4 4.1.3 Coast Guard Administrative System . .. ............... 4.6 4.1.4 Transportation Automated...Office System .. .. ............ 4.6 4.1.5 OST Data Transmission Characteristics .. .. ............. 4.6 4.1.6 OST Data Communications

Common data model for natural language processing based on two existing standard information models: CDA+GrAF.

PubMed

Meystre, Stéphane M; Lee, Sanghoon; Jung, Chai Young; Chevrier, Raphaël D

2012-08-01

An increasing need for collaboration and resources sharing in the Natural Language Processing (NLP) research and development community motivates efforts to create and share a common data model and a common terminology for all information annotated and extracted from clinical text. We have combined two existing standards: the HL7 Clinical Document Architecture (CDA), and the ISO Graph Annotation Format (GrAF; in development), to develop such a data model entitled "CDA+GrAF". We experimented with several methods to combine these existing standards, and eventually selected a method wrapping separate CDA and GrAF parts in a common standoff annotation (i.e., separate from the annotated text) XML document. Two use cases, clinical document sections, and the 2010 i2b2/VA NLP Challenge (i.e., problems, tests, and treatments, with their assertions and relations), were used to create examples of such standoff annotation documents, and were successfully validated with the XML schemata provided with both standards. We developed a tool to automatically translate annotation documents from the 2010 i2b2/VA NLP Challenge format to GrAF, and automatically generated 50 annotation documents using this tool, all successfully validated. Finally, we adapted the XSL stylesheet provided with HL7 CDA to allow viewing annotation XML documents in a web browser, and plan to adapt existing tools for translating annotation documents between CDA+GrAF and the UIMA and GATE frameworks. This common data model may ease directly comparing NLP tools and applications, combining their output, transforming and "translating" annotations between different NLP applications, and eventually "plug-and-play" of different modules in NLP applications. Copyright © 2011 Elsevier Inc. All rights reserved.

MYC RNAi-PT Combination Nanotherapy for Metastatic Prostate Cancer Treatment

DTIC Science & Technology

2017-10-01

Department of the Army position, policy or decision unless so designated by other documentation. REPORT DOCUMENTATION PAGE Form Approved OMB No ...Suite 1204, Arlington, VA 22202- 4302. Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to...of the NPs loaded with MYC siRNA and cisplatin prodrug (synthesized in Year 1 of this project) against the Pt-resistant PCa cells. In parallel, we

78 FR 36092 - Payment or Reimbursement for Emergency Services for Nonservice-Connected Conditions in Non-VA...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-06-17

... expanded veterans' eligibility for reimbursement. This document corrects a typographical error without... programs--Veterans, Health care, Health facilities, Health professions, Health records, Homeless, Medical and dental schools, Medical devices, Medical research, Mental health programs, Nursing homes...

Novel Therapeutic Approaches for the Treatment of Depression and Cognitive Deficits in a Rodent Model of Gulf War Veterans’ Illness

DTIC Science & Technology

2017-10-01

Richmond, VA 23298 REPORT DATE: October 2017 TYPE OF REPORT : Annual PREPARED FOR: U.S. Army Medical Research and Materiel Command Fort Detrick...this report are those of the author(s) and should not be construed as an official Department of the Army position, policy or decision unless so...designated by other documentation. REPORT DOCUMENTATION PAGE Form Approved OMB No. 0704-0188 Public reporting burden for this collection of

Integrated clinical workstations for image and text data capture, display, and teleconsultation.

PubMed Central

Dayhoff, R.; Kuzmak, P. M.; Kirin, G.

1994-01-01

The Department of Veterans Affairs (VA) DHCP Imaging System digitally records clinically significant diagnostic images selected by medical specialists in a variety of hospital departments, including radiology, cardiology, gastroenterology, pathology, dermatology, hematology, surgery, podiatry, dental clinic, and emergency room. These images, which include true color and gray scale images, scanned documents, and electrocardiogram waveforms, are stored on network file servers and displayed on workstations located throughout a medical center. All images are managed by the VA's hospital information system (HIS), allowing integrated displays of text and image data from all medical specialties. Two VA medical centers currently have DHCP Imaging Systems installed, and other installations are underway. PMID:7949899

47 CFR 90.553 - Encryption.

Code of Federal Regulations, 2010 CFR

2010-10-01

... (Reference Information Center) or at the National Archives and Records Administration (NARA). For information... TIA/EIA, 2500 Wilson Boulevard, Arlington, VA, 22201; Global Engineering Documents, 15 Inverness Way...

Turbine Engine Diagnostics System Study

DTIC Science & Technology

1991-10-01

objective of this report. Tehnical pNW Decuanfmesln Page 1. Ropro. 1/ 2. ,ornm.o Acceosioa No. 3 . o.p.ifteCatalog Me. DOT/FAA/CT-91/16 4. Titeo en. depeI 0o...Safety Information Service, Springfield, Performance Virginia 22161 I9. seewrity Clossa. too *is ,pw#) 3 . 0 n4 .i. (*#A pop) ,g. 21. me. of eeoc...1. INTRODUCTION 1 2. BACKGROUND 2 3 . PHASE I TECHNICAL OBJECTIVES 4 4. SYSTEM SURVEY 7 4.1 Literature Search 7 4.2 Industry Survey 10 4.3 Technology

Study of Bird Ingestions into Small Inlet Area Aircraft Turbine Engines

DTIC Science & Technology

1990-12-01

engines (ALF502, TFE731 , TPE331, and JTI5D) included in the study. This includes 24 months of operations for the first three engines and 12 months of...through the National Teclical Bird Ingestion- TFE731 Information Service, Springfield, 4 Tuibine Engine,’ TPt331 Virginia 22161 Turbofan Engine...ALF502 Engine 7 2.2 Operations, TFE731 Engine 8 2.3 Operations, TPE331 Engine 9 3.1 Distribution of Bird Weights 13 3.2 Aircraft Ingestions by Month

78 FR 9455 - Agency Information Collection (eBenefits Portal) Activity Under OMB Review; Correction

Federal Register 2010, 2011, 2012, 2013, 2014

2013-02-08

... DEPARTMENT OF VETERANS AFFAIRS [OMB Control No. 2900-0737] Agency Information Collection (e... error. The notice incorrectly identified the responsible VA organization. This document corrects that error by removing ``Office of Information and Technology'' and adding, in its place, ``Veterans Benefits...

Standard Engineering Installation Package for Dual Frequency Signaling Unit (DFSU).

DTIC Science & Technology

1982-03-15

Center, Cameron Station, Alexandria, VA 22314. Government activities may requisition copies oy writing to the Commander, Headquarters, Fort Huachuca, ATTN...Protective ac ground ins-alled: Yes No (1) All equipment crcunded to ac prozective g-ourd by separate wires: Y-s No Pigure 2-1. Sample Sita Surve) Ci- eck !st...20305 12 - Defense Documentation Center, Cameron Station, Alexandria, VA 22134 4 - 1st Signal Brigade USACC-Korea, APO San Francisco 96218 2 - USACC

Resistance and Seakeeping Database for USCG 157 FT WLM

DTIC Science & Technology

1991-07-01

Technical Information Service, Springfield, Virginia 22161 X Prepared for: U.S. Coast Guard Research and Development Center 1082 Shennecossett Road...specification or regulation. . SAMUEL F. POWEL, III Technical Director United States Coast Guard Research & Development Center 1082 Shennecossett Road...14. Sponsoring Agency Code 1082 Shennecossett Road Office of Engineering, Logistics, Groton, Connecticut 06340-6096 and Development Washington, D.C

Near East/South Asia Report.

DTIC Science & Technology

1985-10-04

Government. PROCUREMENT OF PUBLICATIONS JPRS publications may be ordered from the National Technical Information Service, Springfield, Virginia 22161. In...Correspondence pertaining to niatters other than procurement may be addressed to Joint Publications Research Service, 1000 North Glebe Road, Arlington, Virginia... solution " to the Jewish problem. The time, the place, and other circumstances may have made equally methodical execution of that plan impossible. But

Southeast Asia Report

DTIC Science & Technology

1987-04-21

PROCUREMENT OF PUBLICATIONS JPRS publications may be ordered from the National Technical Information Service, Springfield, Virginia 22161. In order- ing, it...to matters other than procurement may be addressed to Joint Publications Research Service, 1000 North Glebe Road, Arlington, Virginia 22201. JPRS...Denies Graft Charges (Oscar M. Quiambao; PHILIPPINE DAILY INQUIRER, 31 Mar 87) 36 Banks’ Reserve Deficiency Declines ( BUSINESS DAY, 1 Apr 87

East Europe Report, Political, Sociological and Military Affairs, No. 2199.

DTIC Science & Technology

1983-09-15

PROCUREMENT OF PUBLICATIONS JPRS publications may be ordered from the National Technical Information Service, Springfield, Virginia 22161. In order...pertaining to matters other than procurement may be addressed to Joint Publications Research Service, 1000 North Glebe Road, Arlington, Virginia 22201...Political Activities New Solutions Sought, by Ryszard Buczek Party Serves People in Plants, by Krystyna Majda Provincial Trade Union Developments

Ethical issues regarding caring for dermatology patients in the U.S. Department of Veterans Affairs Health Care System.

PubMed

Reich, Reuben; Stevens, Emily; Dellavalle, Robert P

2012-01-01

The U.S. Department of Veterans Affairs (VA) operates the largest integrated health care system within the United States. VA budgets continue to escalate in an environment of heightened financial prudence and accountability. Despite having received many awards in areas from patient satisfaction and safety to product innovations, like any health care system, the VA is not immune to ethical conflict that requires exploration and evaluation. Several VA dermatologists, including section chiefs, were interviewed, and their responses to ethical complexities encountered or anticipated were analyzed in fictional case scenarios. Five morally concerning issues were highlighted. These include (1) providing care in a teaching setting with limited resources to a patient population with few other health care alternatives; (2) stereotyping patients, altogether an uncommon act, is possibly easier to do in the VA and has the potential to negatively affect patient care; (3) service-related disability claim cases often include medical opinion and findings documented in the medical record when judgments are made, thus the VA physician can have a significant effect on the outcome of these claims; (4) whether the VA provides a setting for apathetic physicians to thrive or instead allows for a more meaningful work experience and then how to manage the subpar performer; (5) except for the treatment of HIV lipodystrophy with injectables, primary cosmetic procedures are prohibited at the VA and can lead to difficulties for the VA dermatologist attempting to comply in a era where dermatology is being more closely associated with cosmesis. Published by Elsevier Inc.

76 FR 22854 - Streamlined Patent Reexamination Proceedings; Notice of Public Meeting

Federal Register 2010, 2011, 2012, 2013, 2014

2011-04-25

... proposed changes in this document are divided into three categories: changes to both ex parte and inter..., Alexandria, VA 22313-1450, marked to the attention of Kenneth M. Schor. Although comments may be submitted by... parte and inter partes reexamination proceedings. The proposed changes in this notice are divided into...

Weight Reduction Potential of Automobiles and Light Trucks, 1979 Summary Source Document

DOT National Transportation Integrated Search

1980-03-01

The purpose of this report is to provide an assessment of the potential for weight reduction for passenger cars and light trucks (including pickup trucks, vans, and utility vehicles of GVWR up to 8500 pounds) in the 1980 to 2000 model year period. Va...

77 FR 12522 - Tentative Eligibility Determinations; Presumptive Eligibility for Psychosis and Other Mental Illness

Federal Register 2010, 2011, 2012, 2013, 2014

2012-03-01

... DEPARTMENT OF VETERANS AFFAIRS 38 CFR Part 17 RIN 2900-AN87 Tentative Eligibility Determinations; Presumptive Eligibility for Psychosis and Other Mental Illness AGENCY: Department of Veterans Affairs. ACTION: Proposed rule. SUMMARY: This document proposes to amend the Department of Veterans Affairs (VA) regulation...

Nuclear Air Blast Effects.

DTIC Science & Technology

1982-06-01

AD-All? 43 SCIENCE APPLICATZOhu INC NCLAA VA F/6 19/4I NUICLEAR AIR BLAST IFPCTS(U) JUR " PRY UNCLASSIFID SAI-63-636-VA NLOOI I-C lit? I. 1174~ 132...SiCuftIt, CLASSFICA?1lOw OF fl.IS PAQ-C( fhbl Dal. Lnt.,.d, REPORT DOCUMENTATION4 PAGE apoI ct~ NUCLEAR AIR BLAST EFFECTS FINAL REPORT SAI-83-836-WA...TUCSON a WASHINGTON NUCLEAR AIR BLAST EFFECTS FINAL REPORT SAI-83-836-WA Submitted to: Laboratory for Computational Physics Naval Research Laboratory

Automated Detection of Privacy Sensitive Conditions in C-CDAs: Security Labeling Services at the Department of Veterans Affairs

PubMed Central

Bouhaddou, Omar; Davis, Mike; Donahue, Margaret; Mallia, Anthony; Griffin, Stephania; Teal, Jennifer; Nebeker, Jonathan

2016-01-01

Care coordination across healthcare organizations depends upon health information exchange. Various policies and laws govern permissible exchange, particularly when the information includes privacy sensitive conditions. The Department of Veterans Affairs (VA) privacy policy has required either blanket consent or manual sensitivity review prior to exchanging any health information. The VA experience has been an expensive, administratively demanding burden on staffand Veterans alike, particularly for patients without privacy sensitive conditions. Until recently, automatic sensitivity determination has not been feasible. This paper proposes a policy-driven algorithmic approach (Security Labeling Service or SLS) to health information exchange that automatically detects the presence or absence of specific privacy sensitive conditions and then, to only require a Veteran signed consent for release when actually present. The SLS was applied successfully to a sample of real patient Consolidated-Clinical Document Architecture(C-CDA) documents. The SLS identified standard terminology codes by both parsing structured entries and analyzing textual information using Natural Language Processing (NLP). PMID:28269828

Automated Detection of Privacy Sensitive Conditions in C-CDAs: Security Labeling Services at the Department of Veterans Affairs.

PubMed

Bouhaddou, Omar; Davis, Mike; Donahue, Margaret; Mallia, Anthony; Griffin, Stephania; Teal, Jennifer; Nebeker, Jonathan

2016-01-01

Care coordination across healthcare organizations depends upon health information exchange. Various policies and laws govern permissible exchange, particularly when the information includes privacy sensitive conditions. The Department of Veterans Affairs (VA) privacy policy has required either blanket consent or manual sensitivity review prior to exchanging any health information. The VA experience has been an expensive, administratively demanding burden on staffand Veterans alike, particularly for patients without privacy sensitive conditions. Until recently, automatic sensitivity determination has not been feasible. This paper proposes a policy-driven algorithmic approach (Security Labeling Service or SLS) to health information exchange that automatically detects the presence or absence of specific privacy sensitive conditions and then, to only require a Veteran signed consent for release when actually present. The SLS was applied successfully to a sample of real patient Consolidated-Clinical Document Architecture(C-CDA) documents. The SLS identified standard terminology codes by both parsing structured entries and analyzing textual information using Natural Language Processing (NLP).

Integrating community-based verbal autopsy into civil registration and vital statistics (CRVS): system-level considerations

PubMed Central

de Savigny, Don; Riley, Ian; Chandramohan, Daniel; Odhiambo, Frank; Nichols, Erin; Notzon, Sam; AbouZahr, Carla; Mitra, Raj; Cobos Muñoz, Daniel; Firth, Sonja; Maire, Nicolas; Sankoh, Osman; Bronson, Gay; Setel, Philip; Byass, Peter; Jakob, Robert; Boerma, Ties; Lopez, Alan D.

2017-01-01

ABSTRACT Background: Reliable and representative cause of death (COD) statistics are essential to inform public health policy, respond to emerging health needs, and document progress towards Sustainable Development Goals. However, less than one-third of deaths worldwide are assigned a cause. Civil registration and vital statistics (CRVS) systems in low- and lower-middle-income countries are failing to provide timely, complete and accurate vital statistics, and it will still be some time before they can provide physician-certified COD for every death. Proposals: Verbal autopsy (VA) is a method to ascertain the probable COD and, although imperfect, it is the best alternative in the absence of medical certification. There is extensive experience with VA in research settings but only a few examples of its use on a large scale. Data collection using electronic questionnaires on mobile devices and computer algorithms to analyse responses and estimate probable COD have increased the potential for VA to be routinely applied in CRVS systems. However, a number of CRVS and health system integration issues should be considered in planning, piloting and implementing a system-wide intervention such as VA. These include addressing the multiplicity of stakeholders and sub-systems involved, integration with existing CRVS work processes and information flows, linking VA results to civil registration records, information technology requirements and data quality assurance. Conclusions: Integrating VA within CRVS systems is not simply a technical undertaking. It will have profound system-wide effects that should be carefully considered when planning for an effective implementation. This paper identifies and discusses the major system-level issues and emerging practices, provides a planning checklist of system-level considerations and proposes an overview for how VA can be integrated into routine CRVS systems. PMID:28137194

Nuclear Weapons Effects on Army Tactical Systems. Volume 1. Overview

DTIC Science & Technology

1979-04-01

UNCLASSI I I E >D ICV.RI , CLAISGFICAIO04 or TRIS v f, I t’,, *I tn, ) REPORT DOCUMENTATION PAGE ..... ro"..,T.UV IOR REP041 UM"ER . oOVI ACCESSION NO...Effects on Archimy. e ~ Tactical System!p- e . -,- o 0. CON . on GRANT NUMBER(., Joseph J. Halpin (also ed.) John P. Swirczynski (also ed.) D 212 112...THIS PAGE(7h"n Va0m Ent..’. E ) FOREWORD This document describes the general insights and the key issues for the nuclear survivability of tactical

Schedule for Rating Disabilities; the Endocrine System. Final rule.

PubMed

2017-11-02

This document amends the Department of Veterans Affairs (VA) Schedule for Rating Disabilities (VASRD) by revising the portion of the Schedule that addresses endocrine conditions and disorders of the endocrine system. The effect of this action is to ensure that the VASRD uses current medical terminology and to provide detailed and updated criteria for evaluation of endocrine disorders.

Changes in Patient-Reported Alcohol-Related Advice Following Veterans Health Administration Implementation of Brief Alcohol Interventions.

PubMed

Chavez, Laura J; Williams, Emily C; Lapham, Gwen T; Rubinsky, Anna D; Kivlahan, Daniel R; Bradley, Katharine A

2016-05-01

Brief alcohol interventions are recommended for primary care patients who screen positive for alcohol misuse, but implementation is challenging. The U.S. Veterans Health Administration (Veterans Affairs [VA]) implemented brief interventions for patients with alcohol misuse in 2008, and rates of brief interventions documented in the electronic medical record increased from 24% to 78% (2008-2011). This study examined whether an independent measure of brief interventions-patient-reported alcohol-related advice-also increased among VA outpatients who screened positive for alcohol misuse on a mailed survey. This retrospective cross-sectional study included VA outpatient respondents to the VA's Survey of Healthcare Experiences of Patients (SHEP; 2007-2011) who reported past-year alcohol use and answered a question about alcohol-related advice. Alcohol-related advice was defined as a report of past-year advice from a VA clinician to abstain from or reduce drinking. The adjusted prevalence of alcoholrelated advice among patients who screened positive for alcohol misuse (SHEP AUDIT-C ≥ 5) was estimated for each year. Among patients with alcohol misuse (n = 61,843), the adjusted prevalence of alcohol-related advice increased from 40.4% (95% CI [39.3%, 41.5%]) in 2007 to 55.5% (95% CI [53.3%, 57.8%]) in 2011. Rates of alcoholrelated advice increased significantly each year except the last. The VA's efforts to implement brief interventions were associated with increased patient-reported alcohol-related advice over time, with a majority of patients with alcohol misuse reporting its receipt. Other systems considering similar approaches to implementation may benefit from collecting patient-reported measures of brief interventions for an additional perspective on implementation.

DEVELOPMENT OF RECOMMENDATIONS AND METHODS TO SUPPORT ASSESSMENT OF SOIL VENTING PERFORMANCE AND CLOSURE: PUBLISHED REPORT

EPA Science Inventory

The purpose of this document is to improve the current "state of the art" and "state of the science" of soil venting application. A strategy is proposed for venting closure. A vadose zone paradigm is developed to dynamically link the performance of ground-water remediation to va...

[Vascular access guidelines for hemodialysis].

PubMed

Rodríguez Hernández, J A; González Parra, E; Julián Gutiérrez, J M; Segarra Medrano, A; Almirante, B; Martínez, M T; Arrieta, J; Fernández Rivera, C; Galera, A; Gallego Beuter, J; Górriz, J L; Herrero, J A; López Menchero, R; Ochando, A; Pérez Bañasco, V; Polo, J R; Pueyo, J; Ruiz, Camps I; Segura Iglesias, R

2005-01-01

Quality of vascular access (VA) has a remarkable influence in hemodialysis patients outcomes. Dysfunction of VA represents a capital cause of morbi-mortality of these patients as well an increase in economical. Spanish Society of Neprhology, aware of the problem, has decided to carry out a revision of the issue with the aim of providing help in comprehensión and treatment related with VA problems, and achieving an homogenization of practices in three mayor aspects: to increase arteriovenous fistula utilization as first vascular access, to increment vascular access monitoring practice and rationalise central catheters use. We present a consensus document elaborated by a multidisciplinar group composed by nephrologists, vascular surgeons, interventional radiologysts, infectious diseases specialists and nephrological nurses. Along six chapters that cover patient education, creation of VA, care, monitoring, complications and central catheters, we present the state of the art and propose guidelines for the best practice, according different evidence based degrees, with the intention to provide help at the professionals in order to make aproppiate decissions. Several quality standars are also included.

Examples of Rate-Theory Constitutive Equations Which Unify Elasticity and Plasticity

DTIC Science & Technology

1979-01-01

8217%LEYEI IAD- E Y.30Ol CONTRACT REPORT ARBRL-CR-00389 0"I o EXAMPLES OF RATE-THEORY CONSTITUTIVE p. EQUATIONS WHICH UNIFY ELASTICITY AND PLASTICITY...of Coomerce , Springfield, Virginia 22161. ° 1I The findings in this report are not to be coustrued as an official Department of the Army position...unless so designated by other authorized docunents. ’rows )J wJ e -Aumiei or xiiiif~atwui.. ’ , j~w i th~v rwport do.Jd wro Ln’matitute i ndorvemwvstI of

78 FR 12600 - VA Homeless Providers Grant and Per Diem Program

Federal Register 2010, 2011, 2012, 2013, 2014

2013-02-25

... documentation of a formal assessment on a standardized scale of any serious symptomatology or serious impairment... involved in making life decisions that will increase self-determination. (7) The measureable objectives...

37 CFR 2.190 - Addresses for trademark correspondence with the United States Patent and Trademark Office.

Code of Federal Regulations, 2014 CFR

2014-07-01

... recordation; requests for copies of trademark documents; and certain documents filed under the Madrid Protocol... to review an action of the Office's Madrid Processing Unit, when filed by mail, must be mailed to: Madrid Processing Unit, 600 Dulany Street, MDE-7B87, Alexandria, VA 22314-5793. [68 FR 48289, Aug. 13...

37 CFR 2.190 - Addresses for trademark correspondence with the United States Patent and Trademark Office.

Code of Federal Regulations, 2013 CFR

2013-07-01

... recordation; requests for copies of trademark documents; and certain documents filed under the Madrid Protocol... to review an action of the Office's Madrid Processing Unit, when filed by mail, must be mailed to: Madrid Processing Unit, 600 Dulany Street, MDE-7B87, Alexandria, VA 22314-5793. [68 FR 48289, Aug. 13...

37 CFR 2.190 - Addresses for trademark correspondence with the United States Patent and Trademark Office.

Code of Federal Regulations, 2011 CFR

2011-07-01

... recordation; requests for copies of trademark documents; and certain documents filed under the Madrid Protocol... to review an action of the Office's Madrid Processing Unit, when filed by mail, must be mailed to: Madrid Processing Unit, 600 Dulany Street, MDE-7B87, Alexandria, VA 22314-5793. [68 FR 48289, Aug. 13...

37 CFR 2.190 - Addresses for trademark correspondence with the United States Patent and Trademark Office.

Code of Federal Regulations, 2012 CFR

2012-07-01

... recordation; requests for copies of trademark documents; and certain documents filed under the Madrid Protocol... to review an action of the Office's Madrid Processing Unit, when filed by mail, must be mailed to: Madrid Processing Unit, 600 Dulany Street, MDE-7B87, Alexandria, VA 22314-5793. [68 FR 48289, Aug. 13...

37 CFR 2.190 - Addresses for trademark correspondence with the United States Patent and Trademark Office.

Code of Federal Regulations, 2010 CFR

2010-07-01

... filed through the Office's web site, at http://www.uspto.gov. Paper documents and cover sheets to be... trademark documents can be ordered through the Office's web site at www.uspto.gov. Paper requests for...: Madrid Processing Unit, 600 Dulany Street, MDE-7B87, Alexandria, VA 22314-5793. [68 FR 48289, Aug. 13...

JPRS Report, Science & Technology, China: Energy

DTIC Science & Technology

1989-06-26

certain areas such as modular HTGR technology. In nuclear power develop - ment we currently face both challenges and opportunities, both risks and...22161 JmC QUALITY EJSPSÜSED 3 Science & Technology China: Energy JPRS-CEN-89-006 CONTENTS 26 June 1989 NATIONAL DEVELOPMENTS No Easy Solution Seen...Be Developed [XINHUA, 16 May 89] 21 National Oil Firm Sets 5-Year Goals [CEI Database, 9 May 89] , 21 Zhongyuan Oil Field Is Among Fastest

JPRS Report. Science & Technology, USSR: Engineering & Equipment.

DTIC Science & Technology

1988-12-19

unlimited Science & Technology USSR: Engineering & Equipment ^PRODUCED BY ^J’ODNALTECSL OF AMERCE SPR/NGnEL^ff’^1-INFORMATION S 22161 SERVICE...rv> DTIC QUALITY mSHBOTSD j5 Science & Technology USSR: Engineering & Equipment JPRS-UEQ-88-006 CONTENTS 19 DECEMBER 1988 Nuclear Energy Fuel...PROMYSHLENNOST, No 4, Apr 88] 36 Determining the Demand for Automated Foundry Equipment [A.A. Panov; MEKHAN1ZATS1YA IAVTOMATIZATSIYA PROIZVODSTVA, Apr 88] 40

China Report, Political, Sociological and Military Affairs, No. 428

DTIC Science & Technology

1983-06-09

Appeared for pabüw reime«? Dbrtrtbutlam üaUmltad ^ 99806 7 7 m FBIS FOREIGN BROADCAST INFORMATION SERVICE NOTE JPRS publications contain...JPRS publications may be ordered from the National Technical Information Service , Springfield, Virginia 22161. In order- ing, it is recommended that...Announcements issued semi-monthly by the National Technical Information Service , and are listed in the Monthly Catalog of U.S. Government Publications

Vietnam Report, Number 2393, Tap Chi Cong San, Number 6, June 1982.

DTIC Science & Technology

1982-09-14

PROCUREMENT OF PUBLICATIONS JPRS publications may be ordered from the National Technical Information Service, Springfield, Virginia 22161. In order- ing, it...to matters other than procurement may be addressed to Joint Publications Research Service, 1000 North Glebe Road, Arlington, Virginia 22201. JPRS...concentrate all efforts on preventing the other side from making a wrong move, thereby formulating a constructive solution to the replacement of the arms

JPRS Report, East Europe.

DTIC Science & Technology

1991-06-26

22161 East Europe JPRS-EER-91-092 CONTENTS 26 June 1991 BULGARIA Decision of Social Democratic Leadership Published [SVOBODEN NAROD 18 Jun] 1...POLITIKA 10 Jun] 26 Economic Situation in Bosnia Discussed [BORBA 12 Jun] 27 JPRS-EER-91-092 26 June 1991 BULGARIA Decision of Social Democratic ... Leadership Published AU2406192291 Sofia SVOBODENNAROD in Bulgarian 18 Jun 91 p 1 ["Text" of a decision issued at the regular session of the

Noise Abatement Technology Options for Conventional Turboprop Airplanes.

DTIC Science & Technology

1981-06-01

Noise Reduction Service, Springfield, Virginia 22161. Cost/ Benefit 19. Security cIosoil. (of Ohio rope$) 30. Securityr Clesoi. (of IN ae go ) 21. Mo. of...Aircraft ......... .................. 2 1.3 Cost and Performance Effects ... ........ 5 1.4 Cost/ Benefit Relationships .... ......... 6 1.5 Stage 3 Noise...5.4 Measures of Noise Benefits ..... ..... 84 5.4.1 Effective Perceived Noise Levels For FAR Part 36 Conditions ... ........ 84 5.4.2 Area Enclosed by

What Aircrews Should Know About Their Occupational Exposure to Ionizing Radiation

DTIC Science & Technology

2003-10-01

aircrews, and their children irradiated in utero , the principal health concern is a small increase in the lifetime risk of fatal cancer . For both of...from cancer : adults, p.301; all ages, p.303. — Risks from irradiation in utero , p.302. — Inherited genetic defects from parental...Aircrews, Ionizing Radiation, Galactic Cosmic Radiation, Cancer Risk, Hereditary Risks, Radiation Exposure Limits Springfield, Virginia 22161 19

PlateRunner: A Search Engine to Identify EMR Boilerplates.

PubMed

Divita, Guy; Workman, T Elizabeth; Carter, Marjorie E; Redd, Andrew; Samore, Matthew H; Gundlapalli, Adi V

2016-01-01

Medical text contains boilerplated content, an artifact of pull-down forms from EMRs. Boilerplated content is the source of challenges for concept extraction on clinical text. This paper introduces PlateRunner, a search engine on boilerplates from the US Department of Veterans Affairs (VA) EMR. Boilerplates containing concepts should be identified and reviewed to recognize challenging formats, identify high yield document titles, and fine tune section zoning. This search engine has the capability to filter negated and asserted concepts, save and search query results. This tool can save queries, search results, and documents found for later analysis.

Modeling and Characterization of Microbarom Signals in the Pacific

DTIC Science & Technology

2006-09-01

MS 6201 Fort Belvoir, VA 22060-6201 Form Approved REPORT DOCUMENTATION PAGE OMB No. 0704-0188 Public reporting burden for this collection of...maintaining the data needed, and completing and reviewing this collection of information. Send comments regarding this burden estimate or any other aspect of...this collection of information, including suggestions for reducing this burden to Department of Defense, Washington Headquarters Services

78 FR 37710 - Safety Zone; Wicomico Community Fireworks Rain Date, Great Wicomico River, Heathsville, VA

Federal Register 2010, 2011, 2012, 2013, 2014

2013-06-24

...: Coast Guard, DHS. ACTION: Temporary Final rule. SUMMARY: The Coast Guard is establishing a temporary... event Rain Date. This action is necessary to provide for the safety of life on navigable waters during.... DATES: This rule is effective on July 7, 2013, from 9 p.m. to 10 p.m. ADDRESSES: Documents indicated in...

76 FR 3601 - Codex Alimentarius Commission: Meeting of the Codex Committee on Pesticide Residues

Federal Register 2010, 2011, 2012, 2013, 2014

2011-01-20

..., One Potomac Yard, Room S-7100, 2777 South Crystal Drive, Arlington, VA 22202. Documents related to the..., color, national origin, gender, religion, age, disability, political beliefs, sexual orientation, and...

630 kVA high temperature superconducting transformer

NASA Astrophysics Data System (ADS)

Zueger, H.

This document describes the 630 KVA HTS transformer project made by ABB jointly with EDF and ASC. The project started April 1994 and its goal was to manufacture a real scale superconducting distribution transformer and to operate it during one year in the grid of Geneva's utility (SIG). The conclusion highlights the future perspective of HTS transformers.

76 FR 30020 - Safety Zone; Wicomico Community Fireworks, Great Wicomico River, Mila, VA

Federal Register 2010, 2011, 2012, 2013, 2014

2011-05-24

.... ACTION: Temporary final rule. SUMMARY: The Coast Guard is establishing a temporary safety zone on the.... This action is necessary to provide for the safety of life on navigable waters during the Wicomico... rule is effective from 9 p.m. on July 2, 2011, until 10 p.m. on July 3, 2011. ADDRESSES: Documents...

Dysregulated microRNA activity in Shwachman-Diamond Syndrome

DTIC Science & Technology

2017-09-01

Army position, policy or decision unless so designated by other documentation. REPORT DOCUMENTATION PAGE Form Approved OMB No . 0704-0188 Public...Arlington, VA 22202-4302. Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for...commitment, and found that SDS hematopoiesis was left-shifted with selective loss of granulocyte-monocyte progenitors (GMPs). Differential gene

A pilot study of a heuristic algorithm for novel template identification from VA electronic medical record text.

