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Kinds of VA Terms modified by VA Selected AbstractsDiagnosis of invasion depth in early colorectal carcinoma by pit pattern analysis with magnifying endoscopyDIGESTIVE ENDOSCOPY, Issue 2001Shinji Tanaka Background: The aim of this study was to clarify whether various pit patterns on the surface of colorectal tumors are associated with various levels of submucosal invasion. Methods: We examined pathologic features of the pit pattern of the tumor surface in 457 colorectal adenomas and early carcinomas. The examinations involved the use of magnifying endoscopy with indigocarmine dye spraying or crystal violet staining methods. Regarding the pit pattern classification, we used the types I, II, IIIL, IIIS, IV, VA and VN. We subclassified the VN pit pattern according to the area of the tumor surface covered into grades A (small), B (medium) and C (large). Results: Magnifying colonoscopic observation revealed the rates of submucosal invasion associated with specific pit patterns to be 1% (3/213) for IIIL, 5% (2/42) for IIIS, 8% (4/57) for IV, 14% (13/93) for VA and 80% (42/52) for VN. The rates of submucosal massive invasion (> 400 ,m) associated with specific pit patterns was 0% (0/213) for IIIL, 0% (0/42) for IIIS, 4% (2/57) for IV, 5% (5/93) for VA and 72% (38/52) for VN. Within the VN pit pattern subclassification, the incidence of submucosal invasion , 1500 ,m was found each grade (A, B & C): 5% (1/19) for grade A, 64% (14/22) for grade B and 93% (13/14) for grade C. Conclusion: Determination of pit pattern is useful for prediction of submucosal invasion depth and for decisions concerning treatment in colorectal tumors. Lesions with VA and non-grade C VN pit patterns are candidates for total endoscopic resection. A grade C VN pit pattern is a definite indicator of severely invasive submucosal carcinoma, which is unresectable by endoscopic resection. [source] Getting the Scale Right: A Comparison of Analytical Methods for Vulnerability Assessment and Household-level TargetingDISASTERS, Issue 2 2001Linda Stephen This paper introduces broad concepts of vulnerability, food security and famine. It argues that the concepts and theories driving development and implementation of vulnerability assessment tools are related to their utility. The review concludes that socio-geographic scale is a key issue, and challenge. It analyses three vulnerability assessment (VA) methods, using Ethiopia as a case study. Facing the challenges of vulnerability assessment and early warning requires providing accurate information at the required scale, useful for multiple decision-makers within realistic institutional capacities. [source] Influence of feeding ecology on blood mercury concentrations in four species of turtlesENVIRONMENTAL TOXICOLOGY & CHEMISTRY, Issue 8 2007Christine M. Bergeron Abstract Mercury is a relatively well-studied pollutant because of its global distribution, toxicity, and ability to bioaccumulate and biomagnify in food webs; however, little is known about bioaccumulation and toxicity of Hg in turtles. Total Hg (THg) concentrations in blood were determined for 552 turtles representing four different species (Chelydra serpentina, Sternotherus odoratus, Chrysemys picta, and Pseudemys rubriventris) from a Hg-contaminated site on the South River (VA, USA) and upstream reference sites. Methylmercury and Se concentrations also were determined in a subset of samples. Because the feeding ecology of these species differs drastically, stable isotopes of carbon (,13C) and nitrogen (,15N) were employed to infer the relationship between relative trophic position and Hg concentrations. Significant differences were found among sites and species, suggesting that blood can be used as a bioindicator of Hg exposure in turtles. We found differences in THg concentrations in turtles from the contaminated site that were consistent with their known feeding ecology: C. serpentina , S. odoratus > C. picta > P. rubriventris. This trend was generally supported by the isotope data, which suggested that individual turtles were feeding at more than one trophic level. Methylmercury followed similar spatial patterns as THg and was the predominant Hg species in blood for all turtles. Blood Se concentrations were low in the system, but a marginally positive relationship was found between THg and Se when species were pooled. The blood THg concentrations for the turtles in the present study are some of the highest reported in reptiles, necessitating further studies to investigate potential adverse effects of these high