PubMed

Redd, Andrew M; Gundlapalli, Adi V; Divita, Guy; Carter, Marjorie E; Tran, Le-Thuy; Samore, Matthew H

2017-07-01

Templates in text notes pose challenges for automated information extraction algorithms. We propose a method that identifies novel templates in plain text medical notes. The identification can then be used to either include or exclude templates when processing notes for information extraction. The two-module method is based on the framework of information foraging and addresses the hypothesis that documents containing templates and the templates within those documents can be identified by common features. The first module takes documents from the corpus and groups those with common templates. This is accomplished through a binned word count hierarchical clustering algorithm. The second module extracts the templates. It uses the groupings and performs a longest common subsequence (LCS) algorithm to obtain the constituent parts of the templates. The method was developed and tested on a random document corpus of 750 notes derived from a large database of US Department of Veterans Affairs (VA) electronic medical notes. The grouping module, using hierarchical clustering, identified 23 groups with 3 documents or more, consisting of 120 documents from the 750 documents in our test corpus. Of these, 18 groups had at least one common template that was present in all documents in the group for a positive predictive value of 78%. The LCS extraction module performed with 100% positive predictive value, 94% sensitivity, and 83% negative predictive value. The human review determined that in 4 groups the template covered the entire document, with the remaining 14 groups containing a common section template. Among documents with templates, the number of templates per document ranged from 1 to 14. The mean and median number of templates per group was 5.9 and 5, respectively. The grouping method was successful in finding like documents containing templates. Of the groups of documents containing templates, the LCS module was successful in deciphering text belonging to the template and text that was extraneous. Major obstacles to improved performance included documents composed of multiple templates, templates that included other templates embedded within them, and variants of templates. We demonstrate proof of concept of the grouping and extraction method of identifying templates in electronic medical records in this pilot study and propose methods to improve performance and scaling up. Published by Elsevier Inc.

Functional and visual acuity outcomes of cataract surgery in Timor-Leste (East Timor).

PubMed

Naidu, Girish; Correia, Marcelino; Nirmalan, Praveen; Verma, Nitin; Thomas, Ravi

2014-12-01

To report functional outcomes following cataract surgery in Timor-Leste. Pre- and post-intervention study measuring visual function improvement following cataract surgery. Presenting visual acuity (VA) was measured and visual function documented using the Indian vision function questionnaire (IND-VFQ). All 174 persons undergoing cataract surgery from November 2009 to January 2011 in Timor-Leste were included. Mean age was 65.4 years; 113 (64.9%) were male, 143 (82.1%) were from a rural background and 151 (86.8%) were illiterate. Pre-operatively, 77 of 174 patients (44.3%, 95% confidence interval, CI, 37.0-51.7%) were blind (VA ≤3/60), 77 (44.3%, 95% CI 37.0-51.7%) were visually impaired (VA <6/18->3/60), while 20 (11.5%, 95% CI 7.4-16.9%) had presenting acuity ≥6/18 in the better eye. Following surgery, significant improvement in visual function was demonstrated by an effect size of 2.8, 3.7 and 3.9 in the domains of general functioning, psychosocial impact and visual symptoms, respectively. Four weeks following surgery, 85 patients (48.9%, 95% CI 41.5-66.3%) had a presenting VA ≥6/18, 74 (42.5%, 95% CI 35.3-45.9%) were visually impaired and 15 (8.6%, 95% CI 5.0-13.6%) were blind. IND-VFQ improvement occurred even in patients remaining visually impaired or blind following surgery. In this setting, cataract surgery led to a significant improvement in visual function but the VA results did not meet World Health Organization quality criteria. IND-VFQ results, although complementary to clinical VA outcomes did not, in isolation, reflect the need to improve program quality.

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

Impact of presumed service-connected diagnosis on the Department of Veterans Affairs healthcare utilization patterns of Vietnam-Theater Veterans

PubMed Central

Fried, Dennis A.; Rajan, Mangala; Tseng, Chin-lin; Helmer, Drew

2018-01-01

Abstract During the Vietnam War, the US military sprayed almost 20 million gallons of Agent Orange (AO), an herbicide contaminated with dioxin, over Vietnam. Approximately, 2.7 million US military personnel may have been exposed to AO during their deployment. Ordinarily, veterans who can demonstrate a nexus between a diagnosed condition and military service are eligible for Department of Veterans Affairs (VA) service-connected disability compensation. Vietnam Veterans have had difficulty, however, establishing a nexus between AO exposure and certain medical conditions that developed many years after the war. In response, VA has designated certain conditions as “presumed service connected” for Vietnam Veterans who were present and possibly exposed. Veterans with any of these designated conditions do not have to document AO exposure, making it easier for them to access the VA disability system. The extent to which VA healthcare utilization patterns reflect easier access afforded those with diagnosed presumptive conditions remains unknown. In this cross-sectional study, we hypothesized that Vietnam Veterans with diagnosed presumptive conditions would be heavier users of the VA healthcare system than those without these conditions. In our analysis of 85,699 Vietnam Veterans, we used binary and cumulative logit multivariable regression to assess associations between diagnosed presumptive conditions and VA healthcare utilization in 2013. We found that diagnosed presumptive conditions were associated with higher odds of 5+ VHA primary care visits (OR = 2.01, 95% CI: 1.93–2.07), 5+ specialty care visits (OR = 2.11, 95% CI: 2.04–2.18), emergency department use (OR = 1.22, 95% CI: 1.11–1.34), and hospitalization (OR = 1.23, 95% CI: 1.17–1.29). Consistent with legislative intent, presumptive policies appear to facilitate greater VA system utilization for Vietnam Veterans who may have been exposed to AO. PMID:29742706

Multimorbidity and healthcare utilisation among high-cost patients in the US Veterans Affairs Health Care System

PubMed Central

Zulman, Donna M; Pal Chee, Christine; Wagner, Todd H; Yoon, Jean; Cohen, Danielle M; Holmes, Tyson H; Ritchie, Christine; Asch, Steven M

2015-01-01

Objectives To investigate the relationship between multimorbidity and healthcare utilisation patterns among the highest cost patients in a large, integrated healthcare system. Design In this retrospective cross-sectional study of all patients in the U.S. Veterans Affairs (VA) Health Care System, we aggregated costs of individuals’ outpatient and inpatient care, pharmacy services and VA-sponsored contract care received in 2010. We assessed chronic condition prevalence, multimorbidity as measured by comorbidity count, and multisystem multimorbidity (number of body systems affected by chronic conditions) among the 5% highest cost patients. Using multivariate regression, we examined the association between multimorbidity and healthcare utilisation and costs, adjusting for age, sex, race/ethnicity, marital status, homelessness and health insurance status. Setting USA VA Health Care System. Participants 5.2 million VA patients. Measures Annual total costs; absolute and share of costs generated through outpatient, inpatient, pharmacy and VA-sponsored contract care; number of visits to primary, specialty and mental healthcare; number of emergency department visits and hospitalisations. Results The 5% highest cost patients (n=261 699) accounted for 47% of total VA costs. Approximately two-thirds of these patients had chronic conditions affecting ≥3 body systems. Patients with cancer and schizophrenia were less likely to have documented comorbid conditions than other high-cost patients. Multimorbidity was generally associated with greater outpatient and inpatient utilisation. However, increased multisystem multimorbidity was associated with a higher outpatient share of total costs (1.6 percentage points per affected body system, p<0.01) but a lower inpatient share of total costs (−0.6 percentage points per affected body system, p<0.01). Conclusions Multisystem multimorbidity is common among high-cost VA patients. While some patients might benefit from disease-specific programmes, for most patients with multimorbidity there is a need for interventions that coordinate and maximise efficiency of outpatient services across multiple conditions. PMID:25882486

Impact of presumed service-connected diagnosis on the Department of Veterans Affairs healthcare utilization patterns of Vietnam-Theater Veterans: A cross-sectional study.

PubMed

Fried, Dennis A; Rajan, Mangala; Tseng, Chin-Lin; Helmer, Drew

2018-05-01

During the Vietnam War, the US military sprayed almost 20 million gallons of Agent Orange (AO), an herbicide contaminated with dioxin, over Vietnam. Approximately, 2.7 million US military personnel may have been exposed to AO during their deployment. Ordinarily, veterans who can demonstrate a nexus between a diagnosed condition and military service are eligible for Department of Veterans Affairs (VA) service-connected disability compensation. Vietnam Veterans have had difficulty, however, establishing a nexus between AO exposure and certain medical conditions that developed many years after the war. In response, VA has designated certain conditions as "presumed service connected" for Vietnam Veterans who were present and possibly exposed. Veterans with any of these designated conditions do not have to document AO exposure, making it easier for them to access the VA disability system. The extent to which VA healthcare utilization patterns reflect easier access afforded those with diagnosed presumptive conditions remains unknown. In this cross-sectional study, we hypothesized that Vietnam Veterans with diagnosed presumptive conditions would be heavier users of the VA healthcare system than those without these conditions. In our analysis of 85,699 Vietnam Veterans, we used binary and cumulative logit multivariable regression to assess associations between diagnosed presumptive conditions and VA healthcare utilization in 2013. We found that diagnosed presumptive conditions were associated with higher odds of 5+ VHA primary care visits (OR = 2.01, 95% CI: 1.93-2.07), 5+ specialty care visits (OR = 2.11, 95% CI: 2.04-2.18), emergency department use (OR = 1.22, 95% CI: 1.11-1.34), and hospitalization (OR = 1.23, 95% CI: 1.17-1.29). Consistent with legislative intent, presumptive policies appear to facilitate greater VA system utilization for Vietnam Veterans who may have been exposed to AO.

The Shipbuilding Technology Transfer Program, Program Summary Report

DTIC Science & Technology

1981-08-31

Davis Highway, Suite 1204, Arlington VA 22202-4302. Respondents should be aware that notwithstanding any other provision of law, no person shall be...NAME OF RESPONSIBLE PERSON a. REPORT unclassified b. ABSTRACT unclassified c. THIS PAGE unclassified Standard Form 298 (Rev. 8-98) Prescribed...Information for this study was derived from source documentation sup- plied by IHI, information obtained directly from IHI consulting person - nel

Continuing Education in the Era of Quantum Change. 2003 ACHE Proceedings. (65th Annual Meeting, Charlottesville, VA, November 8-12, 2003)

ERIC Educational Resources Information Center

Barrineau, Irene T., Ed.

2003-01-01

This document presents the proceedings of the 2003 annual meeting of the Association for Continuing Higher Education (ACHE). These proceedings record the 65th Annual Meeting of ACHE held in Charlottesville, Virginia. President Allen Varner's theme for this annual meeting was, "Continuing Education in the Era of Quantum Change." The theme…

Victorian Audit of Surgical Mortality is associated with improved clinical outcomes.

PubMed

Beiles, C Barry; Retegan, Claudia; Maddern, Guy J

2015-11-01

Improved outcomes are desirable results of clinical audit. The aim of this study was to use data from the Victorian Audit of Surgical Mortality (VASM) and the Victorian Admitted Episodes Dataset (VAED) to highlight specific areas of clinical improvement and reduction in mortality over the duration of the audit process. This study used retrospective, observational data from VASM and VAED. VASM data were reported by participating public and private health services, the Coroner and self-reporting surgeons across Victoria. Aggregated VAED data were supplied by the Victorian Department of Health. Assessment of outcomes was performed using chi-squared trend analysis over successive annual audit periods. Because initial collection of data was incomplete in the recruitment phase, statistical analysis was confined to the last 3-year period, 2010-2013. A 20% reduction in surgical mortality over the past 5 years has been identified from the VAED data. Progressive increase in both surgeon and hospital participation, significant reduction in both errors in management as perceived by assessors and increased direct consultant involvement in cases returned to theatre have been documented. The benefits of VASM are reflected in the association with a reduction of mortality and adverse clinical outcomes, which have clinical and financial benefits. It is a purely educational exercise and continued participation in this audit will ensure the highest standards of surgical care in Australia. This also highlights the valuable collaboration between the Victorian Department of Health and the RACS. © 2014 Royal Australasian College of Surgeons.

Regional Anesthesia and Valproate Sodium for the Prevention of Chronic Post-Amputation Pain

DTIC Science & Technology

2013-10-01

revised documents August Non-perishable Supplies ordered & received DUKE IRB approved study via expedited review September Submitted all revisions...2013 February March April May June July August September October HRPO request for revised, addtn’l docs VA approved protocol...A few candidate gene polymorphisms have been linked to pain susceptibility, including catechol-O-methyltranferase ( COMT ). This gene modulates

Penaid Nonproliferation: Hindering the Spread of Countermeasures Against Ballistic Missile Defenses

DTIC Science & Technology

2014-01-01

50 Penaid Nonproliferation: Hindering the Spread of Countermeasures Against Ballistic Missile Defenses 42 /2010! Plume Signature Control...and Richard Speier, “Penaid Nonproliferation: Analysis and Recommendations,” briefing, Veridian Corp., Arlington, Va., June 29, 2000. “ Missile ...is a nonprofit institution that helps improve policy and decisionmaking through research and analysis . This electronic document was made available

USAF Bioenvironmental Noise Data Handbook. Volume 172. Hush-House Noise Suppressor (Aero Systems Engineering, Inc.) Far-Field Noise.

DTIC Science & Technology

1982-07-01

other data are used for any purpose other than a definitely related Government procurement operation, the GoverMent, therebY incur no responsiblity...Royal Road Springfield, Virginia 22161 Federal Government agencies and their contractors registered with Defense 1Tcbnlcal information Center should...As Specified in ANSI Standard Number S1.4-(R1976) PNLT Tone Corrected Perceived Noise Level As Specified in Federal Aviation Regulation (FAR) Part 36

Headquarters, 172nd Military Airlift Group Mississippi Air National Guard, A.C. Thompson Field, Jackson, Mississippi

DTIC Science & Technology

1988-07-01

purchased from: National Technical Information Service 5285 Port Royal Road Springfield, Virginia 22161 Federal Government agencies and their contractors...Bi-1 APPDFrMIX A - Restaes of Search Team V?_7ibers .... .............. ... A-i APP2-EDIX B - Outside Agency Contact List...ANGB, ,when the land at Site No. 1, which was owned by the city of 3 Jackson, was leased to the National Weather Service . A mre elaborate systz of

Clinical and radiological outcomes following traumatic Grade 3 and 4 vertebral artery injuries: a 10-year retrospective analysis from a Level I trauma center. The Parkland Carotid and Vertebral Artery Injury Survey.

PubMed

Scott, William W; Sharp, Steven; Figueroa, Stephen A; Eastman, Alexander L; Hatchette, Charles V; Madden, Christopher J; Rickert, Kim L

2015-05-01

Grade 3 and 4 blunt vertebral artery (VA) injuries may carry a different natural course from that of lower-grade blunt VA injuries. Proper screening, management, and follow-up of these injuries remain controversial. Grade 3 and 4 blunt VA injuries were analyzed to define their natural history and establish a rational management plan based on lesion progression and cerebral infarction. A retrospective review of a prospectively maintained database of all blunt traumatic carotid and vertebral artery injuries from August 2003 to April 2013 was performed, and Grade 3 and 4 blunt VA injuries were identified. Grade 3 injuries were defined as stenosis of the vessel greater than 50% or the development of a pseudoaneurysm, and Grade 4 injuries were defined as complete vessel occlusion. Demographic information, radiographic imaging findings, number of imaging sessions performed per individual, length of radiographic follow-up, radiographic outcome at end of follow-up, treatment(s) provided, and documentation of ischemic stroke or transient ischemic attack were recorded. A total of 79 high-grade (Grade 3 and 4) blunt VA injuries in 67 patients were identified. Fifty-nine patients with 66 high-grade blunt VA injuries were available for follow-up. There were 17 patients with 23 Grade 3 injuries and 42 patients with 43 Grade 4 injuries. The mean follow-up duration was 58 days for Grade 3 and 67 days for Grade 4 blunt VA injuries. Repeat imaging of Grade 3 blunt VA injuries showed that 39% of injuries were radiographically stable, 43% resolved, and 13% improved, while 1 injury radiographically worsened. Repeat imaging of the Grade 4 blunt VA injuries showed that 65% of injuries were radiographically stable (persistent occlusion), 30% improved (recanalization of the vessel), and in 2 cases (5%) the injury resolved. All Grade 3 injuries that were treated were managed with aspirin or clopidogrel alone, as were the majority of Grade 4 injuries. There were 3 cerebral infarctions thought to be related to Grade 4 blunt VA injuries, which were likely present on admission. All 3 of these patients died at a mean of 13.7 days after hospital admission. No cerebral infarctions directly related to Grade 3 blunt VA injuries were identified. The majority of high-grade blunt VA injuries remain stable or are improved at final follow-up. Despite a 4% rate of radiographic worsening in the Grade 3 blunt VA injury group and a 35% recanalization rate in the Grade 4 blunt VA injury group, there were no adverse clinical outcomes associated with these radiographic changes. No cerebral infarctions were noted in the Grade 3 group. A 7% stroke rate was identified in the Grade 4 blunt VA injury group; however, this was confined to the immediate postinjury period and was associated with 100% mortality. While these data suggest that these high-grade vertebral artery injuries may require less intensive radiographic follow-up, future prospective studies are needed to make conclusive changes related to treatment and management.

NASA Automated Rendezvous and Capture Review. A compilation of the abstracts

NASA Technical Reports Server (NTRS)

1991-01-01

This document presents a compilation of abstracts of papers solicited for presentation at the NASA Automated Rendezvous and Capture Review held in Williamsburg, VA on November 19-21, 1991. Due to limitations on time and other considerations, not all abstracts could be presented during the review. The organizing committee determined however, that all abstracts merited availability to all participants and represented data and information reflecting state-of-the-art of this technology which should be captured in one document for future use and reference. The organizing committee appreciates the interest shown in the review and the response by the authors in submitting these abstracts.

Unhealthy alcohol use in older adults: Association with readmissions and emergency department use in the 30 days after hospital discharge☆

PubMed Central

Chavez, Laura J.; Liu, Chuan-Fen; Tefft, Nathan; Hebert, Paul L; Clark, Brendan J.; Rubinsky, Anna D.; Lapham, Gwen T.; Bradley, Katharine A.

2016-01-01

Background Unhealthy alcohol use could impair recovery of older patients after medical or surgical hospitalizations. However, no prior research has evaluated whether older patients who screen positive for unhealthy alcohol use are at increased risk of readmissions or emergency department (ED) visits within 30 days after discharge. This study examined the association between AUDIT-C alcohol screening results and 30-day readmissions or ED visits. Methods Veterans Affairs (VA) patients age 65 years or older, were eligible if they were hospitalized for a medical or surgical condition (2/1/2009–10/1/2011) and had an AUDIT-C score documented in their VA electronic medical record in the year before they were hospitalized. VA and Medicare data identified VA or non-VA index hospitalizations, readmissions, and ED visits. Primary analyses adjusted for demographics, comorbid conditions, and past-year health care utilization. Results Among 579,330 hospitalized patients, 13.7% were readmitted and 12.0% visited an ED within 30 days of discharge. In primary analyses, high-risk drinking (n = 7167) and nondrinking (n =357,086) were associated with increased probability of readmission (13.8%, 95% CI 13.0–14.6%; and 14.2%, 95% CI 14.1–14.3%, respectively), relative to low-risk drinking (12.9%; 95% CI 12.7–13.0%). Only nondrinkers had increased risk for ED visits. Conclusions Alcohol screening results indicating high-risk drinking that were available in medical records were modestly associated with risk for 30-day readmissions and were not associated with risk for ED visits. PMID:26644137

Does compliance with amblyopia management improve following supervised occlusion treatment?

PubMed

El-Ghrably, I A; Longville, D; Gnanaraj, L

2007-01-01

To demonstrate improvement in compliance following supervised occlusion therapy for amblyopia in children who had failed to respond to outpatient treatment. Retrospective review of the visual outcome of 30 children who were admitted to an ophthalmology ward for 1-day intensive supervised occlusion. These children had documented poor compliance and previously failed to respond to the outpatient occlusion treatment. During their stay a trained ophthalmology nurse educated parents regarding amblyopia and the benefits of occlusion therapy. Visual acuity (VA) of the amblyopic and fellow eyes was recorded on admission, discharge, and at each subsequent visit. The compliance was recorded from parent's history and also indirectly by noticing improvement in vision. The mean supervised occlusion was 7.4 hours (range 4-12 hours). The compliance with occlusion therapy improved in 23 children (77%) after discharge. The mean duration of occlusion after discharge improved to 4 hours (range 1-12 hours). The mean follow-up was 18 months (range 4-24 months). Though there was no dramatic improvement in VA at discharge there was a statistically significant improvement in VA between admission and last recorded VA (p<0.0001). Of the 23 children who were compliant with occlusion following discharge, 21 (91%) gained at least one line of acuity in their amblyopic eye on the last assessment of their VA and five of them achieved 6/12. Of the seven children who did not comply with occlusion following discharge, only one patient gained one line improvement in his amblyopic eye. This study shows that supervised occlusion treatment and parental education was effective in children who had initially failed traditional outpatient treatment.

Exploiting Captions for Access to Multimedia Databases

DTIC Science & Technology

1991-04-01

Sherman Gee ONT-221 Chief of Naval Research 800 N. Quincy Street Arlington, VA 2217-5000 Leah Wong Code 443 Command and Control Departments Naval...This report was prepared in conjunction with research funded by the Naval Postgraduate School un- der Direct Funding. Reproduction of all or part of this...MCGHEE P.-MAR Chairman Dean of Research Department of Computer Science UNCLASSIFIED SECURIHY CLASSIFICATION 1 RTIS PAGE REPORT DOCUMENTATION PAGE la

Data breaches. Final rule.

PubMed

2008-04-11

This document adopts, without change, the interim final rule that was published in the Federal Register on June 22, 2007, addressing data breaches of sensitive personal information that is processed or maintained by the Department of Veterans Affairs (VA). This final rule implements certain provisions of the Veterans Benefits, Health Care, and Information Technology Act of 2006. The regulations prescribe the mechanisms for taking action in response to a data breach of sensitive personal information.

How to make the most of failure mode and effect analysis.

PubMed

Stalhandske, Erik; DeRosier, Joseph; Patail, Bryanne; Gosbee, John

2003-01-01

Current accreditation standards issued by the Joint Commission for the Accreditation of Healthcare Organizations (JCAHO) require hospitals to carry out a proactive risk assessment on at least 1 high-risk activity each year for each accredited program. Because hospital risk managers and patient safety managers generally do not have the knowledge or level of comfort for conducting a proactive risk assessment, they will appreciate the expertise offered by biomedical equipment technicians (BMETs), occupational safety and health professionals, and others. The skills that have been developed by BMETs and others while conducting job safety analyses or failure mode effect analysis can now be applied to a health care proactive analysis. This article touches on the Health Care Failure Mode and Effect Analysis (HFMEA) model that the Department of Veterans Affairs (VA) National Center for Patient Safety developed for proactive risk assessment within the health care community. The goal of this article is to enlighten BMETs and others on the growth of proactive risk assessment within health care and also on the support documents and materials produced by the VA. For additional information on HFMEA, visit the VA website at www.patientsafety.gov/HFMEA.html.

Measuring Use of Evidence-Based Psychotherapy for PTSD in VA Residential Treatment Settings with Clinician Survey and Electronic Medical Record Templates.

PubMed

Shiner, Brian; Leonard Westgate, Christine; Simiola, Vanessa; Thompson, Richard; Schnurr, Paula P; Cook, Joan M

2018-03-14

Available studies on implementation of evidence-based psychotherapy (EBP) for patients attending Department of Veterans Affairs (VA) residential post-traumatic stress disorder (PTSD) programs rely on therapist self-report of EBP delivery. Patient-level data on receipt of EBP are needed both to corroborate therapist self-report and to understand patient factors that predict receipt of EBPs for PTSD. We identified 159 therapists from 38 VA residential PTSD programs who responded to a survey about EBP implementation during the 2015 fiscal year (FY15). Therapists self-reported their use of two EBPs, including prolonged exposure delivered in an individual format (PE-I) and cognitive processing therapy delivered in individual and group formats (CPT-I and CPT-G). Using electronic medical record (EMR) templates mandated for EBP documentation in FY15, we measured contemporaneous patient-level receipt of EBPs for PTSD. We assessed the degree of correlation between therapist self-reported EBP delivery and patient receipt of EBT as measured by EMR templates using polychoric correlation coefficients. We determined patient and therapist factors that predicted the receipt of EBPs with multivariable logistic regression, using random effects and robust standard error estimation, and controlling for site. The Veterans IRB of Northern New England provided a waiver of informed consent; as this was a retrospective review, no patients or therapists were contacted, and all data were stored, transmitted, and analyzed on secure VA servers. The VA Connecticut Health Care System Human Research Protection Program approved secondary use of therapist survey data for this project. When EMR template use became mandated in FY15, the proportion of patients in residential PTSD programs who received at least one EBP session that was recorded with an EMR template increased dramatically from 8.8% to 33.9%. There was adequate correlation and between survey-based and EMR-based measures of EBP receipt, with polychoric correlation values of 0.77 for PE-I, 0.69 for CPT-I, and 0.82 for CPT-G. Multiple patient factors were positive (e.g., female gender) and negative (e.g., depressive disorders) predictors of receipt of EBPs, even after controlling for site. Among therapist factors, only EBP consultant or trainer status was a positive predictor of EBP provision and only therapist race was a negative predictor of EBT provision after controlling for site. Following a FY15 mandate, EMR templates documenting EBP delivery were widely used by therapists working in VA residential PTSD programs. EBP receipt measured using EMR templates was consistent with therapist self-report of EBT delivery. There were several patient-level predictors of EBP receipt and therapist-level predictors of EBP delivery. However, therapists most likely to deliver EBPs were clustered at a limited number of sites.

Integration of Information Operations in Combat

DTIC Science & Technology

2008-12-01

provided ground truth and accurate reporting of critical events from the local population’s perspective . JCO teams organized into functional areas to...INTENTIONALLY LEFT BLANK i REPORT DOCUMENTATION PAGE Form Approved OMB No. 0704-0188 Public reporting burden for this collection of information is...Operations and Reports , 1215 Jefferson Davis Highway, Suite 1204, Arlington, VA 22202-4302, and to the Office of Management and Budget, Paperwork Reduction

Catalog of War Games

DTIC Science & Technology

1992-10-09

PROGRAM CATALOG OF WAR GAMES 92-30805 U *3fl91\\k~o 9 2 SECURITY CLASSIFICATION OF THIS PAGE I ,i REPORT DOCUMENTATION PAGE la. REPORT SECURITY...4401 Ford Ave ELEMENT NO. NO. NO. ACCESSION NO. AIyxndriA. VA 229i2-14O1 --. 11. TITLE (Include Security Classification) Catalog of War Games 12...SCURITY CLASSIFICATiON OF THIS PAGE DECLARATION OF ACCORD 1. PURPOSE This catalog provides information on the primary war games , combat simulations

The process of implementing a rural VA wound care program for diabetic foot ulcer patients.

PubMed

Reiber, Gayle E; Raugi, Gregory J; Rowberg, Donald

2007-10-01

Delivering and documenting evidence-based treatment to all Department of Veterans Affairs (VA) foot ulcer patients has wide appeal. However, primary and secondary care medical centers where 52% of these patients receive care are at a disadvantage given the frequent absence of trained specialists to manage diabetic foot ulcers. A retrospective review of diabetic foot ulcer patient records and a provider survey were conducted to document the foot ulcer problem and to assess practitioner needs. Results showed of the 125 persons with foot ulcers identified through administrative data, only, 21% of diabetic foot patients were correctly coded. Chronic Care and Microsystem models were used to prepare a tailored intervention in a VA primary care medical center. The site Principal Investigators, a multidisciplinary site wound care team, and study investigators jointly implemented a diabetic foot ulcer program. Intervention components include wound care team education and training, standardized good wound care practices based on strong scientific evidence, and a wound care template embedded in the electronic medical record to facilitate data collection, clinical decision making, patient ordering, and coding. A strategy for delivering offloading pressure devices, regular case management support, and 24/7 emergency assistance also was developed. It took 9 months to implement the model. Patients were enrolled and followed for 1 year. Process and outcome evaluations are on-going.

Variations in the implementation and characteristics of chiropractic services in VA.

PubMed

Lisi, Anthony J; Khorsan, Raheleh; Smith, Monica M; Mittman, Brian S

2014-12-01

In 2004, the US Department of Veterans Affairs expanded its delivery of chiropractic care by establishing onsite chiropractic clinics at select facilities across the country. Systematic information regarding the planning and implementation of these clinics and describing their features and performance is lacking. To document the planning, implementation, key features and performance of VA chiropractic clinics, and to identify variations and their underlying causes and key consequences as well as their implications for policy, practice, and research on the introduction of new clinical services into integrated health care delivery systems. Comparative case study of 7 clinics involving site visit-based and telephone-based interviews with 118 key stakeholders, including VA clinicians, clinical leaders and administrative staff, and selected external stakeholders, as well as reviews of key documents and administrative data on clinic performance and service delivery. Interviews were recorded, transcribed, and analyzed using a mixed inductive (exploratory) and deductive approach. Interview data revealed considerable variations in clinic planning and implementation processes and clinic features, as well as perceptions of clinic performance and quality. Administrative data showed high variation in patterns of clinic patient care volume over time. A facility's initial willingness to establish a chiropractic clinic, along with a higher degree of perceived evidence-based and collegial attributes of the facility chiropractor, emerged as key factors associated with higher and more consistent delivery of chiropractic services and higher perceived quality of those services.

38 CFR 26.6 - Environmental documents.

Code of Federal Regulations, 2014 CFR

2014-07-01

...) Environmental Impact Statements. The head of each VA element shall include a detailed written statement “in... Regulations, 40 CFR part 1502. An environmental impact statement shall be prepared in accordance with the following procedures: (1) Typical Classes of Action Which Normally Do Require Environmental Impact...

38 CFR 26.6 - Environmental documents.

Code of Federal Regulations, 2013 CFR

2013-07-01

...) Environmental Impact Statements. The head of each VA element shall include a detailed written statement “in... Regulations, 40 CFR part 1502. An environmental impact statement shall be prepared in accordance with the following procedures: (1) Typical Classes of Action Which Normally Do Require Environmental Impact...

38 CFR 26.6 - Environmental documents.

Code of Federal Regulations, 2012 CFR

2012-07-01

...) Environmental Impact Statements. The head of each VA element shall include a detailed written statement “in... Regulations, 40 CFR part 1502. An environmental impact statement shall be prepared in accordance with the following procedures: (1) Typical Classes of Action Which Normally Do Require Environmental Impact...

The Malaysian Eagle Aerial Reconnaissance Vehicle (ARV)

DTIC Science & Technology

2002-06-01

Santa Monica, CA Report Documentation Page Form ApprovedOMB No . 0704-0188 Public reporting burden for the collection of information is estimated to...Jefferson Davis Highway, Suite 1204, Arlington VA 22202-4302. Respondents should be aware that notwithstanding any other provision of law, no person

Minority Report: Potential Challenges in Employing Global Strike Against Violent Non-State Actors in 2035

DTIC Science & Technology

2012-02-13

for Academic Year 2012, 19 May 2011. 2 Thomas K. Anderson, et al ., Air Force Doctrine Document (AFDD) 3-60: Targeting (Montgomery, AL : Lemay...Gen Robert W. Mixon, et al ., Multi-Service Tactics, Techniques, and Procedures for Targeting Time-Sensitive Targets (Ft Monroe, VA: U.S. Army...intelligence is all-knowing. 26 References Anderson, Thomas K., et al ., Air Force Doctrine Document (AFDD) 3-60: Targeting (Montgomery, AL : Lemay

A Preliminary Assessment of the Regionally Aligned Forces (RAF) Concept’s Implications for Army Personnel Management

DTIC Science & Technology

2015-01-01

Headquarters Services , Directorate for Information Operations and Reports, 1215 Jefferson Davis Highway, Suite 1204, Arlington VA 22202-4302. Respondents should...be aware that notwithstanding any other provision of law , no person shall be subject to a penalty for failing to comply with a collection of...Electronic Distribution Rights This document and trademark(s) contained herein are protected by law . This representation of RAND intellectual

Drug use and HIV risks among migrant workers on the DelMarVa Peninsula.

PubMed

Inciardi, J A; Surratt, H L; Colón, H M; Chitwood, D D; Rivers, J E

1999-01-01

Because high rates of drug use have been documented in the migrant farm worker population, the National Institute on Drug Abuse funded the Migrant Health Study to examine HIV risk behaviors among drug-using farm workers and their sexual partners. Many of these individuals were home-based in South Florida and migrated during the work season to various points along the Eastern Migratory Stream. The focus of this paper is a description of the characteristics and behaviors of the 151 respondents contacted on the DelMarVa Peninsula during 1994 and 1995. The data indicate that drug use was widespread in this population, a significant proportion were at risk for HIV infection, and 6% were HIV positive. As a result of these findings, public health agencies on the peninsula have instituted HIV education programs in those clinics utilized by both local and transient agricultural workers.

Multimorbidity and healthcare utilisation among high-cost patients in the US Veterans Affairs Health Care System.

PubMed

Zulman, Donna M; Pal Chee, Christine; Wagner, Todd H; Yoon, Jean; Cohen, Danielle M; Holmes, Tyson H; Ritchie, Christine; Asch, Steven M

2015-04-16

To investigate the relationship between multimorbidity and healthcare utilisation patterns among the highest cost patients in a large, integrated healthcare system. In this retrospective cross-sectional study of all patients in the U.S. Veterans Affairs (VA) Health Care System, we aggregated costs of individuals' outpatient and inpatient care, pharmacy services and VA-sponsored contract care received in 2010. We assessed chronic condition prevalence, multimorbidity as measured by comorbidity count, and multisystem multimorbidity (number of body systems affected by chronic conditions) among the 5% highest cost patients. Using multivariate regression, we examined the association between multimorbidity and healthcare utilisation and costs, adjusting for age, sex, race/ethnicity, marital status, homelessness and health insurance status. USA VA Health Care System. 5.2 million VA patients. Annual total costs; absolute and share of costs generated through outpatient, inpatient, pharmacy and VA-sponsored contract care; number of visits to primary, specialty and mental healthcare; number of emergency department visits and hospitalisations. The 5% highest cost patients (n=261,699) accounted for 47% of total VA costs. Approximately two-thirds of these patients had chronic conditions affecting ≥3 body systems. Patients with cancer and schizophrenia were less likely to have documented comorbid conditions than other high-cost patients. Multimorbidity was generally associated with greater outpatient and inpatient utilisation. However, increased multisystem multimorbidity was associated with a higher outpatient share of total costs (1.6 percentage points per affected body system, p<0.01) but a lower inpatient share of total costs (-0.6 percentage points per affected body system, p<0.01). Multisystem multimorbidity is common among high-cost VA patients. While some patients might benefit from disease-specific programmes, for most patients with multimorbidity there is a need for interventions that coordinate and maximise efficiency of outpatient services across multiple conditions. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

38 CFR 26.6 - Environmental documents.

Code of Federal Regulations, 2011 CFR

2011-07-01

... significant impact on, official local or regional zoning or comprehensive land use plans; and, (xiii...) Environmental Impact Statements. The head of each VA element shall include a detailed written statement “in... Regulations, 40 CFR part 1502. An environmental impact statement shall be prepared in accordance with the...

Fabrication and Evaluation of InSb CID Arrays

DTIC Science & Technology

1976-08-01

Eck l Mail Stop 55 Santa Barbara Research Center 75 Coromar Drive Goleta, California 93017 Stephen P. Emmons ’■ Mail Stop 134 Texas Instruments...Attn: Code 2629 ° Attn: Code 2627 6 Defense Documentation Center, Bldg. 5 - S47031 Cameron Station, Alexandrias Va. 22314 12

An Advanced Tabu Search Approach to the Airlift Loading Problem

DTIC Science & Technology

2006-12-01

This report specified that analysis of 14,692 strategic airlift missions demonstrated that … more than 86 percent flew with payloads that were lighter...The University of Texas at Austin December, 2006 Report Documentation Page Form ApprovedOMB No. 0704-0188 Public reporting burden for the collection...Information Operations and Reports , 1215 Jefferson Davis Highway, Suite 1204, Arlington VA 22202-4302. Respondents should be aware that notwithstanding any

Building the Global Community: The Next Step. Report of a Conference Sponsored by the American Council on International Intercultural Education and the Stanley Foundation (Warrington, VA, November 28-30, 1994).

ERIC Educational Resources Information Center

Bakke, Amy; Tharp, Bonnie

In November 1994, 24 practitioners from the field of international education and the federal government met to clarify community college goals in international and intercultural education, articulate a clear mission statement, and determine strategies and plans of action. This document provides an overview of the discussions and conclusions…

Restructuring Civil Affairs for Persistent Engagement

DTIC Science & Technology

2010-04-29

REPORT DOCUMENTATION PAGE Form Approved OMB No. 0704-0188 Public reporting burden for this collection of information is estimated to average 1 hour...and Reports (0704-0188), 1215 Jefferson Davis Highway, Suite 1204, Arlington, VA 22202-4302. Respondents should be aware that notwithstanding any...currently valid OMB control number. PLEASE DO NOT RETURN YOUR FORM TO THE ABOVE ADDRESS. 1. REPORT DATE (DD-MM-YYYY) 29-04-2010 2. REPORT TYPE SAMS

Seismic Response to Sonic Boom-Coupled Rayleigh Waves

DTIC Science & Technology

1990-06-28

90 \\" VA ’ NOTICE When Government drawings, specifications, or other data are used for any purpose other than in connection with a definitely...your organization no longer employs the addressee, please nofify HSD/XART, Brooks AFB TX 78235-5000 to help us maintain a current mailing list. Copies...of this report should not be returned unless return is required by security considerations, contractual obligations, or notice on a specific document

Health and Health Care Access of Rural Women Veterans: Findings From the National Survey of Women Veterans.

PubMed

Cordasco, Kristina M; Mengeling, Michelle A; Yano, Elizabeth M; Washington, Donna L

2016-09-01

Disparities in health and health care access between rural and urban Americans are well documented. There is evidence that these disparities are mirrored within the US veteran population. However, there are few studies assessing this issue among women veterans (WVs). Using the 2008-2009 National Survey of Women Veterans, a population-based cross-sectional national telephone survey, we examined rural WVs' health and health care access compared to urban WVs. We measured health using the Medical Outcomes Study Short-Form (SF-12); access using measures of regular source of care (RSOC), health care utilization, and unmet needs; and barriers to getting needed care. Rural WVs have significantly worse physical health functioning compared to urban WVs (mean physical component score of 43.6 for rural WVs versus 47.2 for urban WVs; P = .007). Rural WVs were more likely to have a VA RSOC (16.4% versus 10.6%; P = .009) and use VA health care (21.7% versus 12.9%; P < .001), and had fewer non-VA health care visits compared with urban WVs (mean 4.2 versus 5.9; P = .021). They had similar overall numbers of health care visits (mean 5.8 versus 7.1; P = .11 ). Access barriers were affordability for rural WVs and work release time for urban WVs. Rural WVs additionally reported that transportation was a major factor affecting health care decisions. Our findings demonstrate VA's crucial role in addressing disparities in health and health care access for rural WVs. As VA continues to strive to optimally meet the needs of all WVs, innovative care models need to account for their high health care needs and persistent barriers to care. © 2016 National Rural Health Association.

The One-On-One Stochastic Duel. Part III

DTIC Science & Technology

1980-11-15

bl; P(I a )mca~ P(T a 4) a, a-,,. and cZ.+ %i 1 -0 P(Ji -J) - p P(J j a~. 3ini2,..., and Aa+ 7, p u J1-0~ P(A) qi A- + 3- [na/a 3+ pVpB - - 1 qVa - 1 imO...AUTHORIED DOCUMENTS$ SECURITY CLASSIFICATION OF THIS PAGE (%ohmn Data Efntined_"’_ REPORT DOCUMENTATION PAGE REFoRE CIPNS.,UTIJG FONS 1 . REPORT NUMBER R2...DUEL: PART III O TECHNICAL REPORT S. PERFORMING ORG. REPORT NUMBER r" t’ /)1r ISE R 80- 1 " 7. AUTHOR(s) --- M---CfO RN UBRs ,,. J. Ancker, Jr. DAG

APL-UW High-Frequency Ocean Environmental Acoustic Models Handbook

DTIC Science & Technology

1994-10-01

120 160-180 Sperm Whale 0.2-32 5 -6 1 Killer Whale 0.1-30 14 178 Bottlenose Dolphin 15-130 100-130 >20M "Unknown C. GENERALIZED MARINE MAMMAL AMBIENT...DoD contractors only; Software Documentation; Apr 95. Other requests shall be referred to Chief of Naval Research , 800 N. Quincy St., Arlington, VA...Documentation. Date of Determination: April 1995. Other requests shall be referred to the Chief of Naval Research , 800 North Quincy Street, Arlington

An early evaluation of implementation of brief intervention for unhealthy alcohol use in the US Veterans Health Administration

PubMed Central

Williams, Emily C.; Rubinsky, Anna D.; Chavez, Laura J.; Lapham, Gwen T.; Rittmueller, Stacey E.; Achtmeyer, Carol E.; Bradley, Katharine A.

2014-01-01

Aims The US Veterans Health Administration [Veterans Affairs (VA)] used performance measures and electronic clinical reminders to implement brief intervention for unhealthy alcohol use. We evaluated whether documented brief intervention was associated with subsequent changes in drinking during early implementation. Design Observational, retrospective cohort study using secondary clinical and administrative data. Setting Thirty VA facilities. Participants Outpatients who screened positive for unhealthy alcohol use [Alcohol Use Disorders Identification Test Consumption (AUDIT-C ≥ 5)] in the 6 months after the brief intervention performance measure (n = 22 214) and had follow-up screening 9–15 months later (n = 6210; 28%). Measurements Multi-level logistic regression estimated the adjusted prevalence of resolution of unhealthy alcohol use (follow-up AUDIT-C <5 with ≥2 point reduction) for patients with and without documented brief intervention (documented advice to reduce or abstain from drinking). Findings Among 6210 patients with follow-up alcohol screening, 1751 (28%) had brief intervention and 2922 (47%) resolved unhealthy alcohol use at follow-up. Patients with documented brief intervention were older and more likely to have other substance use disorders, mental health conditions, poor health and more severe unhealthy alcohol use than those without (P-values < 0.05). Adjusted prevalences of resolution were 47% [95% confidence interval (CI) = 42–52%] and 48% (95% CI = 42–54%) for patients with and without documented brief intervention, respectively (P = 0.50). Conclusions During early implementation of brief intervention in the US Veterans Health Administration, documented brief intervention was not associated with subsequent changes in drinking among outpatients with unhealthy alcohol use and repeat alcohol screening. PMID:24773590

75 FR 73016 - Proposed Establishment of Class E Airspace; Kenbridge, VA

Federal Register 2010, 2011, 2012, 2013, 2014

2010-11-29

... the Internet at http:[sol][sol]www.regulations.gov. FOR FURTHER INFORMATION CONTACT: Richard Horrocks...:[sol][sol]www.regulations.gov. Comments wishing the FAA to acknowledge receipt of their comments on... comments submitted through http:[sol][sol]www.regulations.gov. Recently published rulemaking documents can...

75 FR 65279 - Schedule for Rating Disabilities; AL Amyloidosis (Primary Amyloidosis)

Federal Register 2010, 2011, 2012, 2013, 2014

2010-10-22

... DEPARTMENT OF VETERANS AFFAIRS 38 CFR Part 4 RIN 2900-AN75 Schedule for Rating Disabilities; AL... document proposes to amend the Department of Veterans Affairs (VA) Schedule for Rating Disabilities (rating... establish criteria for disability evaluation to fully implement the decision by the Secretary of Veterans...

48 CFR 801.602-78 - Processing solicitations and contract documents for legal or technical review-Veterans Health...

Code of Federal Regulations, 2011 CFR

2011-10-01

..., Central Office (except Office of Construction and Facilities Management), the National Acquisition Center... facilities, Central Office (except Office of Construction and Facilities Management), the National... takes exception to the accord and satisfaction language VA specifies, assignment of claims, changes to...

A 3-year prospective study on ocular injuries with tennis or cricket ball while playing cricket: A case series.

PubMed

Mahapatra, Santosh Kumar; Malhotra, Kundan; Mendke, Rohit Ganapatrao

2018-02-01

The purpose of this study is to study the clinical features, visual outcome, management, and ocular complications of ocular injury, following trauma with tennis or cricket ball. A prospective, noncomparative case study of patients having injury with tennis/cricket ball while playing cricket was conducted between January 2013 and April 2016. Seventy-six eyes of 76 patients were studied. Presenting vision, age, gender, time since injury, general and ocular examination, intraocular pressure, indirect ophthalmoscopy, B scan, and X-ray/computed tomography scan findings were noted. Patients were managed medically or surgically as per the need and followed up at least for 6 months. Seventy-six eyes of 76 patients were studied. All cases were male, except two. Majority (80.2%) were <25 years. Median presenting visual acuity (VA) was 6/36 and median final VA was 6/18. Significant findings in the decreasing order of frequency were sphincter tear (26.3%), retinal detachment (23.6%), angle recession (18.4%), choroidal rupture (17.1%), and Berlin's edema (15.7%). Most of the cases (69.7%) were managed medically. Only 30.2% cases needed surgical intervention. Final visual outcome in our study was depended on initial VA (P = 0.000). It was also correlating with presenting clinical feature (P = 0.010) and type of intervention (medical/surgical) (P = 0.001). Cricket-related ocular injury generally has a poor prognosis with most cases being closed globe injury; retinal detachment is the most common vision-threatening presentation. In spite of being a common event, cricket-related injury is sparingly documented and hence needs further studies for proper documentation, prognostication, and formulation of definitive management plan.

Critical issues in an electronic documentation system.

PubMed

Weir, Charlene R; Nebeker, Jonathan R

2007-10-11

The Veterans Health Administration (VHA), of the U.S. Department of Veteran Affairs has instituted a medical record (EMR) that includes electronic documentation of all narrative components of the medical record. To support clinicians using the system, multiple efforts have been instituted to ease the creation of narrative reports. Although electronic documentation is easier to read and improves access to information, it also may create new and additional hazards for users. This study is the first step in a series of studies to evaluate the issues surrounding the creation and use of electronic documentation. Eighty-eight providers across multiple clinical roles were interviewed in 10 primary care sites in the VA system. Interviews were tape-recorded, transcribed and qualitatively analyzed for themes. In addition, specific questions were asked about perceived harm due to electronic documentation practices. Five themes relating to difficulties with electronic documentation were identified: 1) information overload; 2) hidden information; 3) lack of trust; 4) communication; 5) decision-making. Three providers reported that they knew of an incident where current documentation practices had caused patient harm and over 75% of respondents reported significant mis-trust of the system.

Cataract surgical outcomes from a large-scale micro-surgical campaign in China.

PubMed

Xiao, Baixiang; Guan, Chunhong; He, Yaling; Le Mesurier, Richard; Müller, Andreas; Limburg, Hans; Iezze, Beatrice

2013-10-01

To assess cataract surgical outcomes during the Jiangxi Provincial Government's "Brightness and Smile Initiative" (BSI) in South East China during May 2009 to July 2010. This cross sectional combined with retrospective study included 1157 cataract surgical patients (1254 eyes) recruited from six counties in Jiangxi during the initiative. Patient information before surgery and at discharge was obtained from hospitals' case records. Patient follow-up eye examinations were conducted during field visits in the autumn of 2010. Fifteen months after the initiative started, study subjects were examined by provincial ophthalmologists using a Snellen visual chart, portable slit lamp, torch and ophthalmoscope. The World Health Organization (WHO) cataract surgical outcome monitoring tally sheet and the outcome categories good (visual acuity, VA, ≥ 0.3 (6/18)), borderline (VA <0.3 but ≥ 0.1 (6/60)) and poor (VA < 0.1) were used for data collection and analysis. A total of 99.7% of operated patients had intraocular lenses implanted. The percentage of eyes with good outcomes (presenting VA) at follow-up was low (49.6%), while the borderline and poor outcome rates were high (34.1% and 16.3%, respectively), in comparison to WHO recommendations. There was a significant outcome difference at follow-up (p < 0.01) between eyes operated by county surgeons trained by an International Non-Government Organization and those operated on by other visiting surgeons. This study documented a low rate of good cataract surgical outcomes from the BSI in Jiangxi. The quality of cataract surgery should be improved further in the province.

Implementation and dissemination of a transition of care program for rural veterans: a controlled before and after study.

PubMed

Leonard, Chelsea; Lawrence, Emily; McCreight, Marina; Lippmann, Brandi; Kelley, Lynette; Mayberry, Ashlea; Ladebue, Amy; Gilmartin, Heather; Côté, Murray J; Jones, Jacqueline; Rabin, Borsika A; Ho, P Michael; Burke, Robert

2017-10-23

Adapting promising health care interventions to local settings is a critical component in the dissemination and implementation process. The Veterans Health Administration (VHA) rural transitions nurse program (TNP) is a nurse-led, Veteran-centered intervention designed to improve transitional care for rural Veterans funded by VA national offices for dissemination to other VA sites serving a predominantly rural Veteran population. Here, we describe our novel approach to the implementation and evaluation = the TNP. This is a controlled before and after study that assesses both implementation and intervention outcomes. During pre-implementation, we assessed site context using a mixed method approach with data from diverse sources including facility-level quantitative data, key informant and Veteran interviews, observations of the discharge process, and a group brainstorming activity. We used the Practical Robust Implementation and Sustainability Model (PRISM) to inform our inquiries, to integrate data from all sources, and to identify factors that may affect implementation. In the implementation phase, we will use internal and external facilitation, paired with audit and feedback, to encourage appropriate contextual adaptations. We will use a modified Stirman framework to document adaptations. During the evaluation phase, we will measure intervention and implementation outcomes at each site using the RE-AIM framework (Reach, Effectiveness, Adoption, Implementation, and Maintenance). We will conduct a difference-in-differences analysis with propensity-matched Veterans and VA facilities as a control. Our primary intervention outcome is 30-day readmission and Emergency Department visit rates. We will use our findings to develop an implementation toolkit that will inform the larger scale-up of the TNP across the VA. The use of PRISM to inform pre-implementation evaluation and synthesize data from multiple sources, coupled with internal and external facilitation, is a novel approach to engaging sites in adapting interventions while promoting fidelity to the intervention. Our application of PRISM to pre-implementation and midline evaluation, as well as documentation of adaptations, provides an opportunity to identify and address contextual factors that may impede or enhance implementation and sustainability of health interventions and inform dissemination.

Managing the life cycle of electronic clinical documents.

PubMed

Payne, Thomas H; Graham, Gail

2006-01-01

To develop a model of the life cycle of clinical documents from inception to use in a person's medical record, including workflow requirements from clinical practice, local policy, and regulation. We propose a model for the life cycle of clinical documents as a framework for research on documentation within electronic medical record (EMR) systems. Our proposed model includes three axes: the stages of the document, the roles of those involved with the document, and the actions those involved may take on the document at each stage. The model includes the rules to describe who (in what role) can perform what actions on the document, and at what stages they can perform them. Rules are derived from needs of clinicians, and requirements of hospital bylaws and regulators. Our model encompasses current practices for paper medical records and workflow in some EMR systems. Commercial EMR systems include methods for implementing document workflow rules. Workflow rules that are part of this model mirror functionality in the Department of Veterans Affairs (VA) EMR system where the Authorization/ Subscription Utility permits document life cycle rules to be written in English-like fashion. Creating a model of the life cycle of clinical documents serves as a framework for discussion of document workflow, how rules governing workflow can be implemented in EMR systems, and future research of electronic documentation.

Board of Veterans' Appeals: rules of practice--notice of appeal in simultaneously contested claim. Final rule.

PubMed

2001-12-03

The Board of Veterans' Appeals (Board) adjudicates appeals from denials of claims for veterans' benefits filed with the Department of Veterans Affairs (VA). This document amends a Board Rule of Practice, pertaining to a type of notice given in simultaneously contested claim appeals, to eliminate an inconsistency between that Rule of Practice and an Appeals Regulation and to update a presumption related to communication of the notice.

Developing Intelligent Leaders - A Look at the Reserve Officer Training Corps Program

DTIC Science & Technology

2011-05-19

Leavenworth, Kansas AY 2011 REPORT DOCUMENTATION PAGE Form Approved OMB No. 0704-0188 Public reporting burden for this collection of...Directorate for Information Operations and Reports (0704-0188), 1215 Jefferson Davis Highway, Suite 1204, Arlington, VA 22202- 4302. Respondents should be...information if it does not display a currently valid OMB control number. PLEASE DO NOT RETURN YOUR FORM TO THE ABOVE ADDRESS. 1. REPORT DATE (DD-MM-YYYY) 19

2014 Wind Program Peer Review Report

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

none,

The Wind Program Peer Review Meeting was held March 24-28, 2014 in Arlington, VA. Principle investigators from the Energy Department, National Laboratories, academic, and industry representatives presented the progress of their DOE-funded research. This report documents the formal, rigorous evaluation process and findings of nine independent reviewers who examined the technical, scientific, and business results of Wind Program funded projects, as well as the productivity and management effectiveness of the Wind Program itself.

Acquired Immune Deficiency Syndrome (AIDS) and the Veterans' Administration. Hearing before the Subcommittee on Hospitals and Health Care of the Committee on Veterans' Affairs. House of Representatives, One Hundredth Congress, First Session.

ERIC Educational Resources Information Center

Congress of the U.S., Washington, DC. House Committee on Veterans' Affairs.

This document presents witness testimony and prepared statements from the Congressional hearing called to examine the issue of acquired immune deficiency syndrome (AIDS) and the role of the Veterans' Administration (VA) in combating AIDS. Opening statements are included from Representatives G. V. Montgomery, J. Roy Rowland, Joseph P. Kennedy, II,…

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.

Promoting aging well: evaluation of Vital-Aging-Multimedia Program in Madrid, Spain.

PubMed

Caprara, Mariagiovanna; Fernández-Ballesteros, Rocío; Alessandri, Guido

2016-09-01

This article attests to the effectiveness of Vital Aging-Multimedia (VA-M, 'Vivir con Vitalidad-M'), a psycho-educational multimedia program designed to promote successful aging. The program was implemented over 3 months through 35 h of video lessons grouped into 15 thematic units addressing four domains of experience commonly associated with aging well: health and healthy habits, cognitive functioning, aging self-efficacy and well-being and social participation. In accordance with a quasi-experimental design, a total of 115 senior citizens (aged 54-82) participated: 73 subjects attended the VA-M, while 42 subjects with similar characteristics served as controls. All subjects were assessed before and after the program on target variables related to the above domains of functioning. Significant changes in most of the examined variables documented the positive effects of the program. © The Author 2015. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Injury-related gaining momentum as external causes of deaths in Ethiopian health and demographic surveillance sites: evidence from verbal autopsy study

PubMed Central

Gelaye, Kassahun Alemu; Tessema, Fasil; Tariku, Befikadu; Abera, Semaw Ferede; Gebru, Alemseged Aregay; Assefa, Nega; Zelalem, Desalew; Dedefo, Melkamu; Kondal, Mekdes; Kote, Mesfin; Sisay, Mitike Molla; Mekonnen, Wubegzier; Terefe, Mamo Wubshet; Biks, Gashaw Andargie; Eshetu, Firehywot; Abera, Mulumebet; Fekadu, Yoseph; Hailu, Gessessew Bugssa; Tilahun, Etsehiwot; Lakew, Yihunie

2018-01-01

ABSTRACT Background: In Ethiopia, though all kinds of mortality due to external causes are an important component of overall mortality often not counted or documented on an individual basis. Objective: The aim of this study was to describe the patterns of mortality from external causes using verbal autopsy (VA) method at the Ethiopian HDSS Network sites. Methods: All deaths at Ethiopian HDSS sites were routinely registered and followed up with VA interviews. The VA forms comprised deaths up to 28 days, between four weeks and 14 years and 15 years and above. The cause of a death was ascertained based on an interview with next of families or other caregivers using a standardized questionnaire that draws information on signs, symptoms, medical history and circumstances preceding death after 45 days mourning period. Two physician assigned probable causes of death as underlying, immediate and contributing factors independently using information in VA forms based on the WHO ICD-10 and VA code system. Disagreed cases sent to third physician for independent review and diagnosis. The final cause of death considered when two of the three physicians assigned underlying cause of death; otherwise, labeled as undetermined. Results: In the period from 2009 to 2013, a total of 9719 deaths were registered. Of the total deaths, 623 (6.4%) were from external causes. Of these, accidental drowning and submersion, 136 (21.8%), accidental fall, 113 (18.1%) and transport-related accidents, 112 (18.0%) were the topmost three leading external causes of deaths. About 436 (70.0%) of deaths were from the age group above 15 years old. Drowning and submersion and transport-related accidents were high in age group between 5 and 14 years old. Conclusion: In this study, external causes of death are significant public health problems and require attention as one of prior health agenda. PMID:29471744

Use of health information technology to advance evidence-based care: lessons from the VA QUERI program.

PubMed

Hynes, Denise M; Weddle, Timothy; Smith, Nina; Whittier, Erika; Atkins, David; Francis, Joseph

2010-01-01

As the Department of Veterans Affairs (VA) Health Services Research and Development Service's Quality Enhancement Research Initiative (QUERI) has progressed, health information technology (HIT) has occupied a crucial role in implementation research projects. We evaluated the role of HIT in VA QUERI implementation research, including HIT use and development, the contributions implementation research has made to HIT development, and HIT-related barriers and facilitators to implementation research. Key informants from nine disease-specific QUERI Centers. Documentation analysis of 86 implementation project abstracts followed up by semi-structured interviews with key informants from each of the nine QUERI centers. We used qualitative and descriptive analyses. We found: (1) HIT provided data and information to facilitate implementation research, (2) implementation research helped to further HIT development in a variety of uses including the development of clinical decision support systems (23 of 86 implementation research projects), and (3) common HIT barriers to implementation research existed but could be overcome by collaborations with clinical and administrative leadership. Our review of the implementation research progress in the VA revealed interdependency on an HIT infrastructure and research-based development. Collaboration with multiple stakeholders is a key factor in successful use and development of HIT in implementation research efforts and in advancing evidence-based practice.

Mental Status Documentation: Information Quality and Data Processes

PubMed Central

Weir, Charlene; Gibson, Bryan; Taft, Teresa; Slager, Stacey; Lewis, Lacey; Staggers, Nancy

2016-01-01

Delirium is a fluctuating disturbance of cognition and/or consciousness associated with poor outcomes. Caring for patients with delirium requires integration of disparate information across clinicians, settings and time. The goal of this project was to characterize the information processes involved in nurses’ assessment, documentation, decisionmaking and communication regarding patients’ mental status in the inpatient setting. VA nurse managers of medical wards (n=18) were systematically selected across the US. A semi-structured telephone interview focused on current assessment, documentation, and communication processes, as well as clinical and administrative decision-making was conducted, audio-recorded and transcribed. A thematic analytic approach was used. Five themes emerged: 1) Fuzzy Concepts, 2) Grey Data, 3) Process Variability 4) Context is Critical and 5) Goal Conflict. This project describes the vague and variable information processes related to delirium and mental status that undermine effective risk, prevention, identification, communication and mitigation of harm. PMID:28269919

Mental Status Documentation: Information Quality and Data Processes.

PubMed

Weir, Charlene; Gibson, Bryan; Taft, Teresa; Slager, Stacey; Lewis, Lacey; Staggers, Nancy

2016-01-01

Delirium is a fluctuating disturbance of cognition and/or consciousness associated with poor outcomes. Caring for patients with delirium requires integration of disparate information across clinicians, settings and time. The goal of this project was to characterize the information processes involved in nurses' assessment, documentation, decisionmaking and communication regarding patients' mental status in the inpatient setting. VA nurse managers of medical wards (n=18) were systematically selected across the US. A semi-structured telephone interview focused on current assessment, documentation, and communication processes, as well as clinical and administrative decision-making was conducted, audio-recorded and transcribed. A thematic analytic approach was used. Five themes emerged: 1) Fuzzy Concepts, 2) Grey Data, 3) Process Variability 4) Context is Critical and 5) Goal Conflict. This project describes the vague and variable information processes related to delirium and mental status that undermine effective risk, prevention, identification, communication and mitigation of harm.

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.

A Data Analysis of Naval Air Systems Command Funding Documents

DTIC Science & Technology

2017-06-01

Directorate for Information Operations and Reports, 1215 Jefferson Davis Highway, Suite 1204, Arlington, VA 22202-4302, and to the Office of Management ...Business & Financial Managers 15. NUMBER OF PAGES 75 16. PRICE CODE 17. SECURITY CLASSIFICATION OF REPORT Unclassified 18. SECURITY...Summary Statistics for Regressions with a Statistically Significant Relationship

Tagline: Information Extraction for Semi-Structured Text Elements in Medical Progress Notes

ERIC Educational Resources Information Center

Finch, Dezon Kile

2012-01-01

Text analysis has become an important research activity in the Department of Veterans Affairs (VA). Statistical text mining and natural language processing have been shown to be very effective for extracting useful information from medical documents. However, neither of these techniques is effective at extracting the information stored in…

75 FR 11881 - Environmental Impacts Statements; Notice of Availability

Federal Register 2010, 2011, 2012, 2013, 2014

2010-03-12

..., Draft EIS, BLM, CA, Stirling Energy Systems (SES) Solar 2 Project, Construct and Operate, Electric.../2010: Correction to Comment Period from 04/12/2010 to 04/26/2010. EIS No. 20100054, Draft EIS, NASA, VA... FR Notice Published 02/26/2010: Correction to Document Agency from NOAA to NASA. Dated: March 9, 2010...

Effects of catastrophic events on transportation system management and operations : the Pentagon and the national capital region -- September 11, 2001

DOT National Transportation Integrated Search

2002-04-01

The report documents the actions taken by transportation agencies in response to the terrorist attack on the Pentagon in Arlington, Va. on September 11, and is part of a larger effort to examine the impacts of catastrophic events on transportation sy...

Client Goals for Participating in VHA Vocational Rehabilitation: Distribution and Relationship to Outcome

ERIC Educational Resources Information Center

Drebing, C.E.; Van Ormer, E.A.; Schutt, R.K.; Krebs, C.; Losardo, M.; Boyd, C.; Penk, W.; Rosenheck, R.

2004-01-01

Research into vocational rehabilitation (VR) consumer service preferences has been limited. The current study describes the self-reported goals of 228 applicants to a VR program sponsored by the Veterans Administration (VA) and documents the relationship of those goals to participant background variables and outcomes. Participants endorsed a wide…

Calendar of Selected Aeronautical and Space Meetings, July 1989 (Calendrier des Manifestations Aeronautiques et Spatiales (Selection), Juillet 1989)

DTIC Science & Technology

1989-07-01

Matdriaux et Mcanique appliqude 56 08 - Physique de l’Atmosph6re et Environnement terrestre 76 09 - Information, Documentation et Informatique 82 10...S 917, 12201 Sunrise Valley Drive, Reston, VA 22092 US VDE Verband Deutscher Elektrotechniker: Zentralstelle Tagungen, Stresemannallee 15, D-6000

Evaluation of PHI Hunter in Natural Language Processing Research.

PubMed

Redd, Andrew; Pickard, Steve; Meystre, Stephane; Scehnet, Jeffrey; Bolton, Dan; Heavirland, Julia; Weaver, Allison Lynn; Hope, Carol; Garvin, Jennifer Hornung

2015-01-01

We introduce and evaluate a new, easily accessible tool using a common statistical analysis and business analytics software suite, SAS, which can be programmed to remove specific protected health information (PHI) from a text document. Removal of PHI is important because the quantity of text documents used for research with natural language processing (NLP) is increasing. When using existing data for research, an investigator must remove all PHI not needed for the research to comply with human subjects' right to privacy. This process is similar, but not identical, to de-identification of a given set of documents. PHI Hunter removes PHI from free-form text. It is a set of rules to identify and remove patterns in text. PHI Hunter was applied to 473 Department of Veterans Affairs (VA) text documents randomly drawn from a research corpus stored as unstructured text in VA files. PHI Hunter performed well with PHI in the form of identification numbers such as Social Security numbers, phone numbers, and medical record numbers. The most commonly missed PHI items were names and locations. Incorrect removal of information occurred with text that looked like identification numbers. PHI Hunter fills a niche role that is related to but not equal to the role of de-identification tools. It gives research staff a tool to reasonably increase patient privacy. It performs well for highly sensitive PHI categories that are rarely used in research, but still shows possible areas for improvement. More development for patterns of text and linked demographic tables from electronic health records (EHRs) would improve the program so that more precise identifiable information can be removed. PHI Hunter is an accessible tool that can flexibly remove PHI not needed for research. If it can be tailored to the specific data set via linked demographic tables, its performance will improve in each new document set.

Evaluation of PHI Hunter in Natural Language Processing Research

PubMed Central

Redd, Andrew; Pickard, Steve; Meystre, Stephane; Scehnet, Jeffrey; Bolton, Dan; Heavirland, Julia; Weaver, Allison Lynn; Hope, Carol; Garvin, Jennifer Hornung

2015-01-01

Objectives We introduce and evaluate a new, easily accessible tool using a common statistical analysis and business analytics software suite, SAS, which can be programmed to remove specific protected health information (PHI) from a text document. Removal of PHI is important because the quantity of text documents used for research with natural language processing (NLP) is increasing. When using existing data for research, an investigator must remove all PHI not needed for the research to comply with human subjects’ right to privacy. This process is similar, but not identical, to de-identification of a given set of documents. Materials and methods PHI Hunter removes PHI from free-form text. It is a set of rules to identify and remove patterns in text. PHI Hunter was applied to 473 Department of Veterans Affairs (VA) text documents randomly drawn from a research corpus stored as unstructured text in VA files. Results PHI Hunter performed well with PHI in the form of identification numbers such as Social Security numbers, phone numbers, and medical record numbers. The most commonly missed PHI items were names and locations. Incorrect removal of information occurred with text that looked like identification numbers. Discussion PHI Hunter fills a niche role that is related to but not equal to the role of de-identification tools. It gives research staff a tool to reasonably increase patient privacy. It performs well for highly sensitive PHI categories that are rarely used in research, but still shows possible areas for improvement. More development for patterns of text and linked demographic tables from electronic health records (EHRs) would improve the program so that more precise identifiable information can be removed. Conclusions PHI Hunter is an accessible tool that can flexibly remove PHI not needed for research. If it can be tailored to the specific data set via linked demographic tables, its performance will improve in each new document set. PMID:26807078

2014 Water Power Program Peer Review Report

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

none,

2014-08-18

The Water Power Peer Review Meeting was held February 24-28, 2014 in Arlington, VA. Principle investigators from the Energy Department National Laboratories, academic, and industry representatives presented the progress of their DOE-funded research. This report documents the formal, rigorous evaluation process and findings of nine independent reviewers who examined the technical, scientific, and business results of 96 projects of the Water Power Program, as well as the productivity and management effectiveness of the Water Power Program itself.

Haemophilia utilization group study - Part Va (HUGS Va): design, methods and baseline data.

PubMed

Zhou, Z-Y; Wu, J; Baker, J; Curtis, R; Forsberg, A; Huszti, H; Koerper, M; Lou, M; Miller, R; Parish, K; Riske, B; Shapiro, A; Ullman, M; Johnson, K

2011-09-01

To describe the study design, procedures and baseline characteristics of the Haemophilia Utilization Group Study - Part Va (HUGS Va), a US multi-center observational study evaluating the cost of care and burden of illness in persons with factor VIII deficiency. Patients with factor VIII level ≤ 30%, age 2-64 years, receiving treatment at one of six federally supported haemophilia treatment centres (HTCs) were enrolled in the study. Participants completed an initial interview including questions on socio-demographical characteristics, health insurance status, co-morbidities, access to care, haemophilia treatment regimen, factor utilization, self-reported joint pain and motion limitation and health-related quality of life. A periodic follow-up survey collected data regarding time lost from usual activities, disability days, health care utilization and outcomes of care. HTC clinicians documented participants' baseline clinical characteristics and pharmacy dispensing records for 2 years. Between July 2005 and July 2007, 329 participants were enrolled. Average age was 9.7 years for children and 33.5 years for adults; two-thirds had severe haemophilia. The distributions of age, marital status, education level and barriers to haemophilia care were relatively consistent across haemophilic severity categories. Differences were found in participants' employment status, insurance status and income. Overall, children with haemophilia had quality of life scores comparable to healthy counterparts. Adults had significantly lower physical functioning than the general US population. As one of the largest economic studies of haemophilia care, HUGS Va will provide detailed information regarding the burden of illness and health care utilization in the US haemophilia A population. © 2011 Blackwell Publishing Ltd.

The Use of Telemental Health to Meet the Mental Health Needs of Women Using Department of Veterans Affairs Services.

PubMed

Moreau, Jessica L; Cordasco, Kristina M; Young, Alexander S; Oishi, Sabine M; Rose, Danielle E; Canelo, Ismelda; Yano, Elizabeth M; Haskell, Sally G; Hamilton, Alison B

Women veterans are a growing segment of Department of Veterans Affairs (VA) users with distinct mental health needs and well-documented barriers to care. Telemental health holds much promise for reducing barriers to mental health care. We assessed VA stakeholders' perceptions of telemental health's appropriateness and potential to address the mental health needs of women veteran VA users. We conducted semistructured qualitative interviews with 40 key leadership and clinical stakeholders at VA medical centers and associated outpatient clinics. Transcripts were summarized in a template of key domains developed based on the interview guide, and coded for topics relevant to women's mental health needs and telehealth services. Telemental health was perceived to increase access to mental health care, including same-gender care and access to providers with specialized training, especially for rural women and those with other limiting circumstances. Respondents saw women veterans as being particularly poised to benefit from telemental health, owing to responsibilities associated with childcare, spousal care, and elder caregiving. Interviewees expressed enthusiasm for telemental health's potential and were eager to expand services, including women-only mental health groups. Implementation challenges were also noted. Overall, our stakeholders saw telemental health as a good fit for helping to address the perceived needs of women veterans, especially in addressing the geographical barriers experienced by rural women and those with a limited ability to travel. These findings can help to inform gender-tailored expansion of telemental health within and outside of the VA. Published by Elsevier Inc.

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.

A Lifting Surface Theory for Wings Experiencing Leading-Edge Separation

DTIC Science & Technology

1977-06-30

CSR -CHCRÜ TO SPAN RATIO N-l N’SECIION NO. INDICAIOR FORM SCALES TO KURHALUt E0U»T|CNS Fl • 2.» ALEA /IP|»P| I fi ■ AIFA...Documentation Center Cameron Station, Bldg. 5 Alexandria, VA 22314 12 Nielsen Engineering & Research, Inc. 510 Clyde Avenue Mountain View, CA 94043 1 RASA

Correction to: Implementing goals of care conversations with veterans in VA long-term care setting: a mixed methods protocol.

PubMed

Sales, Anne E; Ersek, Mary; Intrator, Orna K; Levy, Cari; Carpenter, Joan G; Hogikyan, Robert; Kales, Helen C; Landis-Lewis, Zach; Olsan, Tobie; Miller, Susan C; Montagnini, Marcos; Periyakoil, Vyjeyanthi S; Reder, Sheri

2018-02-09

The authors would like to correct errors in the original article [1] that may have lead readers to misinterpret the scope, evidence base and target population of VHA Handbook 1004.03 "Life-Sustaining Treatment (LST) Decisions: Eliciting, Documenting, and Honoring Patients' Values, Goals, and Preferences".

77 FR 16990 - Notification of Submission to the Secretary of Agriculture of Two Draft Regulatory Documents...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-03-23

... and Applicability; Clarification and Availability of Test Guideline''; and the second is entitled... Yard (South Bldg.), 2777 S. Crystal Dr., Arlington, VA. The Docket Facility is open from 8:30 a.m. to 4...) 305-5805. FOR FURTHER INFORMATION CONTACT: Rose Kyprianou, Field and External Affairs Division (7506P...

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

Filipino veterans' benefits improvements. Interim final rule.

PubMed

2001-12-27

This document amends Department of Veterans Affairs (VA) adjudication regulations to reflect changes made by the Departments of Veterans Affairs and Housing and Urban Development, and Independent Agencies Appropriations Act, 2001, which changed the rate of compensation payments to certain Filipino veterans residing in the United States and the Veterans Benefits and Health Care Improvement Act of 2000, which changed the amount of the burial benefit paid to the survivors of certain Filipino veterans who were residing in the United States at the times of their deaths.

Hearing on USERRA, Veterans' Preference in the VA Education Services Draft Discussion Bill. Hearing before the Subcommittee on Education, Training, Employment and Housing of the Committee on Veterans' Affairs, House of Representatives, One Hundred Fourth Congress, Second Session.

ERIC Educational Resources Information Center

Congress of the U.S., Washington, DC. House Committee on Veterans' Affairs.

This document records oral and written testimony given at a hearing before a subcommittee of the U.S. House of Representatives Committee on Veterans' Affairs. The testimony pertains to veterans' preferences in hiring in the federal government and problems veterans are having in being reemployed after stints of active duty or during reductions in…

Validation and Support of a Quantitative Infrared Instrument Facility and Generation of a Library of Chemical Warfare and Related Materials by Fourier Transform Infrared Spectroscopy

DTIC Science & Technology

2006-11-01

Hampton, VA 23666 November 2006 Approved for public release: distribution is unlimited. 20070907323 ABERDEEN PROVING GROUND, MD 21010-5424 DISCLAIMER...REPORT DOCUMENTATION PAGE Form Approved OMB No. 0704-0188 Public reporting burden for this collection of information is estimated to average 1 hour...SPONSOR/MONITOR’S REPORT NUMBER(S) 12. DISTRIBUTION I AVAILABILITY STATEMENT Approved for public release; distribution is unlimited. 13. SUPPLEMENTARY

Initial Evaluations of a U.S. Navy Rapidly Relocatable Gulf of Mexico/Caribbean Ocean Forecast System in the Context of the Deepwater Horizon Incident

DTIC Science & Technology

2015-05-06

forecast system covering the Gulf of Mexico and adjacent Caribbean Sea that was designated Americas Seas, or AMSEAS, which is documented in this...Office of Naval Reseach One Liberty Center 875 North Randolph Street, Suite 1425 Arlington, VA 22203-1995 73-6669-05-5 ONR Ocean forecasting Skill...Coastal Ocean Model (Global NCOM). This new regional model domain came to be designated Americas Seas, or AMSEAS. After a short spin-up and initial

Cluster randomized trial of a multilevel evidence-based quality improvement approach to tailoring VA Patient Aligned Care Teams to the needs of women Veterans.

PubMed

Yano, Elizabeth M; Darling, Jill E; Hamilton, Alison B; Canelo, Ismelda; Chuang, Emmeline; Meredith, Lisa S; Rubenstein, Lisa V

2016-07-19

The Veterans Health Administration (VA) has undertaken a major initiative to transform care through implementation of Patient Aligned Care Teams (PACTs). Based on the patient-centered medical home (PCMH) concept, PACT aims to improve access, continuity, coordination, and comprehensiveness using team-based care that is patient-driven and patient-centered. However, how VA should adapt PACT to meet the needs of special populations, such as women Veterans (WVs), was not considered in initial implementation guidance. WVs' numerical minority in VA healthcare settings (approximately 7-8 % of users) creates logistical challenges to delivering gender-sensitive comprehensive care. The main goal of this study is to test an evidence-based quality improvement approach (EBQI) to tailoring PACT to meet the needs of WVs, incorporating comprehensive primary care services and gender-specific care in gender-sensitive environments, thereby accelerating achievement of PACT tenets for women (Women's Health (WH)-PACT). EBQI is a systematic approach to developing a multilevel research-clinical partnership that engages senior organizational leaders and local quality improvement (QI) teams in adapting and implementing new care models in the context of prior evidence and local practice conditions, with researchers providing technical support, formative feedback, and practice facilitation. In a 12-site cluster randomized trial, we will evaluate WH-PACT model achievement using patient, provider, staff, and practice surveys, in addition to analyses of secondary administrative and chart-based data. We will explore impacts of receipt of WH-PACT care on quality of chronic disease care and prevention, health status, patient satisfaction and experience of care, provider experience, utilization, and costs. Using mixed methods, we will assess pre-post practice contexts; document EBQI activities undertaken in participating facilities and their relationship to provider/staff and team actions/attitudes; document WH-PACT implementation; and examine barriers/facilitators to EBQI-supported WH-PACT implementation through a combination of semi-structured interviews and monthly formative progress narratives and administrative data. Lack of gender-sensitive comprehensive care has demonstrated consequences for the technical quality and ratings of care among WVs and may contribute to decisions to continue use or seek care elsewhere under the US Affordable Care Act. We hypothesize that tailoring PACT implementation through EBQI may improve the experience and quality of care at many levels. ClinicalTrials.gov, NCT02039856.

Our Gifted: Our Future. Proceedings of the Annual Northern Virginia Conference on Gifted/Talented Education (5th, Alexandria, VA, March 7-8, 1980).

ERIC Educational Resources Information Center

Orloff, Jeffrey H., Ed.

The document contains 13 selected papers from a conference on working with gifted students. Titles and authors include the following: "A Metacurriculum for the Future" (B. Hubbard); "Building a Curriculum to Train Leadership Abilities" (L. Addison); "Gifted Boys, Gifted Girls--What's the Difference" (B. Becker);…

Variation in winter survival of the invasive hemlock woolly adelgid (Hemiptera: Adelgidae) across the eastern United States

Treesearch

R. Talbot, III Trotter; Kathleen S. Shields

2009-01-01

The hemlock woolly adelgid (Adelges tsugae Annand) is a small, aphid-like insect native to East Asia and western North America. First documented in the eastern United States in Richmond, VA, in 1951, it has spread to at least 17 states, where it causes increased mortality among both eastern and Carolina hemlocks (Tsuga canadensis...

Analytical Tools for Affordability Analysis

DTIC Science & Technology

2015-05-01

function (Womer)  Unit cost as a function of learning and rate  Learning with forgetting (Benkard)  Learning depreciates over time  Discretionary...Analytical Tools for Affordability Analysis David Tate Cost Analysis and Research Division Institute for Defense Analyses Report Documentation...ES) Institute for Defense Analyses, Cost Analysis and Research Division,4850 Mark Center Drive,Alexandria,VA,22311-1882 8. PERFORMING ORGANIZATION

Architecture Analysis with AADL: The Speed Regulation Case-Study

DTIC Science & Technology

2014-11-01

Overview Functional Hazard Analysis ( FHA ) Failures inventory with description, classification, etc. Fault-Tree Analysis (FTA) Dependencies between...University Pittsburgh, PA 15213 Julien Delange Report Documentation Page Form ApprovedOMB No. 0704-0188 Public reporting burden for the collection of...Information Operations and Reports , 1215 Jefferson Davis Highway, Suite 1204, Arlington VA 22202-4302. Respondents should be aware that notwithstanding any

Glossary: Defense Acquisition Acronyms and Terms. Revision 2

DTIC Science & Technology

1987-07-01

Approved REPORT DOCUMENTATION PAGE OMBNo. 070-O 18 la. REPORT SECURITY CLASSIFICATION lb. RESTRICTIVE MARKINGS % unclassified 2a. SECURITY CLASSIFICATION ...WORK UNIT Fort Belvoir, VA 22060-5426 ELEMENT NO. NO. NO. ACCESSION NO. 11. TITLE (Include Security Classification ) Glossary Defense Acquisition...DISTRIBUTION/AVAILABILITY OF ABSTRACT 21 ABSTRACT SECURITY CLASSIFICATION [RUNCLASSIFIED/UNLIMITED 0 SAME AS RPT 0 DTIC USERS unclassified 22a. NAME OF

Clinician Documentation on Receipt of Trauma-Focused Evidence-Based Psychotherapies in a VA PTSD Clinic.

PubMed

Lu, Mary W; Plagge, Jane M; Marsiglio, Mary C; Dobscha, Steven K

2016-01-01

The U.S. Department of Veterans Affairs (VA) is implementing two trauma-focused, evidence-based psychotherapies (TF-EBPs) for posttraumatic stress disorder (PTSD): cognitive processing therapy and prolonged exposure therapy (PE). Veterans with PTSD often do not receive these treatments, and little is known about the reasons veterans may not receive TF-EBPs. The aim of this qualitative study was to summarize clinician-reported reasons in medical records for nonreceipt of TF-EBPs. All veterans (N = 63) identified through PTSD screening who were newly engaged in mental health care and received individual evaluations in a PTSD specialty clinic in fiscal year 2008 were included in the sample. Content analysis of electronic medical records revealed multiple potential reasons for nonreceipt of TF-EBPs including referral to other PTSD treatments, other clinical priorities, poor engagement in care, practical barriers, negative beliefs, and receipt of care in other settings. Eight veterans (13%) initiated TF-EBPs. Further interventions to promote engagement in PTSD treatment are warranted.

Implementing effective policy in a national mental health re-engagement program for Veterans

PubMed Central

Smith, Shawna N.; Lai, Zongshan; Almirall, Daniel; Goodrich, David E.; Abraham, Kristen M.; Nord, Kristina M.; Kilbourne, Amy M.

2016-01-01

Policy is a powerful motivator of clinical change, but implementation success can depend on organizational characteristics. This paper used validated measures of organizational resources, culture and climate to predict uptake of a nationwide VA policy aimed at implementing Re-Engage, a brief care management program that re-establishes contact with Veterans with serious mental illness lost to care. Patient care databases were used to identify 2,738 Veterans lost to care. Local Recovery Coordinators (LRCs) were to update disposition for 2,738 Veterans at 158 VA facilities and, as appropriate, facilitate a return to care. Multivariable regression assessed organizational culture and climate as predictors of early policy compliance (via LRC presence) and uptake at six months. Higher composite climate and culture scores were associated with higher odds of having a designated LRC, but were not predictive of higher uptake. Sites with LRCs had significantly higher rates of updated documentation than sites without LRCs. PMID:27668352

Intranet-based quality improvement documentation at the Veterans Affairs Maryland Health Care System.

PubMed

Borkowski, A; Lee, D H; Sydnor, D L; Johnson, R J; Rabinovitch, A; Moore, G W

2001-01-01

The Pathology and Laboratory Medicine Service of the Veterans Affairs Maryland Health Care System is inspected biannually by the College of American Pathologists (CAP). As of the year 2000, all documentation in the Anatomic Pathology Section is available to all staff through the VA Intranet. Signed, supporting paper documents are on file in the office of the department chair. For the year 2000 CAP inspection, inspectors conducted their document review by use of these Web-based documents, in which each CAP question had a hyperlink to the corresponding section of the procedure manual. Thus inspectors were able to locate the documents relevant to each question quickly and efficiently. The procedure manuals consist of 87 procedures for surgical pathology, 52 procedures for cytopathology, and 25 procedures for autopsy pathology. Each CAP question requiring documentation had from one to three hyperlinks to the corresponding section of the procedure manual. Intranet documentation allows for easier sharing among decentralized institutions and for centralized updates of the laboratory documentation. These documents can be upgraded to allow for multimedia presentations, including text search for key words, hyperlinks to other documents, and images, audio, and video. Use of Web-based documents can improve the efficiency of the inspection process.

Adult non-communicable disease mortality in Africa and Asia: evidence from INDEPTH Health and Demographic Surveillance System sites

PubMed Central

Streatfield, P. Kim; Khan, Wasif A.; Bhuiya, Abbas; Hanifi, Syed M.A.; Alam, Nurul; Bagagnan, Cheik H.; Sié, Ali; Zabré, Pascal; Lankoandé, Bruno; Rossier, Clementine; Soura, Abdramane B.; Bonfoh, Bassirou; Kone, Siaka; Ngoran, Eliezer K.; Utzinger, Juerg; Haile, Fisaha; Melaku, Yohannes A.; Weldearegawi, Berhe; Gomez, Pierre; Jasseh, Momodou; Ansah, Patrick; Debpuur, Cornelius; Oduro, Abraham; Wak, George; Adjei, Alexander; Gyapong, Margaret; Sarpong, Doris; Kant, Shashi; Misra, Puneet; Rai, Sanjay K.; Juvekar, Sanjay; Lele, Pallavi; Bauni, Evasius; Mochamah, George; Ndila, Carolyne; Williams, Thomas N.; Laserson, Kayla F.; Nyaguara, Amek; Odhiambo, Frank O.; Phillips-Howard, Penelope; Ezeh, Alex; Kyobutungi, Catherine; Oti, Samuel; Crampin, Amelia; Nyirenda, Moffat; Price, Alison; Delaunay, Valérie; Diallo, Aldiouma; Douillot, Laetitia; Sokhna, Cheikh; Gómez-Olivé, F. Xavier; Kahn, Kathleen; Tollman, Stephen M.; Herbst, Kobus; Mossong, Joël; Chuc, Nguyen T.K.; Bangha, Martin; Sankoh, Osman A.; Byass, Peter

2014-01-01

Background Mortality from non-communicable diseases (NCDs) is a major global issue, as other categories of mortality have diminished and life expectancy has increased. The World Health Organization's Member States have called for a 25% reduction in premature NCD mortality by 2025, which can only be achieved by substantial reductions in risk factors and improvements in the management of chronic conditions. A high burden of NCD mortality among much older people, who have survived other hazards, is inevitable. The INDEPTH Network collects detailed individual data within defined Health and Demographic Surveillance sites. By registering deaths and carrying out verbal autopsies to determine cause of death across many such sites, using standardised methods, the Network seeks to generate population-based mortality statistics that are not otherwise available. Objective To describe patterns of adult NCD mortality from INDEPTH Network sites across Africa and Asia, according to the WHO 2012 verbal autopsy (VA) cause categories, with separate consideration of premature (15–64 years) and older (65+ years) NCD mortality. Design All adult deaths at INDEPTH sites are routinely registered and followed up with VA interviews. For this study, VA archives were transformed into the WHO 2012 VA standard format and processed using the InterVA-4 model to assign cause of death. Routine surveillance data also provide person-time denominators for mortality rates. Results A total of 80,726 adult (over 15 years) deaths were documented over 7,423,497 person-years of observation. NCDs were attributed as the cause for 35.6% of these deaths. Slightly less than half of adult NCD deaths occurred in the 15–64 age group. Detailed results are presented by age and sex for leading causes of NCD mortality. Per-site rates of NCD mortality were significantly correlated with rates of HIV/AIDS-related mortality. Conclusions These findings present important evidence on the distribution of NCD mortality across a wide range of African and Asian settings. This comes against a background of global concern about the burden of NCD mortality, especially among adults aged under 70, and provides an important baseline for future work. PMID:25377326

Red eyes and red-flags: improving ophthalmic assessment and referral in primary care.

PubMed

Kilduff, Caroline; Lois, Charis

2016-01-01

Up to five percent of primary care consultations are eye-related, yet 96% of General Practitioners (GPs) do not undergo postgraduate ophthalmology training. Most do not feel assured performing eye assessments. Some red eye conditions can become sight threatening, and often exhibit red-flag features. These features include moderate pain, photophobia, reduced visual acuity (VA), eye-trauma, or unilateral marked redness. The aim of this project was to improve primary care assessment and referral of patients presenting with red-flag features based on the NICE 'Red Eye' Clinical Knowledge Summary recommendations. Data was collected retrospectively from 139 red eye consultations. A practice meeting highlighted poor awareness of red-flag features, low confidence levels in eye assessments, and time-constraints during appointments. Interventions were based on feedback from staff. These included a primary care teaching session on red-flag features, a VA measurement tutorial, and provision of a red eye toolkit, including VA equipment, to each consultation room. At baseline, each patient had on average 0.9 red-flag features assessed. Only 36.0% (9/25) of patients with red-flag features were appropriately referred to same-day ophthalmology services. Following two improvement cycles, a significant improvement was seen in almost every parameter. On average, each patient had 2.7 red-flag features assessed (vs 0.9, p<0.001). VA was assessed in 55.6% of consultations (vs 7.9%, p<0.001), pain was quantified in 81.5% (vs 20.9%, p=0.005), eye-trauma or foreign-body (51.8% vs 8.6%, p<0.001), extent of redness was documented in 66.7% (vs 14.4%, p<0.001). Only photophobia remained poorly assessed (18.5% vs 14.4%, p=0.75). Following this, 75.0% (6/8) of patients were appropriately referred. This project reflected the literature regarding low confidence and inexperience amongst GPs when faced with ophthalmic conditions. Improvements in education are required to ensure accurate assessments can be undertaken in a time-constrained environment.

Aerodynamic Interaction Effects of a Helicopter Rotor and Fuselage

NASA Technical Reports Server (NTRS)

Boyd, David D., Jr.

1999-01-01

A three year Cooperative Research Agreements made in each of the three years between the Subsonic Aerodynamics Branch of the NASA Langley Research Center and the Virginia Polytechnic Institute and State University (Va. Tech) has been completed. This document presents results from this three year endeavor. The goal of creating an efficient method to compute unsteady interactional effects between a helicopter rotor and fuselage has been accomplished. This paper also includes appendices to support these findings. The topics are: 1) Rotor-Fuselage Interactions Aerodynamics: An Unsteady Rotor Model; and 2) Rotor/Fuselage Unsteady Interactional Aerodynamics: A New Computational Model.

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.

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

COVART 6.1: FASTGEN Legacy Model User’s Manual

DTIC Science & Technology

2010-03-31

Program Office • Crystal Gateway #4 • Suite 1103 • 200 12 th St. South • Arlington, VA 22202 REPORT DOCUMENTATION PAGE Form Approved... Single Proximity Burst File Layout ................................................ 208 Figure 23-2 OFRAGB Multiple Proximity Burst File Layout...dimensional normal, distribution of shotlines about an aim point (SHOT1) 2. Multiple shotlines over a two-dimensional grid (SHOT2) 3. A single shotline at

Mild Traumatic Brain Injury Pocket Guide (CONUS)

DTIC Science & Technology

2010-01-01

Cognitive Rehab Driving Following TBI Patient Education Clinical Tools and Resources Report Documentation Page Form ApprovedOMB No. 0704-0188 Public... Rehab Driving Following TBI Patient Education Clinical Tools and Resources 2 3 TBI Basics VA/DoD CPG Management of Headaches Management of Other...Symptoms ICD-9 Coding Cognitive Rehab Driving Following TBI Patient Education Clinical Tools and Resources TBI BASICS 4 5 TBI BASICS dod definition

Naval Operations Concept: Implementing the Maritime Strategy

DTIC Science & Technology

2010-01-01

Naval Operations Concept 2010 Implementing The Maritime Strategy Report Documentation Page Form ApprovedOMB No. 0704-0188 Public reporting burden...Directorate for Information Operations and Reports , 1215 Jefferson Davis Highway, Suite 1204, Arlington VA 22202-4302. Respondents should be aware that...display a currently valid OMB control number. 1. REPORT DATE 2010 2. REPORT TYPE 3. DATES COVERED 00-00-2010 to 00-00-2010 4. TITLE AND

Reserve Component Personnel Issues: Questions and Answers

DTIC Science & Technology

2013-07-12

CRS Report for Congress Prepared for Members and Committees of Congress Reserve Component Personnel Issues: Questions and Answers...Service 7-5700 www.crs.gov RL30802 Report Documentation Page Form ApprovedOMB No. 0704-0188 Public reporting burden for the collection of information...Operations and Reports , 1215 Jefferson Davis Highway, Suite 1204, Arlington VA 22202-4302. Respondents should be aware that notwithstanding any other provision

Army Selective Reenlistment Bonus Management System: Functional and User Documentation

DTIC Science & Technology

2005-06-01

Study Note 2005-04 Arlington, VA 22202-3926 12. DISTRIBUTION/AVAILABILITY STATEMENT Approved for public release; distribution is unlimited. 13...of the study, retention parameters that capture the financial incentive effects of the SRB reenlistment program were estimated for Army occupations...all possible outcomes in the Army SRB Data Utility. The Army SRB Program provides financial incentives for reenlistment that vary by occupational

75 FR 35846 - In the Matter of Babcock & Wilcox Nuclear Operations Group, Inc., Lynchburg, VA; Order Imposing...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-06-23

... under 10 CFR 2.315(c), must be filed in accordance with the NRC E-Filing rule (72 FR 49139, August 28, 2007). The E-Filing process requires participants to submit and serve all adjudicatory documents over... below. To comply with the procedural requirements of E-Filing, at least 10 days prior to the filing...

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

Superfund record of decision (EPA Region 3): US Defense General Supply Center (DLA), operable unit 3, Chesterfield County, Richmond, VA, September 29, 1995

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

NONE

This decision document presents the selected remedial action for the National Guard Source Area (NGA), Operable Unit (OU3) at the Defense General Supply Center (DGSC) in Richmond, Virginia. Operable Unit 3 addresses the contaminated soils at the National Guard . The selected alternative requires that institutional controls, including access restriction, property transfer restriction, and preconstruction assessment, be implemented or continued at the site. Also, contaminated soils posing human health risks will be excavated and disposed of.

Description and Use of the Plume Radiation Code ATLES

DTIC Science & Technology

1977-05-13

CONTAINED IN THIS DOCUMENT ARE THOSE 2OF THE AUTHORS AND SHOULD NOT BE INTERPRETED AS NECESSARILY REPRESENTING THE OFFICIAL POLICIES , EITHER EXPRESSED OR...0 o N C?) -4 0 N N cnCD 0 C0 0 *N N N N R N N N I N N N N A V A V A V V V V A V V V V 40 0 )0 0 00 cn 0 C 0 ON M N3 VA A A i * 0 C) )c C ’V0 N 0 N: C

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.

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.

Updating fire safety standards. Final rule; affirmation.

PubMed

2011-11-16

This document affirms as final, without changes, a provision included in a final rule with request for comments that amended the Department of Veterans Affairs (VA) regulations concerning community residential care facilities, contract facilities for certain outpatient and residential services, and State home facilities. That provision established a five-year period within which all covered buildings with nursing home facilities existing as of June 25, 2001, must conform to the automatic sprinkler requirement of the 2009 edition of the National Fire Protection Association (NFPA) 101. This rule helps ensure the safety of veterans in the affected facilities.

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

Federal Register 2010, 2011, 2012, 2013, 2014

2011-07-19

... information as it relates to earned income. VA will use this information to adjust VA benefit payments as... to furnish VA with information necessary to determine eligibility for or amount of benefits. In... Matched: VA records involved in the match are the VA system of records, ``Compensation, Pension, Education...

Black patients sustain vision loss while White and South Asian patients gain vision following delamination or segmentation surgery for tractional complications associated with proliferative diabetic retinopathy.

PubMed

Mastropasqua, R; Luo, Y H-L; Cheah, Y S; Egan, C; Lewis, J J; da Cruz, L

2017-10-01

PurposeThis retrospective comparative case series aims to determine whether patient ethnicity (White versus South Asian versus Black) is related to the outcome of surgical treatment for traction complications of severe proliferative diabetic retinopathy (PDR).SettingMoorfields Eye Hospital London, UK.MethodsAll patients who underwent vitrectomy with, delamination and/or segmentation for PDR over a 5-year period (2009-2014) were reviewed retrospectively. Patients were divided into White, South Asian or Black groups, and their age, gender, HbA1C and type of diabetes were recorded. A total of 484 patients (253 White, 117 South Asian, 114 Black) were included. Twenty-one patients were excluded due to inadequate documentation.OutcomesLogMAR Visual acuity (converted from Snellen) (VA), was recorded pre-operatively and ~6 months post surgery (range 5-8 months). Surgical outcome was classified according to the type and duration of tamponade required post-operatively.ResultsPre-operative VA and HbA1C values were similar across all three ethnic groups (P=0.64 and 0.569, respectively). Change in VA (mean±SD) was 0.41±0.78, 0.14±0.76 and -0.26±0.57 in White, South Asian and Black patient groups respectively (P<0.001). Multiple regression analysis showed that post-op VA was significantly related to race and pre-op VA only (both P<0.001). The Black patient group were more likely to require silicone oil tamponade (P<0.001) and long-term retention of silicone oil (P<0.001) than the White and South Asian patient groups.ConclusionsThis study demonstrates that Black patients on average lose vision following delamination surgery for traction complications of PDR while White and South Asian patients gain vision. The same group is also at higher risk of retaining silicone more than 6 months after surgery. This difference remains even when corrected for glycaemic control. The higher risk of visual loss and long-term retention of silicone oil in black patients requires further investigation. If these results are confirmed, surgeons should consider their patients' ethnicity before proceeding with surgical treatment of diabetic tractional detachment.

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.

SU-E-I-81: Assessment of CT Radiation Dose and Image Quality for An Automated Tube Potential Selection Algorithm Using Adult Anthropomorphic and ACR Phantoms

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

Mahmood, U; Erdi, Y; Wang, W

Purpose: To assess the impact of General Electrics (GE) automated tube potential algorithm, kV assist (kVa) on radiation dose and image quality, with an emphasis on optimizing protocols based on noise texture. Methods: Radiation dose was assessed by inserting optically stimulated luminescence dosimeters (OSLs) throughout the body of an adult anthropomorphic phantom (CIRS). The baseline protocol was: 120 kVp, Auto mA (180 to 380 mA), noise index (NI) = 14, adaptive iterative statistical reconstruction (ASiR) of 20%, 0.8s rotation time. Image quality was evaluated by calculating the contrast to noise ratio (CNR) and noise power spectrum (NPS) from the ACRmore » CT accreditation phantom. CNRs were calculated according to the steps described in ACR CT phantom testing document. NPS was determined by taking the 3D FFT of the uniformity section of the ACR phantom. NPS and CNR were evaluated with and without kVa and for all available adaptive iterative statistical reconstruction (ASiR) settings, ranging from 0 to 100%. Each NPS was also evaluated for its peak frequency difference (PFD) with respect to the baseline protocol. Results: The CNR for the adult male was found to decrease from CNR = 0.912 ± 0.045 for the baseline protocol without kVa to a CNR = 0.756 ± 0.049 with kVa activated. When compared against the baseline protocol, the PFD at ASiR of 40% yielded a decrease in noise magnitude as realized by the increase in CNR = 0.903 ± 0.023. The difference in the central liver dose with and without kVa was found to be 0.07%. Conclusion: Dose reduction was insignificant in the adult phantom. As determined by NPS analysis, ASiR of 40% produced images with similar noise texture to the baseline protocol. However, the CNR at ASiR of 40% with kVa fails to meet the current ACR CNR passing requirement of 1.0.« less

SU-E-I-89: Assessment of CT Radiation Dose and Image Quality for An Automated Tube Potential Selection Algorithm Using Pediatric Anthropomorphic and ACR Phantoms

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

Mahmood, U; Erdi, Y; Wang, W

Purpose: To assess the impact of General Electrics automated tube potential algorithm, kV assist (kVa) on radiation dose and image quality, with an emphasis on optimizing protocols based on noise texture. Methods: Radiation dose was assessed by inserting optically stimulated luminescence dosimeters (OSLs) throughout the body of a pediatric anthropomorphic phantom (CIRS). The baseline protocol was: 120 kVp, 80 mA, 0.7s rotation time. Image quality was assessed by calculating the contrast to noise ratio (CNR) and noise power spectrum (NPS) from the ACR CT accreditation phantom. CNRs were calculated according to the steps described in ACR CT phantom testing document.more » NPS was determined by taking the 3D FFT of the uniformity section of the ACR phantom. NPS and CNR were evaluated with and without kVa and for all available adaptive iterative statistical reconstruction (ASiR) settings, ranging from 0 to 100%. Each NPS was also evaluated for its peak frequency difference (PFD) with respect to the baseline protocol. Results: For the baseline protocol, CNR was found to decrease from 0.460 ± 0.182 to 0.420 ± 0.057 when kVa was activated. When compared against the baseline protocol, the PFD at ASiR of 40% yielded a decrease in noise magnitude as realized by the increase in CNR = 0.620 ± 0.040. The liver dose decreased by 30% with kVa activation. Conclusion: Application of kVa reduces the liver dose up to 30%. However, reduction in image quality for abdominal scans occurs when using the automated tube voltage selection feature at the baseline protocol. As demonstrated by the CNR and NPS analysis, the texture and magnitude of the noise in reconstructed images at ASiR 40% was found to be the same as our baseline images. We have demonstrated that 30% dose reduction is possible when using 40% ASiR with kVa in pediatric patients.« less

Cognitive Performance and Physiological Changes under Heavy Load Carriage

DTIC Science & Technology

2010-07-01

tensions needed to maintain adequate levels of biomechanical functioning have been associated with an increased likelihood of injury, muscle strain...34Fog of War": Documenting cognitive decrements associated with the stress of combat. Paper presented at the Proceedings of the 23rd Army Science...and the mobility of a nation . Quantico, VA. Mastroianni, G. R., Chuba, D. M., & Zupan, M. O. (2003). Self-pacing and cognitive performance while

Bayesian Hierarchical Models to Augment the Mediterranean Forecast System

DTIC Science & Technology

2006-09-30

med.bhm.html LONG-TERM GOALS Eighteen months into the project, the long-term goals and objectives remain as stated in the progress report last...in the representation of the background error Report Documentation Page Form ApprovedOMB No. 0704-0188 Public reporting burden for the collection of...Information Operations and Reports , 1215 Jefferson Davis Highway, Suite 1204, Arlington VA 22202-4302. Respondents should be aware that notwithstanding any

Transportation Energy Conservation Data Book: A Selected Bibliography. Edition 3,

DTIC Science & Technology

1978-11-01

Charlottesville, VA 22901 TITLE: Couputer-Based Resource Accounting Model TT1.1: Methodology for the Design of Urban for Automobile Technology Impact...Evaluation System ACCOUNTING; INDUSTRIAL SECTOR; ENERGY tPIESi Documentation. volume 6. CONSUM PTION: PERFORANCE: DESIGN : NASTE MEAT: Methodology for... Methodology for the Design of Urban Transportation 000172 Energy Flows In the U.S., 1973 and 1974. Volume 1: Methodology * $opdate to the Fational Energy

Long-term weather variability and shifting distribution limits of the invasive hemlock woolly adelgid (Adelges tsugae Annand)

Treesearch

R. Talbot Trotter III

2011-01-01

The hemlock woolly adelgid (HWA) is a small, aphid-like piercing-sucking insect native to Asia and northwestern North America (Havill et al. 2006, 2007). First documented in 1951 in the eastern United States near Richmond, VA, the HWA has spread to infest at least 17 states along the Appalachian Mountains from Georgia to southern Maine, where infestations have been...

Abstracts of ARI Research Publications, FY 1974 and 1975

DTIC Science & Technology

1979-10-01

may obtain these documents from the National Technical Information Service (NTIS), Department of Commerce, Springfield, Va., 22151. The six- digit AD...Siegel, A. I., Wolf, J. J., & Leahy, W. R. (Applied Psycho- logical Services, Inc.). A digital simulation model of message handling in the Tactical...inherent in the mission of interest, (b) incorporate these 28 into a logic for a digital simulation model, and (c) develop a computer program reflecting

TRADOC Library and Information Network (TRALINET)

DTIC Science & Technology

1979-03-01

by the Library of Congress, Dewey materials that have beer photographically reduced Decimal , or any other classification scheme adopted in size for...sites at Forts Hood, TX; Gordon, GA; Monroe, VA; Knox, KY, and Leavenworth, KS. DTIC, formally Defense Documentation Center ( DDC ), serves as the primary...locally expanded subject schedules, whether schedules aic for Dewey , Library of Congress, etc., particularly in the are& of Military Arts and Sciences. 1 4

An Analysis of the Cost-Effectiveness and Efficacy of Tobacco Cessation Aids

DTIC Science & Technology

2007-11-13

NAVSUBMEDRSCHLAB Approved for public release, distribution unlimited Report Documentation Page Form ApprovedOMB No. 0704-0188 Public reporting ...Services, Directorate for Information Operations and Reports , 1215 Jefferson Davis Highway, Suite 1204, Arlington VA 22202-4302. Respondents should be aware...does not display a currently valid OMB control number. 1. REPORT DATE 13 NOV 2007 2. REPORT TYPE Technical Report 3. DATES COVERED 00-00-2007

Naval Operations Concept 2010: Implementing the Maritime Strategy

DTIC Science & Technology

2010-01-01

Naval Operations Concept 2010 Implementing The Maritime Strategy Report Documentation Page Form ApprovedOMB No. 0704-0188 Public reporting burden...Directorate for Information Operations and Reports , 1215 Jefferson Davis Highway, Suite 1204, Arlington VA 22202-4302. Respondents should be aware that...display a currently valid OMB control number. 1. REPORT DATE 2010 2. REPORT TYPE 3. DATES COVERED 00-00-2010 to 00-00-2010 4. TITLE AND

An Empirical Model of the Vertical Structure of German Fogs.

DTIC Science & Technology

1980-11-01

Fitz ) ATTN: Dr. John E. Cockayne Washington, DC 20305 McLean, VA 22102 Director US Army Nuclear & Chemical Agency Defense Nuclear Agency ATTN: MONA-WE...Information Center John M. Hobbie ATTN: DRSMI-RPRD (Documents Section) c/o Kentron International Redstone Arsenal, AL 35809 2003 Byrd Spring Road...ATTN: Mr. John D. Carlyle Culter City, CA 90230 5383 Hollister Avenue Santa Barbara, CA 93111 Commander US Army Combat Developments Commander

Cost, Capability, and the Hunt for a Lightweight Ground Attack Aircraft

DTIC Science & Technology

2009-06-12

Approved for public release; distribution is unlimited. ii REPORT DOCUMENTATION PAGE Form Approved OMB No. 0704-0188 Public reporting burden...Headquarters Services, Directorate for Information Operations and Reports (0704-0188), 1215 Jefferson Davis Highway, Suite 1204, Arlington, VA 22202...1. REPORT DATE (DD-MM-YYYY) 12-06-2009 2. REPORT TYPE Master‘s Thesis 3. DATES COVERED (From - To) AUG 2008 – JUN 2009 4. TITLE AND SUBTITLE

Among patients with unhealthy alcohol use, those with HIV are less likely than those without to receive evidence-based alcohol-related care: A national VA study*

PubMed Central

Williams, Emily C.; Lapham, Gwen T.; Shortreed, Susan M.; Rubinsky, Anna D.; Bobb, Jennifer F.; Bensley, Kara M.; Catz, Sheryl L.; Richards, Julie; Bradley, Katharine A.

2017-01-01

Background Alcohol use has important adverse effects on people living with HIV (PLWH). This study of patients with recognized unhealthy alcohol use estimated and compared rates of alcohol-related care received by PLWH and HIV− patients. Methods Outpatients from the Veterans Health Administration who had one or more positive screen(s) for unhealthy alcohol use (AUDIT-C≥5) documented in their medical records 10/2009–5/2013 were eligible. Primary and secondary outcomes were brief intervention documented ≤14 days after a positive alcohol screen, and a composite measure of any alcohol-related care (brief intervention, specialty addictions treatment or pharmacotherapy documented ≤365 days), respectively. Unadjusted and adjusted regression analyses compared alcohol-related care outcomes in PLWH and HIV− patients. Results The sample included 830,825 outpatients (3,514 PLWH), reflecting 1,172,606 positive screens (1–5 per patient). For PLWH, 57.0% (95% confidence interval 55.4–58.5%) of positive screens were followed by brief intervention, compared to 73.8% (73.7–73.9%) for HIV− patients [relative rate: 0.77 (0.75–0.79), p<0.001]. After adjustment, comparable proportions were 61.0% (59.3–62.6%) for PLWH and 73.7% (73.6–73.8%) for HIV− patients [adjusted RR=0.83 (0.80–0.85); p<0.001]. Secondary outcome results were similar: for PLWH and HIV− patients, 67.1% (65.7–68.6%) and 77.7% (95% CI 77.7–77.8%) of positive screens, respectively, were followed by any alcohol-related care after adjustment [adjusted RR=0.86 (0.85 – 0.88), p<0.001]. Conclusions In this large national sample of VA outpatients with unhealthy alcohol use, PLWH were less likely to receive alcohol-related care than HIV− patients. Special efforts may be needed to ensure alcohol-related care reaches PLWH. PMID:28324813

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

Health information technology and implementation science: partners in progress in the VHA.

PubMed

Hynes, Denise M; Whittier, Erika R; Owens, Arika

2013-03-01

The Department of Veterans Affairs (VA) Quality Enhancement Research Initiative (QUERI) has demonstrated how implementation science can enhance the quality of health care. During this time an increasing number of implementation research projects have developed or utilized health information technology (HIT) innovations to leverage the VA's electronic health record and information systems. To describe the HIT approaches used and to characterize the facilitators and barriers to progress within implementation research projects in the VA QUERI program. Nine case studies were selected from among 88 projects and represented 8 of 14 HIT categories identified. Each case study included key informants whose roles on the project were principal investigator, implementation science and informatics development. We conducted documentation analysis and semistructured in-person interviews with key informants for each of the 9 case studies. We used qualitative analysis software to identify and thematically code information and interview responses. : Thematic analyses revealed 3 domains or pathways critical to progression through the QUERI steps. These pathways addressed: (1) compliance and collaboration with information technology policies and procedures; (2) operating within organizational policies and building collaborations with end users, clinicians, and administrators; and (3) obtaining and maintaining research resources and approvals. Sustained efforts in HIT innovation and in implementation science in the Veterans Health Administration demonstrates the interdependencies of these initiatives and the critical pathways that can contribute to progress. Other health care quality improvement efforts that rely on HIT can learn from the Veterans Health Administration experience.

Prevalence and correlates of cannabis use in an outpatient VA posttraumatic stress disorder clinic.

PubMed

Gentes, Emily L; Schry, Amie R; Hicks, Terrell A; Clancy, Carolina P; Collie, Claire F; Kirby, Angela C; Dennis, Michelle F; Hertzberg, Michael A; Beckham, Jean C; Calhoun, Patrick S

2016-05-01

Recent research has documented high rates of comorbidity between cannabis use disorders and posttraumatic stress disorder (PTSD) in veterans. However, despite possible links between PTSD and cannabis use, relatively little is known about cannabis use in veterans who present for PTSD treatment, particularly among samples not diagnosed with a substance use disorder. This study examined the prevalence of cannabis use and the psychological and functional correlates of cannabis use among a large sample of veterans seeking treatment at a Veterans Affairs (VA) PTSD specialty clinic. Male veterans (N = 719) who presented at a VA specialty outpatient PTSD clinic completed measures of demographic variables, combat exposure, alcohol, cannabis and other drug use, and PTSD and depressive symptoms. The associations among demographic, psychological, and functional variables were estimated using logistic regressions. Overall, 14.6% of participants reported using cannabis in the past 6 months. After controlling for age, race, service era, and combat exposure, past 6-month cannabis use was associated with unmarried status, use of tobacco products, other drug use, hazardous alcohol use, PTSD severity, depressive symptom severity, and suicidality. The present findings show that cannabis use is quite prevalent among veterans seeking PTSD specialty treatment and is associated with poorer mental health and use of other substances. It may be possible to identify and treat individuals who use cannabis in specialty clinics (e.g., PTSD clinics) where they are likely to present for treatment of associated mental health issues. (PsycINFO Database Record (c) 2016 APA, all rights reserved).

Long-term prognosis of patients with life-threatening ventricular arrhythmias induced by coronary artery spasm.

PubMed

Rodríguez-Mañero, Moisés; Oloriz, Teresa; le Polain de Waroux, Jean-Benoit; Burri, Haran; Kreidieh, Bahij; de Asmundis, Carlos; Arias, Miguel A; Arbelo, Elena; Díaz Fernández, Brais; Fernández-Armenta, Juan; Basterra, Nuria; Izquierdo, María Teresa; Díaz-Infante, Ernesto; Ballesteros, Gabriel; Carrillo López, Andrés; García-Bolao, Ignacio; Benezet-Mazuecos, Juan; Expósito-García, Victor; Larraitz-Gaztañaga; Martínez-Sande, Jose Luis; García-Seara, Javier; González-Juanatey, Jose Ramón; Peinado, Rafael

2018-05-01

Coronary artery spasm (CAS) is associated with ventricular arrhythmias (VA). Much controversy remains regarding the best therapeutic interventions for this specific patient subset. We aimed to evaluate the clinical outcomes of patients with a history of life-threatening VA due to CAS with various medical interventions, as well as the need for ICD placement in the setting of optimal medical therapy. A multicentre European retrospective survey of patients with VA in the setting of CAS was aggregated and relevant clinical and demographic data was analysed. Forty-nine appropriate patients were identified: 43 (87.8%) presented with VF and 6 (12.2%) with rapid VT. ICD implantation was performed in 44 (89.8%). During follow-up [59 (17-117) months], appropriate ICD shocks were documented in 12. In 8/12 (66.6%) no more ICD therapies were recorded after optimizing calcium channel blocker (CCB) therapy. SCD occurred in one patient without ICD. Treatment with beta-blockers was predictive of appropriate device discharge. Conversely, non-dihydropyridine CCB therapy was significantly protective against VAs. Patients with life-threatening VAs secondary to CAS are at particularly high-risk for recurrence, especially when insufficient medical therapy is administered. Non-dihydropyridine CCBs are capable of suppressing episodes, whereas beta-blocker treatment is predictive of VAs. Ultimately, in spite of medical intervention, some patients exhibited arrhythmogenic events in the long-term, suggesting that ICD implantation may still be indicated for all.

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

Data Quality and Interoperability Challenges for eHealth Exchange Participants: Observations from the Department of Veterans Affairs' Virtual Lifetime Electronic Record Health Pilot Phase.

PubMed

Botts, Nathan; Bouhaddou, Omar; Bennett, Jamie; Pan, Eric; Byrne, Colene; Mercincavage, Lauren; Olinger, Lois; Hunolt, Elaine; Cullen, Theresa

2014-01-01

Authors studied the United States (U.S.) Department of Veterans Affairs' (VA) Virtual Lifetime Electronic Record (VLER) Health pilot phase relative to two attributes of data quality - the adoption of eHealth Exchange data standards, and clinical content exchanged. The VLER Health pilot was an early effort in testing implementation of eHealth Exchange standards and technology. Testing included evaluation of exchange data from the VLER Health pilot sites partners: VA, U.S. Department of Defense (DoD), and private sector health care organizations. Domains assessed data quality and interoperability as it relates to: 1) conformance with data standards related to the underlying structure of C32 Summary Documents (C32) produced by eHealth Exchange partners; and 2) the types of C32 clinical content exchanged. This analysis identified several standards non-conformance issues in sample C32 files and informed further discourse on the methods needed to effectively monitor Health Information Exchange (HIE) data content and standards conformance.

Regional differences in prescribing quality among elder veterans and the impact of rural residence

PubMed Central

Lund, BC; Charlton, ME; Steinman, MA; Kaboli, PJ

2014-01-01

Purpose Medication safety is a critical concern for older adults. Regional variation in potentially inappropriate prescribing practices may reflect important differences in health care quality. Therefore, the objectives of this study were to characterize prescribing quality variation among older adults across geographic region, and to compare prescribing quality across rural versus urban residence. Methods Cross-sectional study of 1,549,824 older adult veterans with regular Veterans Affairs (VA) primary care and medication use during fiscal year 2007. Prescribing quality was measured by 4 indicators of potentially inappropriate prescribing: Zhan criteria drugs to avoid, Fick criteria drugs to avoid, therapeutic duplication, and drug-drug interactions. Frequency differences across region and rural-urban residence were compared using adjusted odds-ratios. Findings Significant regional variation was observed for all indicators. Zhan criteria frequencies ranged from 13.2% in the Northeast to 21.2% in the South. Nationally, rural veterans had a significantly increased risk for inappropriate prescribing according to all quality indicators. However, regional analyses revealed this effect was limited to the South and Northeast, whereas rural residence was neutral in the Midwest and protective in the West. Conclusions Significant regional variation in prescribing quality was observed among older adult veterans, mirroring recent findings among Medicare beneficiaries. The association between rurality and prescribing quality is heterogeneous, and relying solely on national estimates may yield misleading conclusions. While we documented important variations in prescribing quality, the underlying factors driving these trends remain unknown, and they are a vital area for future research affecting older adults in both VA and non-VA health systems. PMID:23551647

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.

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.

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

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.

Valuation of Capabilities and System Architectural Options to Meet Affordability Requirement

DTIC Science & Technology

2014-03-18

Prepared for the Naval Postgraduate School, Monterey, CA 93943. Report Documentation Page Form ApprovedOMB No. 0704-0188 Public reporting burden for the...for Information Operations and Reports , 1215 Jefferson Davis Highway, Suite 1204, Arlington VA 22202-4302. Respondents should be aware that...display a currently valid OMB control number. 1. REPORT DATE 18 MAR 2014 2. REPORT TYPE 3. DATES COVERED 00-00-2014 to 00-00-2014 4. TITLE AND

Battlefield-Acquired Immunogenicity to Metals Affects Orthopaedic Implant Outcome

DTIC Science & Technology

2012-10-01

Attending Physician #N/A Control cpm 1308.0 Positive control (PHA) cpm 38247.3 29.2 Mildly Reactive 2 to 4 Reactive 4 to 8 Highly Reactive above 8...Kyron, The Veterans Health Administration has to follow Handbook 1200.05, which states: VHA HANDBOOK 1200.05 October 15, 2010 n. Advertising ...The facility Director is responsible for ensuring that recruiting documents, flyers, and advertisements for non-VA research are not posted within or

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

From El Billar to Operations Fenix and Jaque: The Colombian Security Force Experience, 1998-2008

DTIC Science & Technology

2009-12-01

577–601. ———. Sostenibilidad De La Seguridad Democratica. Bogotá: Fundadcion Seguridad & Democracia, 23 February 2005. Rempe, Dennis M...Security Force Experience, 1998–2008 Robert D. Ramsey III Occasional Paper 34 Report Documentation Page Form ApprovedOMB No. 0704-0188 Public reporting ...Services, Directorate for Information Operations and Reports , 1215 Jefferson Davis Highway, Suite 1204, Arlington VA 22202-4302. Respondents should be

Department of Defense Enterprise Architecture Transition Strategy, Version 2.0

DTIC Science & Technology

2008-02-29

the DoD CIO Enterprise Architecture Congruence Community of Practice Report Documentation Page Form ApprovedOMB No. 0704-0188 Public reporting ...Directorate for Information Operations and Reports , 1215 Jefferson Davis Highway, Suite 1204, Arlington VA 22202-4302. Respondents should be aware...does not display a currently valid OMB control number. 1. REPORT DATE 29 FEB 2008 2. REPORT TYPE 3. DATES COVERED 00-00-2008 to 00-00-2008 4

Integrated Layered Manufacturing of a Novel Wireless Motion Sensor System With GPS

DTIC Science & Technology

2007-08-01

temperatures • mobile • self-locating 575 Report Documentation Page Form ApprovedOMB No. 0704-0188 Public reporting burden for the collection of...Information Operations and Reports , 1215 Jefferson Davis Highway, Suite 1204, Arlington VA 22202-4302. Respondents should be aware that notwithstanding any...valid OMB control number. 1. REPORT DATE AUG 2007 2. REPORT TYPE 3. DATES COVERED 00-00-2007 to 00-00-2007 4. TITLE AND SUBTITLE Integrated

2006 Homeland Security Symposium and Exposition. Held in Arlington, VA on 29-31 March 2006

DTIC Science & Technology

2006-03-31

Consequences , Vulnerabilities, and Threats) Prioritize Implement Protective Programs Measure Effectiveness 9March 2006 Major NIPP Theme: Sector Partnership... effect of exposure • Full understanding of the levels of exposure that mark the onset of miosis • Refined human operational exposure standard for GB...Untitled Document 2006 Homeland Security Symposium and Exposition.html[7/7/2016 11:38:26 AM] 2006 Homeland Security Symposium and Exposition

Performance of Wireless Networks Subject to Constraints and Failures

DTIC Science & Technology

2008-01-01

c© 2008 Vartika Bhandari Report Documentation Page Form ApprovedOMB No. 0704-0188 Public reporting burden for the collection of information is... Reports , 1215 Jefferson Davis Highway, Suite 1204, Arlington VA 22202-4302. Respondents should be aware that notwithstanding any other provision of law...number. 1. REPORT DATE 2008 2. REPORT TYPE 3. DATES COVERED 00-00-2008 to 00-00-2008 4. TITLE AND SUBTITLE Performance of Wireless Networks

Military Retirement Fund Audited Financial Statements. Fiscal Year 2011

DTIC Science & Technology

2011-11-04

reporting . Improper Payments Information Act of 2002 (Public Law No. 107-300) The MRF public accounts receivable, $49.6 million, consists mostly of improper... reports death payment contingencies that result from DoD’s responsibility to cover retiree benefits not paid by the VA during the month of death. L... Report Documentation Page Form ApprovedOMB No. 0704-0188 Public reporting burden for the collection of information is estimated to average 1 hour

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

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

Closed-Loop Control for Sonic Fatigue Testing Systems

NASA Technical Reports Server (NTRS)

Rizzi, Stephen A.; Bossaert, Guido

2001-01-01

This article documents recent improvements to the acoustic control system of the Thermal Acoustic Fatigue Apparatus (TAFA), a progressive wave tube test facility at the NASA Langley Research Center, Hampton, VA. A brief summary of past acoustic performance is first given to serve as a basis of comparison with the new performance data using a multiple-input, closed-loop, narrow-band controller. Performance data in the form of test section acoustic power spectral densities and coherence are presented for a variety of input spectra including uniform, band-limited random and an expendable launch vehicle payload bay environment.

Evaluation of RF Anechoic Chamber Fire Protection Systems

DTIC Science & Technology

1980-07-01

Reflection - I Area Primary Reflection Area FIGURE 5. Re fle ct ions in Anechoic Chiamber. I Primary Reflection rce Areas ’ oil Receiver - FIGUE 6.Three...Uaa~a - a- oa -0 m ...- .m al -C . -.. -a a-id .a mCL aC r. 00 v~.a. m a. a’ c ~ a a Luv c C v ’aa C ൉.-a 0 IL a 0 ~ .. -0 - 00- Ckaa I m.-aI 1 :1...CLASSIFICATION OF THIS PAGE (IWhen Data Entered) REPORT DOCUMENTATION PAGE READ INSTRUCTIONSBEFORE COMPLETING FORM I . REPORT NUMBER 2. GOVT ACCESSION NO, 3

Superfund record of decision (EPA Region 3): US Defense General Supply Center, Operable Unit 9, Chesterfield County, VA, September 1993

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

Not Available

1993-09-01

The decision document presents the selected interim remedial action for Operable Unit 9 (OU9) at the Defense General Supply Center (DGSC) in Chesterfield County, Virginia near Richmond. OU9 pertains to groundwater beneath Area 50, the Open Storage Area (OSA), and the Naitonal Guard Area (NGA). This operable unit is the third of nine operable units that are currently being addressed at the DGSC. OU9 addresses interim treatment and containment of groundwater in the upper and lower aquifers beneath Area 50, the OSA, and the NGA.

Environmental Impact Analysis Process. Deployment Area Selection and Land Withdrawal/Acquisition DEIS. Chapter II. Comparative Analysis of Alternatives.

DTIC Science & Technology

1980-12-01

2.3.17 Housing 2-139 2.3.18 Public Finance 2-142 2.3.19 Educational Services 2-143 2.3.20 Health Services Personnel 2-143 2.3.21 Public Safety 2...2-161 2.4.16 Population 2-161 2.4.17 Housing 2-161 2.4.18 Public Finance 2-162 2.4.19 Educational Services 2-162 2.4.20 Health Services Personnel 2...2.5.17 Housing 2-167 2.5.18 Public Finance 2-168 2.5.19 Educational Services 2-168 2.5.20 Health Services Personnel 2-168 2.5.21 Public Safety 2-168

The personal health record paradox: health care professionals' perspectives and the information ecology of personal health record systems in organizational and clinical settings.

PubMed

Nazi, Kim M

2013-04-04

Despite significant consumer interest and anticipated benefits, overall adoption of personal health records (PHRs) remains relatively low. Understanding the consumer perspective is necessary, but insufficient by itself. Consumer PHR use also has broad implications for health care professionals and organizational delivery systems; however, these have received less attention. An exclusive focus on the PHR as a tool for consumer empowerment does not adequately take into account the social and organizational context of health care delivery, and the reciprocal nature of patient engagement. The purpose of this study was to examine the experiences of physicians, nurses, and pharmacists at the Department of Veterans Affairs (VA) using an organizationally sponsored PHR to develop insights into the interaction of technology and processes of health care delivery. The conceptual framework for the study draws on an information ecology perspective, which recognizes that a vibrant dynamic exists among technologies, people, practices, and values, accounting for both the values and norms of the participants and the practices of the local setting. The study explores the experiences and perspectives of VA health care professionals related to patient use of the My HealtheVet PHR portal and secure messaging systems. In-depth interviews were conducted with 30 VA health care professionals engaged in providing direct patient care who self-reported that they had experiences with at least 1 of 4 PHR features. Interviews were transcribed, coded, and analyzed to identify inductive themes. Organizational documents and artifacts were reviewed and analyzed to trace the trajectory of secure messaging implementation as part of the VA Patient Aligned Care Team (PACT) model. Study findings revealed a variety of factors that have facilitated or inhibited PHR adoption, use, and endorsement of patient use by health care professionals. Health care professionals' accounts and analysis of organizational documents revealed a multidimensional dynamic between the trajectory of secure messaging implementation and its impact on organizational actors and their use of technology, influencing workflow, practices, and the flow of information. In effect, secure messaging was the missing element of complex information ecology and its implementation acted as a catalyst for change. Secure messaging was found to have important consequences for access, communication, patient self-report, and patient/provider relationships. Study findings have direct implications for the development and implementation of PHR systems to ensure adequate training and support for health care professionals, alignment with clinical workflow, and features that enable information sharing and communication. Study findings highlight the importance of clinician endorsement and engagement, and the need to further examine both intended and unintended consequences of use. This research provides an integral step toward better understanding the social and organizational context and impact of PHR and secure messaging use in clinical practice settings.

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

Changes in dietary practices and social organization during the pivotal late iron age period in Norway (AD 550-1030): isotope analyses of Merovingian and Viking Age human remains.

PubMed

Naumann, Elise; Price, T Douglas; Richards, Michael P

2014-11-01

Human remains representing 33 individuals buried along the coast in northern Norway were analyzed for diet composition using collagen stable carbon and nitrogen isotope analysis. Where possible, both teeth and bone were included to investigate whether there were dietary changes from childhood to adulthood. A general shift was documented from the Merovingian Age 550-800 AD to the Viking Age AD 800-1050 (VA), with a heavier reliance on marine diet in the VA. Dietary life history data show that 15 individuals changed their diets through life with 11 of these having consumed more marine foods in the later years of life. In combination with (87) Sr/(86) Sr data, it is argued that at least six individuals possibly originated from inland areas and then moved to the coastal region where they were eventually interred. The trend is considered in relation to the increasing expansion of the marine fishing industry at this time, and it is suggested that results from isotope analyses reflect the expanding production and export of stockfish in this region. © 2014 Wiley Periodicals, Inc.

75 FR 7651 - Privacy Act of 1974; System of Records

Federal Register 2010, 2011, 2012, 2013, 2014

2010-02-22

... Administration Leadership and Workforce Development--VA'' (161VA10A2). DATES: Comments on this new system of.... Description of Proposed Systems of Records Veterans Health Administration Leadership and Workforce Development... Affairs. 161VA10A2 SYSTEM NAME: Veterans Health Administration Leadership and Workforce Development--VA...

Research-Airplane-Committee Report on Conference on the Progress of the X-15 Project: A Compilation of the Papers Presented, Held at Langley Aeronautical Lab., Langley Field, VA on 25-26 October 1956

NASA Technical Reports Server (NTRS)

1956-01-01

This document is a compilation of papers presented at the Conference on the Progress of the X-15 project held at the Langley Aeronautical Laboratory on 25-26 October 1956. The conference was held by the Research Airplane Committee of the U. S. Air Force, the U. S. Navy, and the National Advisory Committee for Aeronautics to report on the technical status of this research airplane. The papers were presented by members of the staffs of North American Aviation, Inc., Reaction Motors, Inc., and NACA.

Red eyes and red-flags: improving ophthalmic assessment and referral in primary care

PubMed Central

Kilduff, Caroline; Lois, Charis

2016-01-01

Up to five percent of primary care consultations are eye-related, yet 96% of General Practitioners (GPs) do not undergo postgraduate ophthalmology training. Most do not feel assured performing eye assessments. Some red eye conditions can become sight threatening, and often exhibit red-flag features. These features include moderate pain, photophobia, reduced visual acuity (VA), eye-trauma, or unilateral marked redness. The aim of this project was to improve primary care assessment and referral of patients presenting with red-flag features based on the NICE ‘Red Eye’ Clinical Knowledge Summary recommendations. Data was collected retrospectively from 139 red eye consultations. A practice meeting highlighted poor awareness of red-flag features, low confidence levels in eye assessments, and time-constraints during appointments. Interventions were based on feedback from staff. These included a primary care teaching session on red-flag features, a VA measurement tutorial, and provision of a red eye toolkit, including VA equipment, to each consultation room. At baseline, each patient had on average 0.9 red-flag features assessed. Only 36.0% (9/25) of patients with red-flag features were appropriately referred to same-day ophthalmology services. Following two improvement cycles, a significant improvement was seen in almost every parameter. On average, each patient had 2.7 red-flag features assessed (vs 0.9, p<0.001). VA was assessed in 55.6% of consultations (vs 7.9%, p<0.001), pain was quantified in 81.5% (vs 20.9%, p=0.005), eye-trauma or foreign-body (51.8% vs 8.6%, p<0.001), extent of redness was documented in 66.7% (vs 14.4%, p<0.001). Only photophobia remained poorly assessed (18.5% vs 14.4%, p=0.75). Following this, 75.0% (6/8) of patients were appropriately referred. This project reflected the literature regarding low confidence and inexperience amongst GPs when faced with ophthalmic conditions. Improvements in education are required to ensure accurate assessments can be undertaken in a time-constrained environment. PMID:27493748

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.

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.

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...

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...

Worklife and Wellness in Academic General Internal Medicine: Results from a National Survey.

PubMed

Linzer, Mark; Poplau, Sara; Babbott, Stewart; Collins, Tracie; Guzman-Corrales, Laura; Menk, Jeremiah; Murphy, Mary Lou; Ovington, Kay

2016-09-01

General internal medicine (GIM) careers are increasingly viewed as challenging and unsustainable. We aimed to assess academic GIM worklife and determine remediable predictors of stress and burnout. We conducted an email survey. Physicians, nurse practitioners, and physician assistants in 15 GIM divisions participated. A ten-item survey queried stress, burnout, and work conditions such as electronic medical record (EMR) challenges. An open-ended question assessed stressors and solutions. Results were categorized into burnout, high stress, high control, chaos, good teamwork, high values alignment, documentation time pressure, and excessive home EMR use. Frequencies were determined for national data, Veterans Affairs (VA) versus civilian populations, and hospitalist versus ambulatory roles. A General Linear Mixed Model (GLMM) evaluated associations with burnout. A formal content analysis was performed for open-ended question responses. Of 1235 clinicians sampled, 579 responded (47 %). High stress was present in 67 %, with 38 % burned out (burnout range 10-56 % by division). Half of respondents had low work control, 60 % reported high documentation time pressure, half described too much home EMR time, and most reported very busy or chaotic workplaces. Two-thirds felt aligned with departmental leaders' values, and three-quarters were satisfied with teamwork. Burnout was associated with high stress, low work control, and low values alignment with leaders (all p < 0.001). The 45 VA faculty had less burnout than civilian counterparts (17 % vs. 40 %, p < 0.05). Hospitalists described better teamwork than ambulatory clinicians and fewer hospitalists noted documentation time pressure (both p < 0.001). Key themes from the qualitative analysis were short visits, insufficient support staff, a Relative Value Unit mentality, documentation time pressure, and undervaluing education. While GIM divisions overall demonstrate high stress and burnout, division rates vary widely. Sustainability efforts within GIM could focus on visit length, staff support, schedule control, clinic chaos, and EMR stress.

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

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.

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.

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.

What Are We Missing A Call for Red Teaming Within the Domestic Maritime Domain for Anti-Terrorism Programs

DTIC Science & Technology

2015-12-01

Sherman Kent Center, Central Intelligence Agency 3, no. 2 (October 2004), https://www.cia.gov/ library /kent-center-occasional-papers/vol3no2.htm...Naval Intelligence (Norfolk, VA: Naval Warfare Development Command, 2008), http://www.nwdc.navy.mil/content/ Library /Documents/NDPs/ ndp2/ndp20007.htm...Fathali M. Moghaddam, “ Multiculturalism and Intergroup Relations,” American Psychological Association, November 2011, 95. 114 Matherly, The Red Teaming

Examination of Chesapeake Bay Observing System for Local Environmental Data for Coast Guard Operations

DTIC Science & Technology

2004-12-01

U.S. Coast Guard Research and Development Center 1082 Shennecossett Road, Groton, CT 06340-6048 Report No. CG-D-04-05 Examination of Chesapeake Bay...Director "United States Coast Guard Research & Development Center 1082 Shennecossett Road r Groton, CT 06340-6048 ii Technical Report Documentation Page...and Mary Research & Development Center 11. Contract or Grant No. Route 1208, Greate Road 1082 Shennecossett Road DTCG32-03-C-R0006 Gloucester Point, VA

DOE Biomass Power Program: Strategic Plan 1996-2015

DTIC Science & Technology

1996-12-01

C P L A N 1 9 9 6 - 2 0 1 5 Report Documentation Page Form ApprovedOMB No. 0704-0188 Public reporting burden for the collection of...Operations and Reports , 1215 Jefferson Davis Highway, Suite 1204, Arlington VA 22202-4302. Respondents should be aware that notwithstanding any other...valid OMB control number. 1. REPORT DATE 1996 2. REPORT TYPE N/A 3. DATES COVERED - 4. TITLE AND SUBTITLE DOE Biomass Power Program 5a

The Prevalence of Concha Bullosa and Nasal Septal Deviation and Their Relationship to Maxillary Sinusitis by Volumetric Tomography

DTIC Science & Technology

2010-07-01

2Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI 48109, USA 3Lieutenant Colonel, US Army DENTAC...of the region, independently reviewed Report Documentation Page Form ApprovedOMB No. 0704-0188 Public reporting burden for the collection of...Operations and Reports , 1215 Jefferson Davis Highway, Suite 1204, Arlington VA 22202-4302. Respondents should be aware that notwithstanding any other

A Study of Parallel Software Development with HPF and MPI for Composite Process Modeling Simulations

DTIC Science & Technology

2011-01-01

Minnesota permanently located at the U. S. Army Research Laboratory. Report Documentation Page Form ApprovedOMB No. 0704-0188 Public reporting burden for...Directorate for Information Operations and Reports , 1215 Jefferson Davis Highway, Suite 1204, Arlington VA 22202-4302. Respondents should be aware that...display a currently valid OMB control number. 1. REPORT DATE 2011 2. REPORT TYPE 3. DATES COVERED 00-00-2011 to 00-00-2011 4. TITLE AND SUBTITLE

Time Spent in Indirect Nursing Care

DTIC Science & Technology

1983-09-01

divisions of labor by nursing personnel: a) direct patient care (28-35%); b) indirect care (50-62%); and c) personal time (10-15%). In comparing the... personal time (13-18%) (Kuhn, 1983). It must be noted that, in the VA data, wait time (time waiting to render care) has been subsumed under personal time...interval during the entire eight-hour shift. The first task observed being performed by the monitored person was the activity documented. 5 U. ,. 1 -V

Release of VA Records Relating to HIV. Final rule.

PubMed

2017-03-23

The Department of Veterans Affairs (VA) is amending its medical regulations governing the release of VA medical records. Specifically, VA is eliminating the restriction on sharing a negative test result for the human immunodeficiency virus (HIV) with veterans' outside providers. HIV testing is a common practice today in healthcare and the stigma of testing that may have been seen in the 1980s when HIV was first discovered is no longer prevalent. Continuing to protect negative HIV tests causes delays and an unnecessary burden on veterans when VA tries to share electronic medical information with the veterans' outside providers through electronic health information exchanges. For this same reason, VA will also eliminate restrictions on negative test results of sickle cell anemia. This final rule eliminates the current barriers to electronic medical information exchange.

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...

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

Controlling prescription drug costs: regulation and the role of interest groups in Medicare and the Veterans Health Administration.

PubMed

Frakt, Austin B; Pizer, Steven D; Hendricks, Ann M

2008-12-01

Medicare and the Veterans Health Administration (VA) both finance large outpatient prescription drug programs, though in very different ways. In the ongoing debate on how to control Medicare spending, some suggest that Medicare should negotiate directly with drug manufacturers, as the VA does. In this article we relate the role of interest groups to policy differences between Medicare and the VA and, in doing so, explain why such a large change to the Medicare drug program is unlikely. We argue that key policy differences are attributable to stable differences in interest group involvement. While this stability makes major changes in Medicare unlikely, it suggests the possibility of leveraging VA drug purchasing to achieve savings in Medicare. This could be done through a VA-administered drug-only benefit for Medicare-enrolled veterans. Such a partnership could incorporate key elements of both programs: capacity to accept large numbers of enrollees (like Medicare) and leverage to negotiate prescription drug prices (like the VA). Moreover, it could be implemented at no cost to the VA while achieving savings for Medicare and beneficiaries.

Water Resources Data, New York, Water Year 1996; Volume 1. Eastern New York; Excluding Long Island

USGS Publications Warehouse

Butch, G.K.; Dalton, F.N.; Lent, H.G.; Murray, P.M.

1997-01-01

IntroductionWater-resources data for the 1996 water year for New York consist of records of stage, discharge, and water quality of streams; stage, contents, and water quality of lakes and reservoirs; ground-water levels; and precipitation quality. This volume contains records for water discharge at 122 gaging stations; stage only at 7 gaging stations; stage and contents at 4 gaging stations, and 18 other lakes and reservoirs; water quality at 28 gaging stations and 1 precipitation-quality station; and water levels at 3 observation wells. Also included are data for 33 crest-stage partial-record stations. Additional water data were collected at various sites not involved in the systematic data-collection program, and are published as miscellaneous measurements and analyses in this volume. These data together with the data in Volumes 2 and 3 represent that part of the National Water Data System operated by the U.S. Geological Survey in cooperation with State, Municipal, and Federal agencies in New York.Records of discharge and stage of streams, and contents and stage of lakes and reservoirs, were first published in a series of U.S. Geological Survey water-supply papers entitled, “Surface Water Supply of the United States.” Through September 30, 1960, these water-supply papers were in an annual series and then in a 5-year series for 1961-65 and 1966-70. Records of water quality, water temperatures, and suspended sediment were published from 1941 to 1970 in an annual series of water-supply papers entitled “Quality of Surface Waters of the United States.” Records of ground-water levels were published from 1935 to 1974 in a series of water-supply papers entitled “Ground-Water Levels in the United States.” Water-supply papers may be consulted in the libraries of the principal cities and universities in the United States or may be purchased from the U.S. Geological Survey, Branch of Distribution, 604 South Pickett Street, Alexandria, VA 22304.Since the 1961 water year, streamflow data and since the 1964 water year, water-quality data have been released by the Geological Survey in annual reports on a State-boundary basis. These reports provided rapid release of water data in each state shortly after the end of the water year. Through 1970 the data were also released in the water-supply paper series mentioned above.Streamflow and water-quality data beginning with the 1971 water year, and ground-water data beginning with the 1975 water year are published only in reports on a State-boundary basis. Beginning with the 1975 water year, these Survey reports carry an identification number consisting of the two-letter State abbreviation, the last two digits of the water year, and the volume number. For example, this volume is identified as “U.S. Geological Survey Water-Data Report NY-96-1.” Water-data reports are for sale in paper copy or in microfiche by the National Technical Information Service, U.S. Department of Commerce, Springfield, VA 22161.Additional information, including current prices for ordering specific reports, may be obtained from the District Office at the address given on the back of the title page or by telephone (518) 285-5600.

78 FR 11094 - Drawbridge Operation Regulation; James River, Between Isle of Wight and Newport News, VA

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2013-02-15

... Operation Regulation; James River, Between Isle of Wight and Newport News, VA AGENCY: Coast Guard, DHS... River, mile 5.0, between Isle of Wight and Newport News, VA. This deviation is necessary to facilitate... Isle of Isle and Newport News, VA opens on signal. The James River Bridge has vertical clearances in...

MyRIP interaction with MyoVa on secretory granules is controlled by the cAMP-PKA pathway.

PubMed

Brozzi, Flora; Lajus, Sophie; Diraison, Frederique; Rajatileka, Shavanthi; Hayward, Katy; Regazzi, Romano; Molnár, Elek; Váradi, Anikó

2012-11-01

Myosin- and Rab-interacting protein (MyRIP), which belongs to the protein kinase A (PKA)-anchoring family, is implicated in hormone secretion. However, its mechanism of action is not fully elucidated. Here we investigate the role of MyRIP in myosin Va (MyoVa)-dependent secretory granule (SG) transport and secretion in pancreatic beta cells. These cells solely express the brain isoform of MyoVa (BR-MyoVa), which is a key motor protein in SG transport. In vitro pull-down, coimmunoprecipitation, and colocalization studies revealed that MyRIP does not interact with BR-MyoVa in glucose-stimulated pancreatic beta cells, suggesting that, contrary to previous notions, MyRIP does not link this motor protein to SGs. Glucose-stimulated insulin secretion is augmented by incretin hormones, which increase cAMP levels and leads to MyRIP phosphorylation, its interaction with BR-MyoVa, and phosphorylation of the BR-MyoVa receptor rabphilin-3A (Rph-3A). Rph-3A phosphorylation on Ser-234 was inhibited by small interfering RNA knockdown of MyRIP, which also reduced cAMP-mediated hormone secretion. Demonstrating the importance of this phosphorylation, nonphosphorylatable and phosphomimic Rph-3A mutants significantly altered hormone release when PKA was activated. These data suggest that MyRIP only forms a functional protein complex with BR-MyoVa on SGs when cAMP is elevated and under this condition facilitates phosphorylation of SG-associated proteins, which in turn can enhance secretion.

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.

Highly Anisotropic Adhesive Film Made from Upside-Down, Flat, and Uniform Vertically Aligned CNTs.

PubMed

Hong, Sanghyun; Lundstrom, Troy; Ghosh, Ranajay; Abdi, Hamed; Hao, Ji; Jeoung, Sun Kyoung; Su, Paul; Suhr, Jonghwan; Vaziri, Ashkan; Jalili, Nader; Jung, Yung Joon

2016-12-14

We have created a multifunctional dry adhesive film with transferred vertically aligned carbon nanotubes (VA-CNTs). This unique VA-CNT film was fabricated by a multistep transfer process, converting the flat and uniform bottom of VA-CNTs grown on atomically flat silicon wafer substrates into the top surface of an adhesive layer. Unlike as-grown VA-CNTs, which have a nonuniform surface, randomly entangled CNT arrays, and a weak interface between the CNTs and substrates, this transferred VA-CNT film shows an extremely high coefficient of static friction (COF) of up to 60 and a shear adhesion force 30 times higher (12 N/cm 2 ) than that of the as-grown VA-CNTs under a very small preloading of 0.2 N/cm 2 . Moreover, a near-zero normal adhesion force was observed with 20 mN/cm 2 preloading and a maximum 100-μm displacement in a piezo scanner, demonstrating ideal properties for an artificial gecko foot. Using this unique structural feature and anisotropic adhesion properties, we also demonstrate effective removal and assembly of nanoparticles into organized micrometer-scale circular and line patterns by a single brushing of this flat and uniform VA-CNT film.

BRIEF REPORT: β-Blocker Use Among Veterans with Systolic Heart Failure

PubMed Central

Sinha, Sanjai; Goldstein, Matthew; Penrod, Joan; Hochman, Tsivia; Kamran, Mohammad; Tenner, Craig; Cohen, Gabriela; Schwartz, Mark D

2006-01-01

BACKGROUND β-Blockers reduce mortality in patients with systolic chronic heart failure (CHF), yet prescription rates have remained low among primary care providers. OBJECTIVE To determine the β-blocker prescription rate among patients with systolic CHF at primary care Veterans Affairs (VA) clinics, its change over time; and to determine factors associated with nonprescription. DESIGN Retrospective chart review. SUBJECTS Seven hundred and forty-five patients with diagnostic codes for CHF followed in primary care clinics at 3 urban VA Medical Centers. MEASUREMENTS Rate of β-blocker prescription and comparison of patient characteristics between those prescribed versus those not prescribed β-blockers. RESULTS Only 368 (49%) had documented systolic CHF. Eighty-two percent (303/368) of these patients were prescribed a β-blocker. The prescription rate rose steadily over 3 consecutive 2-year time periods. Patients with more severely depressed ejection fractions were more likely to be on a β-blocker than patients with less severe disease. Independent predictors of nonprescription included chronic obstructive pulmonary disease, asthma, depression, and age. Patients under 65 years old were 12 times more likely to receive β-blockers than those over 85. CONCLUSION Primary care providers at VA Medical Centers achieved high rates of β-blocker prescription for CHF patients. Subgroups with relative contraindications had lower prescription rates and should be targeted for quality improvement initiatives. PMID:17105526

Intermediate-term efficacy of Tm:YAG laser prostate vaporesection for bladder outlet obstruction: initial experience from a UK teaching hospital.

PubMed

Pal, Raj P; Khan, Masood A

2012-01-01

To assess the safety and clinical efficacy of Tm:YAG laser vaporesection of the prostate (ThuVaRP) at intermediate-term follow-up. We identified the first 60 consecutive patients who underwent ThuVaRP at our institute. Operative outcomes assessed were resection time, resection weight, drop in haemoglobin, transfusion rate, catheter time and complication rate. The International Prostate Symptom Score (IPSS) was documented at a mean follow-up period of 19 months postoperatively. 45/60 patients underwent treatment due to lower urinary tract symptoms secondary to benign prostatic obstruction, 11/60 patients had a long-term catheter in situ for refractory urinary retention secondary to benign prostatic obstruction, and 4/60 patients had bladder outflow obstruction secondary to adenocarcinoma of the prostate. 1/60 patients developed urosepsis, 1/60 patients developed a urinary tract infection and 1/60 patients required 3-way catheterization and irrigation due to haematuria. No patients required a blood transfusion. The mean IPSS at a mean follow-up interval of 19 months (range 15-28 months) was 5.1 (range 1-23). Postoperative maximum flow rate improved from 7.9 to 17.1 ml/s, and post-micturition residual volume decreased from 254 to 86 ml. ThuVaRP is safe and appears to have durable efficacy at intermediate follow-up. Copyright © 2011 S. Karger AG, Basel.

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.

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

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.

Expanded HIV Testing in the US Department of Veterans Affairs, 2009–2011

PubMed Central

Halloran, CNS, James; Pedati, Caitlin; Dursa, Erin K.; Durfee, Janet; Martinello, Richard; Davey, Victoria; Ross, David

2013-01-01

Objectives. We measured HIV testing and seropositivity among veterans in Veterans Affairs (VA) care for calendar years 2009 through 2011 and analyzed 2011 results by patient demographics. Methods. We performed a repeated-measures cross-sectional study using standardized electronic data extraction from the VA electronic health records for all veterans with at least 1 outpatient visit during 2009 through 2011. We analyzed testing rates and seropositivity by demographic characteristics for 2011. Results. Of veterans with an outpatient visit, 20.0% had an HIV test in 2011, compared with 9.2% in 2009. Documented HIV testing rates were highest in women and Blacks. Of confirmed positive test results, 67.0% were in outpatients older than 50 years. Seropositivity was highest among men aged 30 to 49 years, women aged 50 to 69 years, and Black outpatients of both genders. Implementation of an electronic clinical reminder was associated with higher testing rates. Conclusions. The significant effect of an electronic clinical reminder suggests that such decision support tools can substantially increase testing rates. The frequency of positive test results in older individuals suggests the need for additional work to define optimum approaches to HIV testing in this population. PMID:24134344

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.

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.

Post Admission Cognitive Therapy (PACT) for the Inpatient Treatment of Military Personnel with Suicidal Behaviors: A Multi-Site Randomized Controlled Trial

DTIC Science & Technology

2013-02-01

author(s) and should not be construed as an official Department of the Army position, policy or decision unless so designated by other documentation. 1...Operations and Reports (0704-0188), 1215 Jefferson Davis Highway, Suite 1204, Arlington, VA 22202-4302. Respondents should be aware that...required, WRNMMC credentialing office will NOT renew privileges unless a peer review can be conducted. However, as it currently stands, peer review

U.S. Navy Capstone Strategies and Concepts (1991-2000): Strategy, Policy, Concept, and Vision Documents

DTIC Science & Technology

2012-03-01

PROJECT NUMBER 5e. TASK NUMBER 5f. WORK UNIT NUMBER 7. PERFORMING ORGANIZATION NAME(S) AND ADDRESS(ES) CNA Corporation,4825 Mark Center Drive... industry & USMC OMFTS experience  Project Team created BPR “activity model” (Oct-Dec 1995) OPNAV N513, N812; HQMC Plans, PP&O; MCCDC; NDC; SRA...Alexandria,VA,22311 8. PERFORMING ORGANIZATION REPORT NUMBER 9. SPONSORING/MONITORING AGENCY NAME(S) AND ADDRESS(ES) 10. SPONSOR/MONITOR’S ACRONYM(S) 11

Tracing Multiple Generations of Active Galactic Nucleau Feedback in the Core of Abell 262

DTIC Science & Technology

2009-06-01

Virgo cluster reveal a series of filaments, which trace regions that are thought 1481 Report Documentation Page Form ApprovedOMB No. 0704-0188 Public...L. Sarazin4, L. D. Anderson3, Gopal-Krishna5, E. M. Douglass3, and N. E. Kassim1 1 Naval Research Laboratory, 4555 Overlook Avenue SW, Code 7213...Washington, DC 20375, USA 2 Interferometrics Inc., 13454 Sunrise Valley Drive, Suite 240, Herndon, VA 20171, USA 3 Institute for Astrophysical Research

System Documentation for the U.S. Army Ambulatory Care Data Base (ACDB) Study: Mainframe, Personal Computer and Optical Scanner File Structure

DTIC Science & Technology

1988-11-01

Leesburg Pike, Falls Church, VA 22041-3203 (1) HQ HSC (HSCL-A), Fort Sam Houston, TX 78234-6000 (1) Dir, The Army Library, ATTN: ANR-AL-RS (Army Studies), Rm...34BSBAB"I 0831 2324 CLIDEFS(53)-="BAAA" : CLIDEFS(67)=l9BDAA"l 0943 2324 0843 2324 REM * CLINIC CODE BY SINGLE BUBBLE 0843 2324 CLIBU8S(40)"BAAGN&uA.’ AAv

Intelligence in the Civil War

DTIC Science & Technology

2007-03-01

I N T E L L I G E N ~C E in the C I V I L W A R Report Documentation Page Form ApprovedOMB No. 0704-0188 Public reporting burden for the collection...Information Operations and Reports , 1215 Jefferson Davis Highway, Suite 1204, Arlington VA 22202-4302 Respondents should be aware that notwithstanding any...currently valid OMB control number 1. REPORT DATE MAR 2007 2. REPORT TYPE 3. DATES COVERED 00-00-2007 to 00-00-2007 4. TITLE AND SUBTITLE

AIS Modeling and a Satellite for AIS Observations in the High North + Draft New ITU-R Report Improved Satellite Detection of AIS

DTIC Science & Technology

2008-09-01

20 Aug 08) Report Documentation Page Form ApprovedOMB No . 0704-0188 Public reporting burden for the collection of information is estimated to average...Jefferson Davis Highway, Suite 1204, Arlington VA 22202-4302. Respondents should be aware that notwithstanding any other provision of law, no person...to eliminate propagation delay – 3 min. reporting interval to lower message rate • Vessel consequences: – No extra hardware – Transponder software

Review of Chemical, Biological, Radiological, and Nuclear (CBRN) Terminology in Technical Guide 316 (TG 316) and Allied Medical Publication 8(C) (AMedP-8(C))

DTIC Science & Technology

2013-05-01

tularensis causing pneumonic tularemia (Aberdeen Proving Ground, MD: USAPHC, January 2012); USAPHC, Technical Guide 316 Supplement F1; USAPHC, Technical...Phase I preliminary BMEGs are completed for anthrax, plague, tularemia , ricin, and Staphylococcal Enterotoxin B (SEB). The Phase II process has been...Exposure to Specified Biological Agents: Brucellosis, Glanders, Q Fever, SEB and Tularemia , IDA Document D-4132 (Alexandria, VA: Institute for Defense

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

Isolation and characterization of diesel degrading bacteria, Sphingomonas sp. and Acinetobacter junii from petroleum contaminated soil

NASA Astrophysics Data System (ADS)

Zhang, Qiuzhuo; Wang, Duanchao; Li, Mengmeng; Xiang, Wei-Ning; Achal, Varenyam

2014-03-01

Two indigenous bacteria of petroleum contaminated soil were characterized to utilize diesel fuel as the sole carbon and energy sources in this work. 16S rRNA gene sequence analysis identified these bacteria as Sphingomonas sp. and Acinetobacter junii. The ability to degrade diesel fuel has been demonstrated for the first time by these isolates. The results of IR analyses showed that Sphingomonas sp. VA1 and A. junii VA2 degraded up to 82.6% and 75.8% of applied diesel over 15 days, respectively. In addition, Sphingomonas sp. VA1 possessed the higher cellular hydrophobicities of 94% for diesel compared to 81% by A. junii VA2. The isolates Sphingomonas sp. VA1 and A. junii VA2 exhibited 24% and 18%, respectively emulsification activity. This study reports two new diesel degrading bacterial species, which can be effectively used for bioremediation of petroleum contaminated sites.

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.

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.

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.

The Effect of Gaze Angle on Visual Acuity in Infantile Nystagmus.

PubMed

Dunn, Matt J; Wiggins, Debbie; Woodhouse, J Margaret; Margrain, Tom H; Harris, Christopher M; Erichsen, Jonathan T

2017-01-01

Most individuals with infantile nystagmus (IN) have an idiosyncratic gaze angle at which their nystagmus intensity is minimized. Some adopt an abnormal head posture to use this "null zone," and it has therefore long been assumed that this provides people with nystagmus with improved visual acuity (VA). However, recent studies suggest that improving the nystagmus waveform could have little, if any, influence on VA; that is, VA is fundamentally limited in IN. Here, we examined the impact of the null zone on VA. Visual acuity was measured in eight adults with IN using a psychophysical staircase procedure with reversals at three horizontal gaze angles, including the null zone. As expected, changes in gaze angle affected nystagmus amplitude, frequency, foveation duration, and variability of intercycle foveation position. Across participants, each parameter (except frequency) was significantly correlated with VA. Within any given individual, there was a small but significant improvement in VA (0.08 logMAR) at the null zone as compared with the other gaze angles tested. Despite this, no change in any of the nystagmus waveform parameters was significantly associated with changes in VA within individuals. A strong relationship between VA and nystagmus characteristics exists between individuals with IN. Although significant, the improvement in VA observed within individuals at the null zone is much smaller than might be expected from the occasionally large variations in intensity and foveation dynamics (and anecdotal patient reports of improved vision), suggesting that improvement of other aspects of visual performance may also encourage use of the null zone.

Contemporary Use of Veno-Arterial Extracorporeal Membrane Oxygenation for Refractory Cardiogenic Shock in Acute Coronary Syndrome.

PubMed

Negi, Smita I; Sokolovic, Mladen; Koifman, Edward; Kiramijyan, Sarkis; Torguson, Rebecca; Lindsay, Joseph; Ben-Dor, Itsik; Suddath, William; Pichard, Augusto; Satler, Lowell; Waksman, Ron

2016-02-01

Refractory cardiogenic shock (RCS) in acute myocardial infarction (AMI) is associated with high rates of mortality. Smaller ventricular assist devices, such as the intraaortic balloon pump, provide limited support. Venoarterial extracorporeal membrane oxygenation (VA-ECMO) offers more robust mechanical ventricular support, but is not widely utilized by interventional cardiologists. This study aimed to evaluate the patient characteristics and outcomes of VA-ECMO with RCS in the setting of AMI. A retrospective chart review of all VA-ECMO cannulations between 2009 and 2014 was performed, and patients with an indication of RCS in AMI were identified. A total of 15 patients underwent VA-ECMO placement for AMI with RCS. One-third of these patients presented with out-of-hospital cardiac arrest, and 60% had ST-elevation myocardial infarction. The Intraaortic balloon pump was placed in addition to VA-ECMO in 60% of patients. Median duration of VA-ECMO support was 45 hours. Successful wean off VA-ECMO was obtained in 50% of the patients, and vascular complications occurred in 53% of patients. The survival rate at discharge was 47%, and all survivors were alive at 30 days post discharge. VA-ECMO is infrequently used in patients for cardiopulmonary resuscitation in the AMI setting. When used judiciously, it has good clinical outcomes in this group of patients. However, use of VA-ECMO should be individualized based on vascular anatomy for best results. Close cooperation among interventional cardiologists, cardiovascular surgeons, cardiologists, cardiac intensivists, and perfusionists is essential for success of this therapy for RCS in AMI.

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.

48 CFR 852.219-72 - Evaluation factor for participation in the VA mentor-protégé program.

Code of Federal Regulations, 2010 CFR

2010-10-01

... participation in the VA mentor-protégé program. 852.219-72 Section 852.219-72 Federal Acquisition Regulations... Texts of Provisions and Clauses 852.219-72 Evaluation factor for participation in the VA mentor-protégé... the VA Mentor-Protégé Program (DEC2009) This solicitation contains an evaluation factor or sub-factor...

Anterior Transposition of Anomalous Tortuous Vertebral Artery Causing Cervical Radiculopathy: A Report of 2 Cases and Review of Literature.

PubMed

Wang, Doris D; Burkhardt, Jan-Karl; Magill, Stephen T; Lawton, Michael T

2017-05-01

Cervical radiculopathy secondary to compression from vertebral artery (VA) tortuosity is a rare entity. We describe successful transposition through an anterolateral approach of tortuous VA loops causing cervical radiculopathy. Two patients with cervical radiculopathy (first case at C5-6 and second case at C3-4) secondary to anomalous VA loop compression underwent anterolateral approaches to the cervical spine for decompression and VA transposition. The anterior transverse foramina were drilled to unroof the VA loop, which was dissected free from the exiting nerve root. In both cases, the affected cervical nerve root was successfully decompressed with both radiographic and clinical improvements in radiculopathy symptoms. We found 8 other cases of VA transposition via either an anterolateral approach or a posterolateral approach described in the literature. Our second case of anterolateral VA transposition at the C3-4 level is the first case at this level and the highest level reported in the literature. Decompression using an anterolateral approach with direct microvascular transposition of the VA is a safe and effective treatment of this pathology and addresses the cause of radiculopathy more directly than the posterolateral approach. Copyright © 2017 Elsevier Inc. All rights reserved.

Mental health and substance use disorder spending in the Department of Veterans Affairs, fiscal years 2000-2007.

PubMed

Wagner, Todd H; Sinnott, Patricia; Siroka, Andrew M

2011-04-01

This study analyzed spending for treatment of mental health and substance use disorders in the Department of Veterans Affairs (VA) in fiscal years (FYs) 2000 through 2007. VA spending as reported in the VA Decision Support System was linked to patient utilization data as reported in the Patient Treatment Files, the National Patient Care Database, and the VA Fee Basis files. All care and costs from FY 2000 to FY 2007 were analyzed. Over the study period the number of veterans treated at the VA increased from 3.7 million to over 5.1 million (an average increase of 4.9% per year), and costs increased .7% per person per year. For mental health and substance use disorder treatment, the volume of inpatient care decreased markedly, residential care increased, and spending decreased on average 2% per year (from $668 in FY 2000 to $578 per person in FY 2007). FY 2007 saw large increases in mental health spending, bucking the trend from FY 2000 through FY 2006. VA's continued emphasis on outpatient and residential care was evident through 2007. This trend in spending might be unimpressive if VA were enrolling healthier Veterans, but the opposite seems to be true: over this time period the prevalence of most chronic conditions, including depression and posttraumatic stress disorder, increased. VA spending on mental health care grew rapidly in 2007, and given current military activities, this trend is likely to increase.

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

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.

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.

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.

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...

The Personal Health Record Paradox: Health Care Professionals’ Perspectives and the Information Ecology of Personal Health Record Systems in Organizational and Clinical Settings

PubMed Central

2013-01-01

Background Despite significant consumer interest and anticipated benefits, overall adoption of personal health records (PHRs) remains relatively low. Understanding the consumer perspective is necessary, but insufficient by itself. Consumer PHR use also has broad implications for health care professionals and organizational delivery systems; however, these have received less attention. An exclusive focus on the PHR as a tool for consumer empowerment does not adequately take into account the social and organizational context of health care delivery, and the reciprocal nature of patient engagement. Objective The purpose of this study was to examine the experiences of physicians, nurses, and pharmacists at the Department of Veterans Affairs (VA) using an organizationally sponsored PHR to develop insights into the interaction of technology and processes of health care delivery. The conceptual framework for the study draws on an information ecology perspective, which recognizes that a vibrant dynamic exists among technologies, people, practices, and values, accounting for both the values and norms of the participants and the practices of the local setting. The study explores the experiences and perspectives of VA health care professionals related to patient use of the My HealtheVet PHR portal and secure messaging systems. Methods In-depth interviews were conducted with 30 VA health care professionals engaged in providing direct patient care who self-reported that they had experiences with at least 1 of 4 PHR features. Interviews were transcribed, coded, and analyzed to identify inductive themes. Organizational documents and artifacts were reviewed and analyzed to trace the trajectory of secure messaging implementation as part of the VA Patient Aligned Care Team (PACT) model. Results Study findings revealed a variety of factors that have facilitated or inhibited PHR adoption, use, and endorsement of patient use by health care professionals. Health care professionals’ accounts and analysis of organizational documents revealed a multidimensional dynamic between the trajectory of secure messaging implementation and its impact on organizational actors and their use of technology, influencing workflow, practices, and the flow of information. In effect, secure messaging was the missing element of complex information ecology and its implementation acted as a catalyst for change. Secure messaging was found to have important consequences for access, communication, patient self-report, and patient/provider relationships. Conclusions Study findings have direct implications for the development and implementation of PHR systems to ensure adequate training and support for health care professionals, alignment with clinical workflow, and features that enable information sharing and communication. Study findings highlight the importance of clinician endorsement and engagement, and the need to further examine both intended and unintended consequences of use. This research provides an integral step toward better understanding the social and organizational context and impact of PHR and secure messaging use in clinical practice settings. PMID:23557596

Empirical analysis on future-cash arbitrage risk with portfolio VaR

NASA Astrophysics Data System (ADS)

Chen, Rongda; Li, Cong; Wang, Weijin; Wang, Ze

2014-03-01

This paper constructs the positive arbitrage position by alternating the spot index with Chinese Exchange Traded Fund (ETF) portfolio and estimating the arbitrage-free interval of futures with the latest trade data. Then, an improved Delta-normal method was used, which replaces the simple linear correlation coefficient with tail dependence correlation coefficient, to measure VaR (Value-at-risk) of the arbitrage position. Analysis of VaR implies that the risk of future-cash arbitrage is less than that of investing completely in either futures or spot market. Then according to the compositional VaR and the marginal VaR, we should increase the futures position and decrease the spot position appropriately to minimize the VaR, which can minimize risk subject to certain revenues.

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...

"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.

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.

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

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.

Alcohol-related and mental health care for patients with unhealthy alcohol use and posttraumatic stress disorder in a National Veterans Affairs cohort.

PubMed

Chen, Jessica A; Owens, Mandy D; Browne, Kendall C; Williams, Emily C

2018-02-01

Unhealthy alcohol use and posttraumatic stress disorder (PTSD) frequently co-occur. Patients with both conditions have poorer functioning and worse treatment adherence compared to those with either condition alone. Therefore, it is possible that PTSD, when co-occurring with unhealthy alcohol use, may influence receipt of evidence-based alcohol-related care and mental health care. We evaluated receipt of interventions for unhealthy alcohol use and receipt of mental health follow-up care among patients screening positive for unhealthy alcohol use with and without PTSD in a national sample from the Veterans Health Administration (VA). National clinical and administrative data from VA's electronic medical record were used to identify all patients who screened positive for unhealthy alcohol use (AUDIT-C score≥5) between 10/1/09-5/30/13. Unadjusted and adjusted Poisson regression models were fit to estimate the relative rate and prevalence of receipt of: brief interventions (advice to reduce or abstain from drinking≤14days after positive screening), specialty addictions treatment for alcohol use disorder (AUD; documented visit≤365days after positive screening), pharmacotherapy for AUD (filled prescription≤365days after positive screening), and mental health care ≤14days after positive screening for patients with and without PTSD (documented with ICD-9 CM codes). In secondary analyses, we tested effect modification by both severity of unhealthy alcohol use and age. Among 830,825 patients who screened positive for unhealthy alcohol use, 140,388 (16.9%) had documented PTSD. Of the full sample, 71.6% received brief interventions, 10.3% received specialty AUD treatment, 3.1% received pharmacotherapy for AUD, and 24.0% received mental health care. PTSD was associated with increased likelihood of receiving all types of care. Adjusted relative rates were 1.04 (95% CI 1.03-1.05) for brief interventions, 1.06 (1.05-1.08) for specialty AUD treatment, 1.35 (1.31-1.39) for AUD pharmacotherapy, and 1.82 (1.80-1.84) for mental health care. Alcohol use severity modified effects of PTSD for specialty AUD treatment, AUD pharmacotherapy, and mental health care such that effects were maintained at lower severity but attenuated among patients with severe unhealthy alcohol use. Age modified all effects with the strength of the association between PTSD and care outcomes being strongest for younger (18-29years) and older veterans (65+ years) and weaker or non-significant for middle-aged veterans (30-44 and 45-64years). In this large national sample of patients with unhealthy alcohol use, PTSD was associated with increased likelihood of receiving alcohol-related and mental health care. PTSD does not appear to be a barrier to care among VA patients with unhealthy alcohol use. Published by Elsevier Inc.

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

Exploration of ICD-9-CM Coding of Chronic Disease within the Elixhauser Comorbidity Measure in Patients with Chronic Heart Failure

PubMed Central

Garvin, Jennifer Hornung; Redd, Andrew; Bolton, Dan; Graham, Pauline; Roche, Dominic; Groeneveld, Peter; Leecaster, Molly; Shen, Shuying; Weiner, Mark G.

2013-01-01

Introduction International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes capture comorbidities that can be used to risk adjust nonrandom patient groups. We explored the accuracy of capturing comorbidities associated with one risk adjustment method, the Elixhauser Comorbidity Measure (ECM), in patients with chronic heart failure (CHF) at one Veterans Affairs (VA) medical center. We explored potential reasons for the differences found between the original codes assigned and conditions found through retrospective review. Methods This descriptive, retrospective study used a cohort of patients discharged with a principal diagnosis coded as CHF from one VA medical center in 2003. One admission per patient was used in the study; with multiple admissions, only the first admission was analyzed. We compared the assignment of original codes assigned to conditions found in a retrospective, manual review of the medical record conducted by an investigator with coding expertise as well as by physicians. Members of the team experienced with assigning ICD-9-CM codes and VA coding processes developed themes related to systemic reasons why chronic conditions were not coded in VA records using applied thematic techniques. Results In the 181-patient cohort, 388 comorbid conditions were identified; 305 of these were chronic conditions, originally coded at the time of discharge with an average of 1.7 comorbidities related to the ECM per patient. The review by an investigator with coding expertise revealed a total of 937 comorbidities resulting in 618 chronic comorbid conditions with an average of 3.4 per patient; physician review found 872 total comorbidities with 562 chronic conditions (average 3.1 per patient). The agreement between the original and the retrospective coding review was 88 percent. The kappa statistic for the original and the retrospective coding review was 0.375 with a 95 percent confidence interval (CI) of 0.352 to 0.398. The kappa statistic for the retrospective coding review and physician review was 0.849 (CI, 0.823–0.875). The kappa statistic for the original coding and the physician review was 0.340 (CI, 0.316–0.364). Several systemic factors were identified, including familiarity with inpatient VA and non-VA guidelines, the quality of documentation, and operational requirements to complete the coding process within short time frames and to identify the reasons for movement within a given facility. Conclusion Comorbidities within the ECM representing chronic conditions were significantly underrepresented in the original code assignment. Contributing factors potentially include prioritization of codes related to acute conditions over chronic conditions; coders’ professional training, educational level, and experience; and the limited number of codes allowed in initial coding software. This study highlights the need to evaluate systemic causes of underrepresentation of chronic conditions to improve the accuracy of risk adjustment used for health services research, resource allocation, and performance measurement. PMID:24159270

VA/Q distribution during heavy exercise and recovery in humans: implications for pulmonary edema

NASA Technical Reports Server (NTRS)

Schaffartzik, W.; Poole, D. C.; Derion, T.; Tsukimoto, K.; Hogan, M. C.; Arcos, J. P.; Bebout, D. E.; Wagner, P. D.

1992-01-01

Ventilation-perfusion (VA/Q) inequality has been shown to increase with exercise. Potential mechanisms for this increase include nonuniform pulmonary vasoconstriction, ventilatory time constant inequality, reduced large airway gas mixing, and development of interstitial pulmonary edema. We hypothesized that persistence of VA/Q mismatch after ventilation and cardiac output subside during recovery would be consistent with edema; however, rapid resolution would suggest mechanisms related to changes in ventilation and blood flow per se. Thirteen healthy males performed near-maximal cycle ergometry at an inspiratory PO2 of 91 Torr (because hypoxia accentuates VA/Q mismatch on exercise). Cardiorespiratory variables and inert gas elimination patterns were measured at rest, during exercise, and between 2 and 30 min of recovery. Two profiles of VA/Q distribution behavior emerged during heavy exercise: in group 1 an increase in VA/Q mismatch (log SDQ of 0.35 +/- 0.02 at rest and 0.44 +/- 0.02 at exercise; P less than 0.05, n = 7) and in group 2 no change in VA/Q mismatch (n = 6). There were no differences in anthropometric data, work rate, O2 uptake, or ventilation during heavy exercise between groups. Group 1 demonstrated significantly greater VA/Q inequality, lower vital capacity, and higher forced expiratory flow at 25-75% of forced vital capacity for the first 20 min during recovery than group 2. Cardiac index was higher in group 1 both during heavy exercise and 4 and 6 min postexercise. However, both ventilation and cardiac output returned toward baseline values more rapidly than did VA/Q relationships. Arterial pH was lower in group 1 during exercise and recovery. We conclude that greater VA/Q inequality in group 1 and its persistence during recovery are consistent with the hypothesis that edema occurs and contributes to the increase in VA/Q inequality during exercise. This is supported by observation of greater blood flows and acidosis and, presumably therefore, higher pulmonary vascular pressures in such subjects.

Time-resolved fluorescent properties of 8-vinyl-deoxyadenosine and 2-amino-deoxyribosylpurine exhibit different sensitivity to their opposite base in duplexes.

PubMed

Kenfack, Cyril A; Piémont, Etienne; Ben Gaied, Nouha; Burger, Alain; Mély, Yves

2008-08-14

8-Vinyl-deoxyadenosine (8VA) has been recently introduced as a fluorescent analogue of adenosine that is less perturbing and less quenched than the well-established 2-amino-deoxyribosylpurine (2AP) probe when inserted in oligonucleotides. To further validate 8VA as a fluorescent substitute of A, we compared the ability of 8VA and 2AP in sequences of the type d(CGT TTT XNX TTT TGC) (with N=8VA or 2AP and X=T and C) to discriminate the nature of the opposite base (Y) in duplexes. For both probes, systematic variations in the amplitudes of the short- and long-lived lifetimes of the fluorescence intensity decays as well as in the amplitude of the fast rotational correlation time of the fluorescence anisotropy decays were observed as a function of the nature of Y. From these parameters, we inferred a stability order 8VA-T > 8VA-G > 8VA-A > 8VA-C, similar to the stability order with the native A base, but different from the stability order with 2AP. Using a combination of molecular mechanics and ab initio calculations, we found that the time-resolved parameters of 8VA, but not the 2AP ones, correlate well with the geometry and the strength of the A-Y base-pairing interaction. This may be rationalized by the smaller structural and electronic perturbations induced by the vinyl group in position 8 as compared to the amino group at position 2. As a consequence, substitution of A by 8VA in a base pair was found to only minimally modify the structure and interaction energy of the base pair. Thus, 8VA can be used as a fluorescent substitute of the natural A, to straightforwardly discriminate the nature of the opposite base. This may find interesting applications notably in the elucidation of the mechanisms and dynamics of the DNA mismatch repair system.

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

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...

Control of the vertebral artery from a posterior approach: a technical report.

PubMed

Ye, Jason Y; Ayyash, Omar M; Eskander, Mark S; Kang, James D

2014-06-01

Vertebral artery (VA) injury is a rare but potentially devastating complication of cervical spinal fusion. The Magerl and Harms techniques are associated with a rate between 0% to 8% and 0% to 5%, respectively. Most of reported VA injuries are related to surgical exposure or screw placement, which in turn is likely due to variability in VA anatomy. The purpose of this report was to present the case of a 77-year-old woman, with a history of right VA occlusion, who sustained an intraoperative left VA injury during posterior cervical spine fusion and the subsequent intraoperative and postoperative management strategies. This is a single-patient case report. The patient was placed prone and into Mayfield tongs. A midline incision was made, and dissection was carried down to the lamina and facet joints from occiput to T2. During dissection, she sustained a left-sided VA injury, which was subsequently controlled. The patient was doing well at her 1-year postoperative visit without any residual neurologic deficits. Her severe neck pain had resolved. A detailed understanding of VA anatomy of each individual patient is paramount. There are four types of anomalies: intraforaminal; extraforaminal; arterial; and anomalies of the surrounding bony and soft-tissue architecture. In the event of a posterior intraoperative VA injury, we outlined an algorithm to deal with this complication: control bleeding temporarily to gain visualization of the arterial injury; remove lateral masses and tissue to adequately visualize the arterial injury; once visualized, control the bleeding and see if there are any neuromonitoring changes as a result of the VA occlusion; and proceed with definitive control of the artery by either repair or ligation. Copyright © 2014 Elsevier Inc. All rights reserved.

Validation of verbal autopsy methods using hospital medical records: a case study in Vietnam.

PubMed

Tran, Hong Thi; Nguyen, Hoa Phuong; Walker, Sue M; Hill, Peter S; Rao, Chalapati

2018-05-18

Information on causes of death (COD) is crucial for measuring the health outcomes of populations and progress towards the Sustainable Development Goals. In many countries such as Vietnam where the civil registration and vital statistics (CRVS) system is dysfunctional, information on vital events will continue to rely on verbal autopsy (VA) methods. This study assesses the validity of VA methods used in Vietnam, and provides recommendations on methods for implementing VA validation studies in Vietnam. This validation study was conducted on a sample of 670 deaths from a recent VA study in Quang Ninh province. The study covered 116 cases from this sample, which met three inclusion criteria: a) the death occurred within 30 days of discharge after last hospitalisation, and b) medical records (MRs) for the deceased were available from respective hospitals, and c) the medical record mentioned that the patient was terminally ill at discharge. For each death, the underlying cause of death (UCOD) identified from MRs was compared to the UCOD from VA. The validity of VA diagnoses for major causes of death was measured using sensitivity, specificity and positive predictive value (PPV). The sensitivity of VA was at least 75% in identifying some leading CODs such as stroke, road traffic accidents and several site-specific cancers. However, sensitivity was less than 50% for other important causes including ischemic heart disease, chronic obstructive pulmonary diseases, and diabetes. Overall, there was 57% agreement between UCOD from VA and MR, which increased to 76% when multiple causes from VA were compared to UCOD from MR. Our findings suggest that VA is a valid method to ascertain UCOD in contexts such as Vietnam. Furthermore, within cultural contexts in which patients prefer to die at home instead of a healthcare facility, using the available MRs as the gold standard may be meaningful to the extent that recall bias from the interval between last hospital discharge and death can be minimized. Therefore, future studies should evaluate validity of MRs as a gold standard for VA studies in contexts similar to the Vietnamese context.

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.

The KiVa antibullying program in primary schools in Chile, with and without the digital game component: study protocol for a randomized controlled trial.

PubMed

Gaete, Jorge; Valenzuela, Daniela; Rojas-Barahona, Cristian; Valenzuela, Eduardo; Araya, Ricardo; Salmivalli, Christina

2017-02-20

Bullying is a major problem worldwide and Chile is no exception. Bullying is defined as a systematic aggressive behavior against a victim who cannot defend him or herself. Victims suffer social isolation and psychological maladjustment, while bullies have a higher risk for conduct problems and substance use disorders. These problems appear to last over time. The KiVa antibullying program has been evaluated in Finland and other European countries, showing preventive effects on victimization and self-reported bullying. The aims of this study are (1) to develop a culturally appropriate version of the KiVa material and (2) to test the effectiveness of the KiVa program, with and without the online game, on reducing experiences of victimization and bullying behavior among vulnerable primary schools in Santiago (Chile), using a cluster randomized controlled trial (RCT) design with three arms: (1) full KiVa program group, (2) partial KiVa (without online game) program group and (3) control group. This is a three-arm, single-blind, cluster randomized controlled trial (RCT) with a target enrolment of 1495 4th and 5th graders attending 13 vulnerable schools per arm. Students in the full and partial KiVa groups will receive universal actions: ten 2-h lessons delivered by trained teachers during 1 year; they will be exposed to posters encouraging them to support victims and behave constructively when witnessing bullying; and a person designated by the school authorities will be present in all school breaks and lunchtimes using a visible KiVa vest to remind everybody that they are in a KiVa school. KiVa schools also will have indicated actions, which consist of a set of discussion groups with the victims and with the bullies, with proper follow-up. Only full KiVa schools will also receive an online game which has the aim to raise awareness of the role of the group in bullying, increase empathy and promote strategies to support victimized peers. Self-reported victimization, bullying others and peer-reported bullying actions, psychological and academic functioning, and sense of school membership will be measured at baseline and 12 months after randomization. This is the first cluster RCT of the KiVa antibullying program in Latin America. ClinicalTrials.gov, Identifier: NCT02898324 . Registered on 8 September 2016.

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.

Conceptualizing and Categorizing Race and Ethnicity in Health Services Research

PubMed Central

Ford, Marvella E; Kelly, P Adam

2005-01-01

Objectives Veterans Affairs (VA) patient populations are becoming increasingly diverse in race and ethnicity. The purpose of this paper is to (1) document the importance of using consistent standards of conceptualizing and categorizing race and ethnicity in health services research, (2) provide an overview of different methods currently used to assess race and ethnicity in health services research, and (3) suggest assessment methods that could be incorporated into health services research to ensure accurate assessment of disease prevalence and incidence, as well as accounts of appropriate health services use, in patients with different racial and ethnic backgrounds. Design A critical review of published literature was used. Principal Findings Race is a complex, multidimensional construct. For some individuals, institutionalized racism and internalized racism are intertwined in the effects of race on health outcomes and health services use. Ethnicity is most commonly used as a social–political construct and includes shared origin, shared language, and shared cultural traditions. Acculturation appears to affect the strength of the relationships among ethnicity, health outcomes, and health services use. Conclusions Improved and consistent methods of data collection need to be developed for use by VA researchers across the country. VA research sites with patients representing specific population groups could use a core set of demographic items in addition to expanded modules designed to assess the ethnic diversity within these population groups. Improved and consistent methods of data collection could result in the collection of higher-quality data, which could lead to the identification of race- and ethnic-specific health services needs. These investigations could in turn lead to the development of interventions designed to reduce or eliminate these disparities. PMID:16179001

Difficulties of Distal Catheter Insertion of Ventriculoatrial Shunting in Infants and Little Children.

PubMed

Erdogan, Hakan; Altun, Adnan; Kuruoglu, Enis; Kaya, Ahmet Hilmi; Dagcinar, Adnan

2017-09-26

Ventriculoatrial (VA) shunting is a well-described cerebrospinal fluid diversion method for the treatment of hydrocephalus. However, it may be very challenging in infants and little children because of atrial catheter placement difficulties. This study aimed to create an algorithm to solve problems faced during open surgical procedures based on the present authors' experience. We conducted a retrospective analysis on 18 infants and children who underwent VA shunt insertion at the Department of Neurosurgery, Ondokuz Mayıs University School of Medicine Hospital between 2005 and 2012. Complications, clinical outcomes, revisions, and solutions for overcoming distal catheter placement difficulties were evaluated. Twenty-six VA shunt operations were performed in 18 patients. Six patients required eight VA shunt revisions. VA shunting was primarily performed from the internal jugular, facial, cephalic, and subclavian veins to the right atrium. In revision procedures, the internal jugular, cephalic, and subclavian veins were used. VA shunting in infants and little children requires careful surgical techniques. Neurosurgeons should necessarily have an appropriate strategy for VA shunting considering the complications and revisions. Our results suggest open surgical solutions to overcome distal catheter placement difficulties in this age group.

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

VA Health Care: Improvements Needed in Monitoring Antidepressant Use for Major Depressive Disorder and in Increasing Accuracy of Suicide Data

DTIC Science & Technology

2014-11-01

VA HEALTH CARE Improvements Needed in Monitoring Antidepressant Use for Major Depressive Disorder and in Increasing...00-2014 4. TITLE AND SUBTITLE VA Health Care: Improvements Needed in Monitoring Antidepressant Use for Major Depressive Disorder and in Increasing...Use for Major Depressive Disorder and in Increasing Accuracy of Suicide Data Why GAO Did This Study In 2013, VA estimated that about 1.5 million

Collaboration in health services research: on developing relationships between VA researchers and those in other institutions.

PubMed Central

Greenlick, M R; Freeborn, D K

1986-01-01

This article explores the potential for collaboration between investigators in institutions outside of the VA and those engaged in research within the VA. The focus is on the potential for collaborative work in health services research; our perspective is that of researchers in a freestanding HMO research center affiliated with the Veterans Administration's Northwest Health Services Research and Development Field Program. The paper begins with a review of the reasons that make collaboration between VA researchers and other health services researchers so appropriate at this time. An example of collaboration is presented, drawing on the experience of the Northwest Field Program and the Kaiser Permanente Center for Health Research. Finally, some difficulties inherent in collaboration between VA and other health services researchers are discussed. PMID:3512485

Efficacy of treatment with ranibizumab in patients with wet age-related macular degeneration in routine clinical care: data from the COMPASS health services research.

PubMed

Wolf, Armin; Kampik, Anselm

2014-04-01

To assess healthcare processes during treatment of neovascular age-related macular degeneration (AMD) in patients under real-life conditions and evaluate efficacy of monthly visual acuity (VA) assessment in a pro re nata treatment regime. A multicentre, prospective, non-interventional study based in Germany included neovascular AMD patients treated with intravitreal ranibizumab. Patients completed a 3-month loading phase with monthly intravitreal injections of 0.5 mg ranibizumab, followed by a 12-month maintenance phase during which investigators documented VA, additional injections, metamorphopsias, routine ophthalmological examinations and adverse events at monthly follow-up visits. Efficacy analysis included change from baseline in best-corrected VA (BCVA) based on descriptive statistics. A total of 2,232 patients were enrolled throughout Germany and 1,729 patients (mean age 77.8 years, 63.2 % women) comprised the efficacy population with a complete set of data. In the clinical setting recorded in our study, only a minority of patients underwent optical coherence tomography during the maintenance phase (71 of 1,729 patients). Patients received a mean total of 4.5 injections; three injections during upload phase and 1.5 additional injections during maintenance phase. Over half of the patients (51.4 %) did not receive additional injections. Mean decimal BCVA increased during the upload phase, (from LogMAR mean of 0.201 at baseline to 0.219 at Month 4) but displayed a decline over time (0.192 at Month 15). Ranibizumab treatment in a real-life setting demonstrated efficacy in neovascular AMD patients, as shown by initial gains in BCVA. However, maintenance and improvement of these gains during the maintenance phase in a clinical routine setting remained below those expected compared with MARINA, ANCHOR and CATT trials, most likely due to a low number of retreatments, and the high number of patients with a poor response in regard to improvements of VA who were not investigated in these studies. This phase IV non-interventional health services research study was conducted under the Novartis internal registration code, CRFB002ADE10.

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.

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.

The use of VA Disability Compensation and Social Security Disability Insurance among working-aged veterans.

PubMed

Wilmoth, Janet M; London, Andrew S; Heflin, Colleen M

2015-07-01

Although there is substantial disability among veterans, relatively little is known about working-aged veterans' uptake of Department of Veterans Affairs (VA) Disability Compensation and Social Security Disability Insurance (DI). This study identifies levels of veteran participation in VA disability and/or DI benefit programs, examines transitions into and out of VA and DI programs among veterans, and estimates the size and composition of the veteran population receiving VA and/or DI benefits over time. Data from the 1992, 1993, 1996, 2001, 2004, and 2008 Survey of Income and Program Participation (SIPP) are used to describe VA and DI program participation among veterans under the age of 65. The majority of working-aged veterans do not receive VA or DI benefits and joint participation is low, but use of these programs has increased over time. A higher percentage of veterans receive VA compensation, which ranges from 4.9% in 1992 to 13.2% in 2008, than DI compensation, which ranges from 2.9% in 1992 to 6.7% in 2008. The rate of joint participation ranges from less than 1% in 1992 to 3.6% in 2008. Veterans experience few transitions between VA and DI programs during the 36-48 months they are observed. The number of veterans receiving benefits from VA and/or DI nearly doubled between 1992 and 2008. There have been substantial shifts in the composition of veterans using these programs, as cohorts who served prior to 1964 are replaced by those who served after 1964. The findings suggest potential gaps in veterans' access to disability programs that might be addressed through improved coordination of VA and DI benefits. Copyright © 2015 Elsevier Inc. All rights reserved.

Who pays when VA users are hospitalized in the private sector? Evidence from three data sources.

PubMed

West, Alan N; Weeks, William B

2007-10-01

Older veterans enrolled in VA healthcare receive much of their medical care in the private sector, through Medicare. Less is known about younger VA enrollees' use of the private sector, or its funding. We compare payers for younger and older enrollees' private sector use in 3 hospitalization datasets. From 1998 to 2000, using private sector discharge data for VA enrollees in New York State, we categorized hospitalizations according to payer (self/family, private insurance, Medicare, Medicaid, other sources). We compared this payer distribution to population-weighted national Medical Expenditure Panel Survey (MEPS) data from 1996-2003 for veterans in VA healthcare. We also compared Medicare utilization in either dataset to hospitalizations for New York veterans from 1998-2000 in the VA-Medicare dataset. Analyses separated patients younger than age 65 from those age 65 or older. VA enrollees under age 65 obtain roughly half their hospitalizations in the private sector; older enrollees use the private sector at least twice as often as the VA. Datasets generally agree on payer distributions. Although older enrollees rely heavily on Medicare, they also use commercial insurance and self/family payments substantially. Half of younger enrollees' non-VA hospitalizations are paid by private insurance, but Medicare, Medicaid, and self/family each pay for one-quarter to one-third of admissions. VA enrollees use the private sector for most of their inpatient care, which is funded by multiple sources. Developing a national UB-92/VA dataset would be critical to understanding veterans' use of the private sector for specific diagnoses and procedures, particularly for the fast growing population of younger veterans.

75 FR 41577 - VBA/VHA Musculoskeletal Forum: Improving VA's Disability Evaluation Criteria

Federal Register 2010, 2011, 2012, 2013, 2014

2010-07-16

... medical science information from presentations made by subject matter experts. VA plans to use this information to update the sections of VA's Schedule for Rating Disabilities (VASRD) that pertain to diseases... FURTHER INFORMATION CONTACT: Mr. Brad Tuttle, VASRD Coordinator, Compensation and Pension Service...

48 CFR 803.7000 - Display of the VA Hotline poster.

Code of Federal Regulations, 2011 CFR

2011-10-01

... poster. 803.7000 Section 803.7000 Federal Acquisition Regulations System DEPARTMENT OF VETERANS AFFAIRS... Improper Business Practices 803.7000 Display of the VA Hotline poster. (a) Under the circumstances described in paragraph (b) of this section, a contractor must display prominently a VA Hotline poster...

48 CFR 803.7000 - Display of the VA Hotline poster.

Code of Federal Regulations, 2012 CFR

2012-10-01

... poster. 803.7000 Section 803.7000 Federal Acquisition Regulations System DEPARTMENT OF VETERANS AFFAIRS... Improper Business Practices 803.7000 Display of the VA Hotline poster. (a) Under the circumstances described in paragraph (b) of this section, a contractor must display prominently a VA Hotline poster...

48 CFR 803.7000 - Display of the VA Hotline poster.

Code of Federal Regulations, 2013 CFR

2013-10-01

... poster. 803.7000 Section 803.7000 Federal Acquisition Regulations System DEPARTMENT OF VETERANS AFFAIRS... Improper Business Practices 803.7000 Display of the VA Hotline poster. (a) Under the circumstances described in paragraph (b) of this section, a contractor must display prominently a VA Hotline poster...

48 CFR 803.7000 - Display of the VA Hotline poster.

Code of Federal Regulations, 2014 CFR

2014-10-01

... poster. 803.7000 Section 803.7000 Federal Acquisition Regulations System DEPARTMENT OF VETERANS AFFAIRS... Improper Business Practices 803.7000 Display of the VA Hotline poster. (a) Under the circumstances described in paragraph (b) of this section, a contractor must display prominently a VA Hotline poster...

48 CFR 803.7000 - Display of the VA Hotline poster.

Code of Federal Regulations, 2010 CFR

2010-10-01

... poster. 803.7000 Section 803.7000 Federal Acquisition Regulations System DEPARTMENT OF VETERANS AFFAIRS... Improper Business Practices 803.7000 Display of the VA Hotline poster. (a) Under the circumstances described in paragraph (b) of this section, a contractor must display prominently a VA Hotline poster...

77 FR 12697 - VA Homeless Providers Grant and Per Diem Program

Federal Register 2010, 2011, 2012, 2013, 2014

2012-03-01

...We propose to revise and reorganize regulations which contain the Department of Veterans Affairs' (VA) Homeless Providers Grant and Per Diem Program. This rulemaking would update our current regulations, implement and authorize new VA policies, and generally improve the clarity of part 61.

Predictors of Help-Seeking Intentions in Operation Enduring Freedom and Operation Iraqi Freedom Veterans and Service Members.

PubMed

Porcari, Carole; Koch, Ellen I; Rauch, Sheila A M; Hoodin, Flora; Ellison, Grant; McSweeney, Lauren

2017-05-01

Despite significant numbers of Afghanistan and Iraqi veterans and service members who report symptoms of posttraumatic stress disorder, depression, anxiety, and substance abuse, the majority do not seek help for these problems. A better understanding of the help-seeking process might aid providers and administrators in outreach and provision of services for those who need them. Past research has shown several variables that influence an individual's help-seeking behavior: demographic variables, the nature and severity of a mental health problem, and psychological variables. The three goals of the study were to determine which variables predicted help-seeking intentions from various sources for a psychological problem, identify barriers to help seeking, and identify sources of help sought in the past year. All Operation Enduring Freedom and Operation Iraqi Freedom veterans and service members registered with a Midwestern VA Healthcare System between 2001 and 2007 received a letter requesting participation in an Internet-based survey. Participants completed nine questionnaires regarding their current physical and psychological health, social support, self-efficacy, public and self-stigma, and barriers to seeking help for a psychological problem. In addition, patterns of help seeking from informal (i.e., partner/spouse, family, friends) and formal (i.e., physician, psychiatrist, or psychologist, either from Veterans Affairs [VA] or the private sector) sources of help were examined. Results from the linear regression model including all formal and informal sources of help indicated a significant model fit with attitudes toward psychotherapy, social support, and current mental health status as significant coefficients. Of note, attitudes toward psychotherapy were a significant coefficient in all help-seeking models; stigma was a significant coefficient with formal and VA sources, and social support was found to be a significant predictor with informal sources. Documentation of a mental health problem on one's record was found to be a significant barrier to help seeking and participants indicated they would most likely seek help in the next year from their partner/spouse, family, or friends versus formal VA or non-VA sources. This is one of the first studies to examine attitudes toward psychotherapy as contributing to help-seeking intentions of veterans and service members and results provide strong support for inclusion of this variable in future studies in addition to social support and stigma. Limitations of the study are discussed as well as suggestions for future research. It is our hope that findings from this study may inform administrators and providers regarding assessment, outreach, and program development for our country's veterans and service members. Reprint & Copyright © 2017 Association of Military Surgeons of the U.S.

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...

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

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

Access to the US Department of Veterans Affairs health system: self-reported barriers to care among returnees of Operations Enduring Freedom and Iraqi Freedom

PubMed Central

2013-01-01

Background The U.S. Department of Veterans Affairs (VA) implemented the Polytrauma System of Care to meet the health care needs of military and veterans with multiple injuries returning from combat operations in Afghanistan and Iraq. Studies are needed to systematically assess barriers to use of comprehensive and exclusive VA healthcare services from the perspective of veterans with polytrauma and with other complex health outcomes following their service in Afghanistan and Iraq. These perspectives can inform policy with regard to the optimal delivery of care to returning veterans. Methods We studied combat veterans (n = 359) from two polytrauma rehabilitation centers using structured clinical interviews and qualitative open-ended questions, augmented with data collected from electronic health records. Our outcomes included several measures of exclusive utilization of VA care with our primary exposure as reported access barriers to care. Results Nearly two thirds of the veterans reported one or more barriers to their exclusive use of VA healthcare services. These barriers predicted differences in exclusive use of VA healthcare services. Experiencing any barriers doubled the returnees’ odds of not using VA exclusively, the geographic distance to VA barrier resulted in a 7 fold increase in the returnees odds of not using VA, and reporting a wait time barrier doubled the returnee’s odds of not using VA. There were no striking differences in access barriers for veterans with polytrauma compared to other returning veterans, suggesting the barriers may be uniform barriers that predict differences in using the VA exclusively for health care. Conclusions This study provides an initial description of utilization of VA polytrauma rehabilitation and other medical care for veteran returnees from all military services who were involved in combat operations in Afghanistan or Iraq. Our findings indicate that these veterans reported important stigmatization and barriers to receiving services exclusively from the VA, including mutable health delivery system factors. PMID:24289747

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.

78 FR 66265 - Drawbridge Operation Regulation; Elizabeth River, Eastern Branch, Norfolk, VA

Federal Register 2010, 2011, 2012, 2013, 2014

2013-11-05

... Operation Regulation; Elizabeth River, Eastern Branch, Norfolk, VA AGENCY: Coast Guard, DHS. ACTION: Notice... Elizabeth River Eastern Branch, mile 1.1, at Norfolk, VA. This deviation is necessary to facilitate... maintenance. The Norfolk Southern 5 railroad Bridge, at mile 1.1, across the Elizabeth River (Eastern Branch...

77 FR 27859 - Privacy Act of 1974; System of Records

Federal Register 2010, 2011, 2012, 2013, 2014

2012-05-11

... Veterans Affairs. ACTION: Notice of New System of Records ``Virtual Lifetime Electronic Record (VLER)-VA... ``Virtual Lifetime Electronic Record (VLER)-VA'' (168VA10P2). DATES: Comments on this new system of records... Virtual Lifetime Electronic Record (VLER) is an overarching program being developed by the Department of...

78 FR 66803 - Privacy Act of 1974; System of Records

Federal Register 2010, 2011, 2012, 2013, 2014

2013-11-06

... information to appropriate agencies, entities, or persons when VA suspects or has confirmed that the integrity...; tracking information as to file location and employee productivity information. Material in this system... to alert them to the presence of dangerous persons in VA facilities or at VA activities conducted in...

Payment for Assistive Devices by the Veterans Administration.

ERIC Educational Resources Information Center

Reeb, Kenneth G., Jr.; Stripling, Thomas E.

This report provides an overview of the Veterans Administration (VA) and how it pays for assistive devices for veterans. It explains the VA payment structure and decision-making responsibilities concerning assistive equipment. Following an introductory section, the report provides background on the VA system, summarizing its legislative origins,…

97. Catalog B, Higher Plants, 200 2 American Chestnut Tree, ...

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

97. Catalog B, Higher Plants, 200 2 American Chestnut Tree, Negative No. 6032 (Photographer and date unknown) THIS GHOST FOREST OF BLIGHTED CHESTNUTS ONCE STOOD APPROXIMATELY AT THE LOCATION OF THE BYRD VISITOR CENTER. - Skyline Drive, From Front Royal, VA to Rockfish Gap, VA , Luray, Page County, VA

76 FR 44288 - Establishment of Class E Airspace; New Market, VA

Federal Register 2010, 2011, 2012, 2013, 2014

2011-07-25

...-380; Airspace Docket No. 11-AEA-12] Establishment of Class E Airspace; New Market, VA AGENCY: Federal... proposes to establish Class E Airspace at New Market, VA, to accommodate the additional airspace needed for the Standard Instrument Approach Procedures developed for New Market Airport. This action would...

Three-dimensional Imaging of High-resolution Computer Tomography of Singers' Larynges-A Pilot Study.

PubMed

Vorik, Alexandra; Unteregger, Fabian; Zwicky, Salome; Schiwowa, Julia; Potthast, Silke; Storck, Claudio

2017-01-01

Biplanar imaging technique is not sufficient for an exact visualization and evaluation of the laryngeal biomechanics during speaking or singing. The aim of this pilot study was to test a 3D-visualization software MIMICS (Materialize Interactive Medical Image Control System, Materialize, Leuven, Belgium) for visualizing laryngeal cartilages and resonance space of living humans during singing based on high-resolution computed tomography (HRCT) and analyzing the biomechanics thereof. This is a prospective pilot study. A total of 10 professional female singers (five sopranos and five altos) was scanned with HRCT in three singing positions fundamental frequency (ƒo), first octave (ƒo+1 8va) and second octave (ƒo+2 8va). All relevant laryngeal structures and resonance space could be 3D visualized. Superimposing the different HRCT scans showed an inward rotation and rocking of the arytenoid cartilages from ƒo+1 8va to ƒo+2 8va and a backward tilting of the cricoid cartilage from ƒo+1 8va to ƒo+2 8va. Moreover, we could demonstrate a vocal fold elongation of 13% from ƒo to ƒo+1 8va and an additional elongation from ƒo+1 8va to ƒo+2 8va of 10% in type A cricothyroid joints (CTJ) A and 4% in CTJ's type B/C. There were no significant differences between sopranos and altos in all parameters (length of the glottis, subglottic diameter, distance between anterior commissure and cervical spine, and CTJ distribution). This noninvasive 3D-visualization technique with MIMICS allows the anatomical structures and landmarks of the larynx to be analyzed. We believe that this pilot study will serve as a basis for further biomechanical studies on speakers' and singers' larynges. Copyright © 2017 The Voice Foundation. Published by Elsevier Inc. All rights reserved.

Evaluation of the Impact of Towing DC-9 Transport Airplanes at Boston-Logan Airport.

DTIC Science & Technology

1980-05-01

42- 22’ 71’ 02’ 12 1617 [t6 -96 F6p olt ln, slotr ADHA ,- r ’ C is on 11 f / 1 -3 . P o s.Nt Ofic /29/3 / 06/64 70 0 ftj. SE 42- 21’ 71’ W1 20 360 337 336...34A-A8 $64 DOUGLAS AIRCRAFT CO LONG BEACH CA PIG/ 1 /2 GG EVALUATION OF THE IMPACT OF TOWING DC-9 TRANSPORT AIRPLANES AT -ETC(U) MAY G0 E A HOOVER DOT...a -ib’f t0 tie U S. pubic through the Nat onj T, r ,ca, h -nrrmatior Ser\\ice, St 1 ’ o c: a q~nii 22161 - - ,.......~ - r’) C 2 TAINKD A ,4

Comparison of topical fixed-combination fortified vancomycin-amikacin (VA solution) to conventional separate therapy in the treatment of bacterial corneal ulcer.

PubMed

Chiang, C-C; Lin, J-M; Chen, W-L; Chiu, Y-T; Tsai, Y-Y

2009-02-01

In an in vitro study, fixed-combination fortified vancomycin and amikacin ophthalmic solutions (VA solution) had the same potency and stable physical properties as the separate components. In this retrospective clinical study, we evaluated the efficacy of the topical VA solution in the treatment of bacterial corneal ulcer and comparison with separate topical fortified vancomycin and amikacin. Separate topical fortified eye drops was used prior to January 2004 and switched to the VA solution afterwards in the treatment of bacterial corneal ulcer. The medical records of 223 patients diagnosed with bacterial corneal ulcers between January 2002 and December 2005 were reviewed retrospectively. There were 122 patients in the VA group and 101 in the separate group. Cure was defined as complete healing of the ulcer accompanied by a nonprogressive stromal infiltrate on two consecutive visits. No significant difference was found between the VA and separate therapy group. The mean treatment duration was 15.4 days in the VA group and 16.1 days in the separate therapy group. The average hospital stay was 5.4 days (VA) and 7.2 days (separate antibiotics). Stromal infiltration regressed significantly without further expansion in both groups. All corneal ulcers completely re-epithelialized without complications related to drugs. VA solution provided similar efficacy to the conventional separate therapy in the treatment of bacterial corneal ulcers; however, it is more convenient and tolerable, promotes patient's compliance, avoids the washout effect, and reduces nurse utilization. Hence, VA solution is a good alternative to separate therapy.

Prevalence of nosocomial infection in long-term-care Veterans Administration medical centers.

PubMed

Steinmiller, A M; Robb, S S; Muder, R R

1991-06-01

Prevention and control of nosocomial infections are major goals of institutional risk-management programs. However, variations in criteria and denominator parameters make comparison of rates across settings difficult. This study addressed those problems by reporting criteria used to identify infections and applying the same denominator across long-term-care facilities. Findings demonstrated a 9.8% prevalence rate for nosocomial infections in four long-term-care VA facilities. Most of the identified infections were consistent with Centers for Disease Control definitions of nosocomial infections. The most frequent indicators of nosocomial infections that did not fully meet those definitions were (1) documented symptoms, (2) antibiotic therapy, and (3) physician diagnosis.

Estimating the costs of VA ambulatory care.

PubMed

Phibbs, Ciaran S; Bhandari, Aman; Yu, Wei; Barnett, Paul G

2003-09-01

This article reports how we matched Common Procedure Terminology (CPT) codes with Medicare payment rates and aggregate Veterans Affairs (VA) budget data to estimate the costs of every VA ambulatory encounter. Converting CPT codes to encounter-level costs was more complex than a simple match of Medicare reimbursements to CPT codes. About 40 percent of the CPT codes used in VA, representing about 20 percent of procedures, did not have a Medicare payment rate and required other cost estimates. Reconciling aggregated estimated costs to the VA budget allocations for outpatient care produced final VA cost estimates that were lower than projected Medicare reimbursements. The methods used to estimate costs for encounters could be replicated for other settings. They are potentially useful for any system that does not generate billing data, when CPT codes are simpler to collect than billing data, or when there is a need to standardize cost estimates across data sources.

Network of fully integrated multispecialty hospital imaging systems

NASA Astrophysics Data System (ADS)

Dayhoff, Ruth E.; Kuzmak, Peter M.

1994-05-01

The Department of Veterans Affairs (VA) DHCP Imaging System records clinically significant diagnostic images selected by medical specialists in a variety of departments, including radiology, cardiology, gastroenterology, pathology, dermatology, hematology, surgery, podiatry, dental clinic, and emergency room. These images are displayed on workstations located throughout a medical center. All images are managed by the VA's hospital information system, allowing integrated displays of text and image data across medical specialties. Clinicians can view screens of `thumbnail' images for all studies or procedures performed on a selected patient. Two VA medical centers currently have DHCP Imaging Systems installed, and others are planned. All VA medical centers and other VA facilities are connected by a wide area packet-switched network. The VA's electronic mail software has been modified to allow inclusion of binary data such as images in addition to the traditional text data. Testing of this multimedia electronic mail system is underway for medical teleconsultation.

Trends in Timing of Dialysis Initiation within Versus Outside the Department of Veterans Affairs.

PubMed

Yu, Margaret K; O'Hare, Ann M; Batten, Adam; Sulc, Christine A; Neely, Emily L; Liu, Chuan-Fen; Hebert, Paul L

2015-08-07

The secular trend toward dialysis initiation at progressively higher levels of eGFR is not well understood. This study compared temporal trends in eGFR at dialysis initiation within versus outside the Department of Veterans Affairs (VA)-the largest non-fee-for-service health system in the United States. The study used linked data from the US Renal Data System, VA, and Medicare to compare temporal trends in eGFR at dialysis initiation between 2000 and 2009 (n=971,543). Veterans who initiated dialysis within the VA were compared with three groups who initiated dialysis outside the VA: (1) veterans whose dialysis was paid for by the VA, (2) veterans whose dialysis was not paid for by the VA, and (3) nonveterans. Logistic regression was used to estimate average predicted probabilities of dialysis initiation at an eGFR≥10 ml/min per 1.73 m(2). The adjusted probability of starting dialysis at an eGFR≥10 ml/min per 1.73 m(2) increased over time for all groups but was lower for veterans who started dialysis within the VA (0.31; 95% confidence interval [95% CI], 0.30 to 0.32) than for those starting outside the VA, including veterans whose dialysis was (0.36; 95% CI, 0.35 to 0.38) and was not (0.40; 95% CI, 0.40 to 0.40) paid for by the VA and nonveterans (0.39; 95% CI, 0.39 to 0.39). Differences in eGFR at initiation within versus outside the VA were most pronounced among older patients (P for interaction <0.001) and those with a higher risk of 1-year mortality (P for interaction <0.001). Temporal trends in eGFR at dialysis initiation within the VA mirrored those in the wider United States dialysis population, but eGFR at initiation was consistently lowest among those who initiated within the VA. Differences in eGFR at initiation within versus outside the VA were especially pronounced in older patients and those with higher 1-year mortality risk. Copyright © 2015 by the American Society of Nephrology.

Trends in Timing of Dialysis Initiation within Versus Outside the Department of Veterans Affairs

PubMed Central

O’Hare, Ann M.; Batten, Adam; Sulc, Christine A.; Neely, Emily L.; Liu, Chuan-Fen; Hebert, Paul L.

2015-01-01

Background and objectives The secular trend toward dialysis initiation at progressively higher levels of eGFR is not well understood. This study compared temporal trends in eGFR at dialysis initiation within versus outside the Department of Veterans Affairs (VA)—the largest non–fee-for-service health system in the United States. Design, setting, participants, & measurements The study used linked data from the US Renal Data System, VA, and Medicare to compare temporal trends in eGFR at dialysis initiation between 2000 and 2009 (n=971,543). Veterans who initiated dialysis within the VA were compared with three groups who initiated dialysis outside the VA: (1) veterans whose dialysis was paid for by the VA, (2) veterans whose dialysis was not paid for by the VA, and (3) nonveterans. Logistic regression was used to estimate average predicted probabilities of dialysis initiation at an eGFR≥10 ml/min per 1.73 m2. Results The adjusted probability of starting dialysis at an eGFR≥10 ml/min per 1.73 m2 increased over time for all groups but was lower for veterans who started dialysis within the VA (0.31; 95% confidence interval [95% CI], 0.30 to 0.32) than for those starting outside the VA, including veterans whose dialysis was (0.36; 95% CI, 0.35 to 0.38) and was not (0.40; 95% CI, 0.40 to 0.40) paid for by the VA and nonveterans (0.39; 95% CI, 0.39 to 0.39). Differences in eGFR at initiation within versus outside the VA were most pronounced among older patients (P for interaction <0.001) and those with a higher risk of 1-year mortality (P for interaction <0.001). Conclusions Temporal trends in eGFR at dialysis initiation within the VA mirrored those in the wider United States dialysis population, but eGFR at initiation was consistently lowest among those who initiated within the VA. Differences in eGFR at initiation within versus outside the VA were especially pronounced in older patients and those with higher 1-year mortality risk. PMID:26206891

Chaplains' Engagement with Suicidality among Their Service Users: Findings from the VA/DoD Integrated Mental Health Strategy.

PubMed

Kopacz, Marek S; Nieuwsma, Jason A; Jackson, George L; Rhodes, Jeffrey E; Cantrell, William C; Bates, Mark J; Meador, Keith G

2016-04-01

Chaplains play an important role in supporting the mental health of current and former military personnel; in this study, the engagement of Department of Veterans Affairs (VA), Army, Navy, and Air Force chaplains with suicidality among their service users were examined. An online survey was used to collect data from 440 VA and 1,723 Department of Defense (DoD) chaplains as part of the VA/DoD Integrated Mental Health Strategy. Differences were noted for demographics, work setting characteristics, encountering suicidality, and self-perceived preparation for dealing with suicidality. Compared to DoD chaplains, VA chaplains encounter more at-risk service users, yet feel less prepared for dealing with suicidality. Published 2015. This article is a U.S. Government work and is in the public domain in the USA.

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...

A Handheld Calculator (HHC) Program for Thermal Imaging Target Acquisition Analysis - A User’s Guide.

DTIC Science & Technology

1982-01-01

Quanticou VA 22134 (R. F. DeKinder. Ji.) Fort Leavenworth. KS 602" Commander Dugway Proving Ground I Commander ATTN: STEDP-MT Atmospheric Sciences Lah...Documentation. Atmo.spheric Sciences Lalsuratun Report h.Sl.TR.48172. January 1981. I. . P. Olser. J. T. Wood. C. J. Nash. (C) I isionics E4) Sensor...7f’’ I PtoiecU Manager MIICV I Diicctoi ’Aairen, MI 48~01)0 Atmospheric Sciences Lab ATTN: 1)1LAS-I) I I’oject Manager White Sands Missile Rang

Compressed Video Segmentation

DTIC Science & Technology

1996-09-01

Fk+gl1mGnCop![ qVa +HeU95.!:r%I>0&CFS+I,:Y45&C47%,:d&C$+&6%=( 1 (3`F-FS+/`+9597@s%8.1F:Q.18.1FS+I9V>AFG+He.: 45,(395`/=.R>t...Report Documentation Page Form ApprovedOMB No. 0704-0188 Public reporting burden for the collection of information is estimated to average 1 hour per...penalty for failing to comply with a collection of information if it does not display a currently valid OMB control number. 1 . REPORT DATE SEP 1996

"Walking in a maze": community providers' difficulties coordinating health care for homeless patients.

PubMed

LaCoursiere Zucchero, Terri; McDannold, Sarah; McInnes, D Keith

2016-09-07

While dual usage of US Department of Veterans Affairs (VA) and non-VA health services increases access to care and choice for veterans, it is also associated with a number of negative consequences including increased morbidity and mortality. Veterans with multiple health conditions, such as the homeless, may be particularly susceptible to the adverse effects of dual use. Homeless veteran dual use is an understudied yet timely topic given the Patient Protection and Affordable Care Act and Veterans Choice Act of 2014, both of which may increase non-VA care for this population. The study purpose was to evaluate homeless veteran dual use of VA and non-VA health care by describing the experiences, perspectives, and recommendations of community providers who care for the population. Three semi-structured focus group interviews were conducted with medical, dental, and behavioral health providers at a large, urban Health Care for the Homeless (HCH) program. Qualitative content analysis procedures were used. HCH providers experienced challenges coordinating care with VA medical centers for their veteran patients. Participants lacked knowledge about the VA health care system and were unable to help their patients navigate it. The HCH and VA medical centers lacked clear lines of communication. Providers could not access the VA medical records of their patients and felt this hampered the quality and efficiency of care veterans received. Substantial challenges exist in coordinating care for homeless veteran dual users. Our findings suggest recommendations related to education, communication, access to electronic medical records, and collaborative partnerships. Without dedicated effort to improve coordination, dual use is likely to exacerbate the fragmented care that is the norm for many homeless persons.

Military Service and Decision Quality in the Management of Knee Osteoarthritis.

PubMed

Henderson, Eric R; Titus, Alexander J; Keeney, Benjamin J; Goodney, Philip P; Lurie, Jon D; Ibrahim, Said A

2018-05-18

Decision quality measures the degree to which care decisions are knowledge-based and value-aligned. Because military service emphasizes hierarchy, command, and mandates some healthcare decisions, military service may attenuate patient autonomy in healthcare decisions and lower decision quality. VA is the nation's largest provider of orthopedic care. We compared decision quality in a sample of VA and non-VA patients seeking care for knee osteoarthritis. Our study sample consisted of patients newly referred to our orthopedic clinic for the management of knee osteoarthritis. None of the study patients were exposed to a knee osteoarthritis decision aid. Consenting patients were administered the Hip/Knee Decision Quality Instrument (HK-DQI). In addition, they were surveyed about decision-making preferences and demographics. We compared results to a non-VA cohort from our academic institution's arthroplasty database. The HK-DQI Knowledge Score was lower in the VA cohort (45%, SD = 22, n = 25) compared with the non-VA cohort (53%, SD = 21, n = 177) (p = 0.04). The Concordance Score was lower in the VA cohort (36%, SD = 49%) compared with the control cohort (70%, SD 46%) (p = 0.003). Non-VA patients were more likely to make a high-quality decision (p = 0.05). Non-VA patients were more likely to favor a shared decision-making process (p = 0.002). Decision quality is lower in Veterans with knee osteoarthritis compared with civilians, placing them at risk for lower treatment satisfaction and possibly unwarranted surgical utilization. Our future work will examine if this difference is from conditioned military service behaviors or confounding demographic factors, and if conventional shared decision-making techniques will correct this deficiency.

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.

Vertebral artery injury in cervical spine surgery: anatomical considerations, management, and preventive measures.

PubMed

Peng, Chan W; Chou, Benedict T; Bendo, John A; Spivak, Jeffrey M

2009-01-01

Vertebral artery (VA) injury can be a catastrophic iatrogenic complication of cervical spine surgery. Although the incidence is rare, it has serious consequences including fistulas, pseudoaneurysm, cerebral ischemia, and death. It is therefore imperative to be familiar with the anatomy and the instrumentation techniques when performing anterior or posterior cervical spine surgeries. To provide a review of VA injury during common anterior and posterior cervical spine procedures with an evaluation of the surgical anatomy, management, and prevention of this injury. Comprehensive literature review. A systematic review of Medline for articles related to VA injury in cervical spine surgery was conducted up to and including journal articles published in 2007. The literature was then reviewed and summarized. Overall, the risk of VA injury during cervical spine surgery is low. In anterior cervical procedures, lateral dissection puts the VA at the most risk, so sound anatomical knowledge and constant reference to the midline are mandatory during dissection. With the development and rise in popularity of posterior cervical stabilization and instrumentation, recognition of the dangers of posterior drilling and insertion of transarticular screws and pedicle screws is important. Anomalous vertebral anatomy increases the risk of injury and preoperative magnetic resonance imaging and/or computed tomography (CT) scans should be carefully reviewed. When the VA is injured, steps should be taken to control local bleeding. Permanent occlusion or ligation should only be attempted if it is known that the contralateral VA is capable of providing adequate collateral circulation. With the advent of endovascular repair, this treatment option can be considered when a VA injury is encountered. VA injury during cervical spine surgery is a rare but serious complication. It can be prevented by careful review of preoperative imaging studies, having a sound anatomical knowledge and paying attention to surgical landmarks intraoperatively. When a VA injury occurs, prompt recognition and management are important.

Optimized classification of 18F-Florbetaben PET scans as positive and negative using an SUVR quantitative approach and comparison to visual assessment.

PubMed

Bullich, Santiago; Seibyl, John; Catafau, Ana M; Jovalekic, Aleksandar; Koglin, Norman; Barthel, Henryk; Sabri, Osama; De Santi, Susan

2017-01-01

Standardized uptake value ratios (SUVRs) calculated from cerebral cortical areas can be used to categorize 18 F-Florbetaben (FBB) PET scans by applying appropriate cutoffs. The objective of this work was first to generate FBB SUVR cutoffs using visual assessment (VA) as standard of truth (SoT) for a number of reference regions (RR) (cerebellar gray matter (GCER), whole cerebellum (WCER), pons (PONS), and subcortical white matter (SWM)). Secondly, to validate the FBB PET scan categorization performed by SUVR cutoffs against the categorization made by post-mortem histopathological confirmation of the Aβ presence. Finally, to evaluate the added value of SUVR cutoff categorization to VA. SUVR cutoffs were generated for each RR using FBB scans from 143 subjects who were visually assessed by 3 readers. SUVR cutoffs were validated in 78 end-of life subjects using VA from 8 independent blinded readers (3 expert readers and 5 non-expert readers) and histopathological confirmation of the presence of neuritic beta-amyloid plaques as SoT. Finally, the number of correctly or incorrectly classified scans according to pathology results using VA and SUVR cutoffs was compared. Composite SUVR cutoffs generated were 1.43 (GCER), 0.96 (WCER), 0.78 (PONS) and 0.71 (SWM). Accuracy values were high and consistent across RR (range 83-94% for histopathology, and 85-94% for VA). SUVR cutoff performed similarly as VA but did not improve VA classification of FBB scans read either by expert readers or the majority read but provided higher accuracy than some non-expert readers. The accurate scan classification obtained in this study supports the use of VA as SoT to generate site-specific SUVR cutoffs. For an elderly end of life population, VA and SUVR cutoff categorization perform similarly in classifying FBB scans as Aβ-positive or Aβ-negative. These results emphasize the additional contribution that SUVR cutoff classification may have compared with VA performed by non-expert readers.

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.

Brand-Name Prescription Drug Use Among Diabetes Patients in the VA and Medicare Part D: A National Comparison

PubMed Central

Gellad, Walid F.; Donohue, Julie M.; Zhao, Xinhua; Mor, Maria K.; Thorpe, Carolyn T.; Smith, Jeremy; Good, Chester B.; Fine, Michael J.; Morden, Nancy E.

2013-01-01

Background Medicare Part D and the Department of Veterans Affairs (VA) use different approaches to manage prescription drug benefits, with implications for spending. Medicare relies on private plans with distinct formularies, whereas VA administers its own benefit using a national formulary. Objective To compare overall and regional rates of brand-name drug use among older adults with diabetes in Medicare and VA. Design Retrospective cohort Setting Medicare and VA Patients National sample in 2008 of 1,061,095 Part D beneficiaries and 510,485 Veterans age 65+ with diabetes. Measurements Percent of patients on oral hypoglycemics, statins, and angiotensin-converting-enzyme inhibitors/angiotensin-receptor-blockers who filled brand-name drugs and percent of patients on long-acting insulin who filled analogues. We compared sociodemographic and health-status adjusted hospital referral region (HRR) brand-name use to examine local practice patterns, and calculated changes in spending if each system’s brand-name use mirrored the other. Results Brand-name use in Medicare was 2–3 times that of VA: 35.3% vs. 12.7% for oral hypoglycemics, 50.7% vs. 18.2% for statins, 42.5% vs. 20.8% for angiotensin-converting-enzyme inhibitors/angiotensin-receptor-blockers, and 75.1% vs. 27.0% for insulin analogues. Adjusted HRR brand-name statin use ranged (5th to 95th percentile) from 41.0%–58.3% in Medicare and 6.2%–38.2% in VA. For each drug group, the HRR at the 95th percentile in VA had lower brand-name use than the 5th percentile HRR in Medicare. Medicare spending in this population would have been $1.4 billion less if brand-name use matched the VA for these medications. Limitation This analysis cannot fully describe the factors underlying differences in brand-name use. Conclusions Medicare beneficiaries with diabetes use 2–3 times more brand-name drugs than a comparable group within VA, at substantial excess cost. Primary Funding Sources VA; NIH; RWJF PMID:23752663

Superior Parietal Lobule Dysfunction in a Homogeneous Group of Dyslexic Children with a Visual Attention Span Disorder

ERIC Educational Resources Information Center

Peyrin, C.; Demonet, J. F.; N'Guyen-Morel, M. A.; Le Bas, J. F.; Valdois, S.

2011-01-01

A visual attention (VA) span disorder has been reported in dyslexic children as potentially responsible for their poor reading outcome. The purpose of the current paper was to identify the cerebral correlates of this VA span disorder. For this purpose, 12 French dyslexic children with severe reading and VA span disorders and 12 age-matched control…

Flexural Stiffness of Myosin Va Subdomains as Measured from Tethered Particle Motion

PubMed Central

Michalek, Arthur J.; Kennedy, Guy G.; Warshaw, David M.; Ali, M. Yusuf

2015-01-01

Myosin Va (MyoVa) is a processive molecular motor involved in intracellular cargo transport on the actin cytoskeleton. The motor's processivity and ability to navigate actin intersections are believed to be governed by the stiffness of various parts of the motor's structure. Specifically, changes in calcium may regulate motor processivity by altering the motor's lever arm stiffness and thus its interhead communication. In order to measure the flexural stiffness of MyoVa subdomains, we use tethered particle microscopy, which relates the Brownian motion of fluorescent quantum dots, which are attached to various single- and double-headed MyoVa constructs bound to actin in rigor, to the motor's flexural stiffness. Based on these measurements, the MyoVa lever arm and coiled-coil rod domain have comparable flexural stiffness (0.034 pN/nm). Upon addition of calcium, the lever arm stiffness is reduced 40% as a result of calmodulins potentially dissociating from the lever arm. In addition, the flexural stiffness of the full-length MyoVa construct is an order of magnitude less stiff than both a single lever arm and the coiled-coil rod. This suggests that the MyoVa lever arm-rod junction provides a flexible hinge that would allow the motor to maneuver cargo through the complex intracellular actin network. PMID:26770194

Hepatoprotective effects of Vaccinium arctostaphylos against CCl4-induced acute liver injury in rats.

PubMed

Ravan, Alireza Pouyandeh; Bahmani, Mahdi; Ghasemi Basir, Hamid Reza; Salehi, Iraj; Oshaghi, Ebrahim Abbasi

2017-09-26

This study was carried out to evaluate the antioxidant and hepatoprotective effects of Vaccinium arctostaphylos (V.a) methanolic extract on carbon tetrachloride (CCl4)-induced acute liver injury in Wistar rats. Total phenolic and total flavonoid contents as well as antioxidant activity of V.a were determined. Extracts of V.a at doses of 200 and 400 mg/kg were administered by oral gavage to rats once per day for 7 days and then were given an intraperitoneal injection of 1 mL/kg CCl4 (1:1 in olive oil) for 3 consecutive days. Serum biochemical markers of liver injury, oxidative markers, as well as hydroxyproline (HP) content and histopathology of liver were evaluated. The obtained results showed that V.a had strong antioxidant activity. Treatment of rats with V.a blocked the CCl4-induced elevation of serum markers of liver function and enhanced albumin and total protein levels. The level of hepatic HP content was also reduced by the administration of V.a treatment. Histological examination of the liver section revealed that V.a prevented the occurrence of pathological changes in CCl4-treated rats. These findings suggested that V.a may be useful in the treatment and prevention of hepatic injury induced by CCl4.

Isolation and characterization of a 17-kDa FKBP-type peptidyl-prolyl cis/trans isomerase from Vibrio anguillarum.

PubMed

Jo, Geon-A; Lee, Jong Min; No, Gyuyou; Kang, Dong Seop; Kim, So-Hyun; Ahn, Sun-Hee; Kong, In-Soo

2015-06-01

Peptidyl-prolyl cis/trans isomerase (PPIase) catalyzes the isomerization of peptide bonds to achieve conformational changes in native folded proteins. An FKBP-type PPIase with an approximate molecular weight of 17kDa was isolated from Vibrio anguillarum O1 and named VaFKBP17. To investigate its biochemical properties, the ppi gene from V. anguillarum O1 was isolated and overexpressed in Escherichia coli. A protease-coupled assay for isomerization activity, using Succinyl-Ala-Phe-Pro-Phe-p nitroanilide as substrate, indicated that the activity of VaFKBP17 was highest at low temperature (5°C) and alkaline conditions (pH 10). The immunosuppressant FK506 inhibited the isomerization activity of VaFKBP17. The chaperone activity of VaFKBP17 was assessed using a citrate synthase thermal aggregation activity assay. To evaluate its ability to catalyze protein refolding, the effect of VaFKBP17 on inclusion bodies was investigated during a dilution process. In this assay, VaFKBP17 was able to assist protein refolding. These results provide evidence that VaFKBP17 possesses chaperone-like activity. The structural homology of VaFKBP17 relative to other known bacterial FKBPs was also examined. Copyright © 2015 Elsevier Inc. All rights reserved.

Adenovirus Virus-Associated RNAII-Derived Small RNAs Are Efficiently Incorporated into the RNA-Induced Silencing Complex and Associate with Polyribosomes▿ §

PubMed Central

Xu, Ning; Segerman, Bo; Zhou, Xiaofu; Akusjärvi, Göran

2007-01-01

Adenovirus type 5 encodes two highly structured short RNAs, the virus-associated (VA) RNAI and RNAII. Both are processed by Dicer into small RNAs that are incorporated into the RNA-induced silencing complex (RISC). We show here, by cloning of small RNAs, that approximately 80% of Ago2-containing RISC immunopurified from late-infected cells is associated with VA RNA-derived small RNAs (mivaRNAs). Most surprisingly, VA RNAII, which is expressed at 20-fold lower levels compared to that of VA RNAI, appears to be the preferred substrate for Dicer and accounts for approximately 60% of all small RNAs in RISC. The mivaRNAs are derived from the 3′ strand of the terminal stems of the VA RNAs, with the major fraction of VA RNAII starting at position 138. The small RNAs derived from VA RNAI were more heterogeneous in size, with the two predominant small RNAs starting at positions 137 and 138. Collectively, our results suggest that the mivaRNAs are efficiently used for RISC assembly in late-infected cells. Potentially, they function as miRNAs, regulating translation of cellular mRNAs. In support of this hypothesis, we detected a fraction of the VA RNAII-derived mivaRNAs on polyribosomes. PMID:17652395

Adenovirus virus-associated RNAII-derived small RNAs are efficiently incorporated into the rna-induced silencing complex and associate with polyribosomes.

PubMed

Xu, Ning; Segerman, Bo; Zhou, Xiaofu; Akusjärvi, Göran

2007-10-01

Adenovirus type 5 encodes two highly structured short RNAs, the virus-associated (VA) RNAI and RNAII. Both are processed by Dicer into small RNAs that are incorporated into the RNA-induced silencing complex (RISC). We show here, by cloning of small RNAs, that approximately 80% of Ago2-containing RISC immunopurified from late-infected cells is associated with VA RNA-derived small RNAs (mivaRNAs). Most surprisingly, VA RNAII, which is expressed at 20-fold lower levels compared to that of VA RNAI, appears to be the preferred substrate for Dicer and accounts for approximately 60% of all small RNAs in RISC. The mivaRNAs are derived from the 3' strand of the terminal stems of the VA RNAs, with the major fraction of VA RNAII starting at position 138. The small RNAs derived from VA RNAI were more heterogeneous in size, with the two predominant small RNAs starting at positions 137 and 138. Collectively, our results suggest that the mivaRNAs are efficiently used for RISC assembly in late-infected cells. Potentially, they function as miRNAs, regulating translation of cellular mRNAs. In support of this hypothesis, we detected a fraction of the VA RNAII-derived mivaRNAs on polyribosomes.

75 FR 29660 - Safety Zone; Wicomico Community Fireworks, Great Wicomico River, Mila, VA

Federal Register 2010, 2011, 2012, 2013, 2014

2010-05-27

...-AA00 Safety Zone; Wicomico Community Fireworks, Great Wicomico River, Mila, VA AGENCY: Coast Guard, DHS... the Great Wicomico River in the vicinity of Mila, VA in support of the Wicomico Community Fireworks... protect mariners from the hazards associated with fireworks displays. DATES: This rule is effective from 9...

FACILITIES FOR EDUCATION IN VA HOSPITALS. FINAL REPORT.

ERIC Educational Resources Information Center

GREEN, ALAN C.; AND OTHERS

THIS STUDY WAS AUTHORIZED BY THE VA DEPARTMENT OF MEDICINE AND SURGERY FOR THE PURPOSE OF IDENTIFYING AND DETERMINING THE FACILITIES NEEDED TO PROPERLY HOUSE AND SUPPORT EDUCATION ACTIVITIES IN EXISTING AND FUTURE VA HOSPITALS AND TO PRODUCE ARCHITECTURAL GUIDANCE IN THE DESIGN OF THE FACILITIES. CURRENT PRACTICES AND SIGNIFICANT TRENDS IN MEDICAL…

75 FR 33216 - Payment or Reimbursement for Emergency Treatment Furnished by Non-VA Providers in Non-VA...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-06-11

... treatment of eligible veterans at non-VA facilities and expand the circumstances under which payment for..., potentially eligible veterans would be appropriately afforded ample opportunity to qualify for this expanded...; 64.010, Veterans Nursing Home Care; and 64.011, Veterans Dental Care. Signing Authority The Secretary...

Prevalence and causes of visual impairment in Asian and non-Hispanic white preschool children: Multi-ethnic Pediatric Eye Disease Study.

PubMed

Tarczy-Hornoch, Kristina; Cotter, Susan A; Borchert, Mark; McKean-Cowdin, Roberta; Lin, Jesse; Wen, Ge; Kim, Jeniffer; Varma, Rohit

2013-06-01

To determine the prevalence and causes of decreased visual acuity (VA). Population-based cross-sectional study. Multi-ethnic sample of children 30 to 72 months of age identified in Los Angeles. All eligible children underwent a comprehensive ophthalmic evaluation including monocular VA testing, cover testing, cycloplegic autorefraction, fundus evaluation, and VA retesting with refractive correction. Decreased VA was defined as presenting or best-measured VA worse than 20/50 in children 30 to 47 months of age and worse than 20/40 for children 48 months of age and older. The prevalence and causes of decreased VA were determined, for both presenting and best-measured VA, in the better-seeing and the worse-seeing eyes. Prevalence and causes of decreased vision. Presenting VA was assessed in 1840 children and best-measured VA was assessed in 1886 children. Presenting VA was decreased in the worse eye of 4.2% of Asian children and of 3.6% of non-Hispanic white (NHW) children. Close to one-fourth of these cases had no identifiable cause, and 81% of these resolved on retesting. Decreased presenting VA in the worse eye with an identifiable ophthalmic cause was present in 3.4% of Asian children and in 2.6% of NHW children. Decreased presenting VA attributable to simple refractive error (myopia ≥ 0.5 diopters [D]; hyperopia ≥ 3.0 D; astigmatism ≥ 2.0 D or ≥ 1.5 D for children older than 36 months) was present in the worse eye of 2.3% of Asian children and of 1.4% of NHW children and in the better eye of 0.5% of Asian children and of 0.3% of NHW children. Decreased best-measured VA attributable to a cause was present in the worse eye of 1.2% of both Asian children and NHW children and in the better eye of 0.2% of Asian and of 0.3% of NHW children. Amblyopia related to refractive error was the most common cause, and was 10 times as common as ocular disease. Severe visual impairment was rare. Seventy percent of all decreased VA in Asian and NHW preschool children and more than 90% of decreased VA with an identifiable cause is related to refractive error--either uncorrected refractive error or amblyopia resulting from refractive error. 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.

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…

VA Vascular Injury Study (VAVIS): VA-DoD extremity injury outcomes collaboration.

PubMed

Shireman, Paula K; Rasmussen, Todd E; Jaramillo, Carlos A; Pugh, Mary Jo

2015-02-03

Limb injuries comprise 50-60% of U.S. Service member's casualties of wars in Afghanistan and Iraq. Combat-related vascular injuries are present in 12% of this cohort, a rate 5 times higher than in prior wars. Improvements in medical and surgical trauma care, including initial in-theatre limb salvage approaches (IILS) have resulted in improved survival and fewer amputations, however, the long-term outcomes such as morbidity, functional decline, and risk for late amputation of salvaged limbs using current process of care have not been studied. The long-term care of these injured warfighters poses a significant challenge to the Department of Defense (DoD) and Department of Veterans Affairs (VA). The VA Vascular Injury Study (VAVIS): VA-DoD Extremity Injury Outcomes Collaborative, funded by the VA, Health Services Research and Development Service, is a longitudinal cohort study of Veterans with vascular extremity injuries. Enrollment will begin April, 2015 and continue for 3 years. Individuals with a validated extremity vascular injury in the Department of Defense Trauma Registry will be contacted and will complete a set of validated demographic, social, behavioral, and functional status measures during interview and online/ mailed survey. Primary outcome measures will: 1) Compare injury, demographic and geospatial characteristics of patients with IILS and identify late vascular surgery related limb complications and health care utilization in Veterans receiving VA vs. non-VA care, 2) Characterize the preventive services received by individuals with vascular repair and related outcomes, and 3) Describe patient-reported functional outcomes in Veterans with traumatic vascular limb injuries. This study will provide key information about the current process of care for Active Duty Service members and Veterans with polytrauma/vascular injuries at risk for persistent morbidity and late amputation. The results of this study will be the first step for clinicians in VA and military settings to generate evidence-based treatment and care approaches to these injuries. It will identify areas where rehabilitation medicine and vascular specialty care or telehealth options are needed to allow for better planning, resource utilization, and improved DoD-to-VA care transitions.

Developmental dyslexia: the visual attention span deficit hypothesis.

PubMed

Bosse, Marie-Line; Tainturier, Marie Josèphe; Valdois, Sylviane

2007-08-01

The visual attention (VA) span is defined as the amount of distinct visual elements which can be processed in parallel in a multi-element array. Both recent empirical data and theoretical accounts suggest that a VA span deficit might contribute to developmental dyslexia, independently of a phonological disorder. In this study, this hypothesis was assessed in two large samples of French and British dyslexic children whose performance was compared to that of chronological-age matched control children. Results of the French study show that the VA span capacities account for a substantial amount of unique variance in reading, as do phonological skills. The British study replicates this finding and further reveals that the contribution of the VA span to reading performance remains even after controlling IQ, verbal fluency, vocabulary and single letter identification skills, in addition to phoneme awareness. In both studies, most dyslexic children exhibit a selective phonological or VA span disorder. Overall, these findings support a multi-factorial view of developmental dyslexia. In many cases, developmental reading disorders do not seem to be due to phonological disorders. We propose that a VA span deficit is a likely alternative underlying cognitive deficit in dyslexia.