concentrations. [source] Variations in ,-Hexachlorocyclohexane enantiomer ratios in relation to microbial activity in a temperate estuaryENVIRONMENTAL TOXICOLOGY & CHEMISTRY, Issue 7 2003Tiruponithura V. Padma Abstract Changes in the enantiomer ratios (ERs) of chiral pollutants in the environment are often considered evidence of biological alteration despite the lack of data on causal or mechanistic relationships between microbial parameters and ER values. Enantiomer ratios that deviate from 1:1 in the environment provide evidence for the preferential microbial degradation of one enantiomer, whereas ER values equal to 1 provide no evidence for microbial degradation and may mistakenly be interpreted as evidence that biodegradation is not important. In an attempt to link biological and geochemical information related to enantioselective processes, we measured the ERs of the chiral pesticide ,-hexachlorocyclohexane (,-HCH) and bacterial activity (normalized to abundance) in surface waters of the York River (VA, USA) bimonthly throughout one year. Despite lower overall ,-HCH concentrations, ,-HCH ER values were unexpectedly close to 1:1 in the freshwater region of the estuary with the highest bacterial activity. In contrast, ER values were nonracemic (ER , 1) and ,-HCH concentrations were significantly higher in the higher salinity region of the estuary, where bacterial activity was lower. Examination of these data may indicate that racemic environmental ER values are not necessarily reflective of a lack of biodegradation or recent input into the environment, and that nonenantioselective biodegradation may be important in certain areas. [source] Quantitative Assessment of Seizure Severity for Clinical Trials: A Review of Approaches to Seizure ComponentsEPILEPSIA, Issue 1 2001Joyce A. Cramer Summary: Quantitative assessment of seizure severity has been approached using a variety of systems. This review describes currently available methods and possible new approaches to seizure assessment for clinical trials. A review of the literature on methods of seizure assessments resulted in tabulation of the seizure rating scales known as VA, Chalfont-National Hospital, Liverpool, Hague, and the Occupational Hazard Scale. Seizures have been evaluated by simply counting all events, counting events by type, by clinician ratings, patient ratings, and combinations. Each of the scales has advantages and disadvantages. Most scales share core components: seizure frequency, seizure type, seizure duration, postictal events, postictal duration, automatisms, seizure clusters, known patterns, warnings, tongue biting, incontinence, injuries, and functional impairment. This review revealed a partial consensus about aspects of seizures that are important markers for severity. However, usefulness of the existing scales is limited by lack of data on responsiveness. New approaches are needed to assess changes in seizure severity as a result of an intervention in a clinical trial. [source] Inpatient substance abuse care and the outcome of subsequent community residential and outpatient careADDICTION, Issue 6 2000Rudolf H. Moos Aim. To compare participation in treatment and 1-year substance use, symptom and functioning outcomes between patients with substance use disorders who did versus those who did not have an episode of inpatient care immediately prior to an episode of community residential and outpatient mental health care. Design. Two matched groups of 257 patients each with substance use disorders were assessed at entry to and discharge from a community residential facility (CRF) and at a 1-year follow-up. Findings. Patients in the two treatment groups received a comparable amount of CRF and outpatient mental health care. Nevertheless, patients who had prior inpatient care were more likely to be employed at 1-year follow-up. In addition, when they entered CRF care directly, patients with co-morbid psychiatric disorders were more likely to continue use of alcohol and drugs in the CRF and less likely to complete the program. These patients also experienced more distress and psychiatric symptoms, and were less likely to be employed at the 1-year follow-up. Conclusions. Among patients who seek treatment at Department of Veterans Affairs (VA) facilities, those who have both substance use and psychiatric disorders and enter CRF care directly have somewhat worse outcomes than those who have an immediately prior episode of inpatient care. [source] Cerebral vasomotor reactivity of bilateral severe carotid stenosis: is stroke unavoidable?EUROPEAN JOURNAL OF NEUROLOGY, Issue 2 2006A. Y. Gur We evaluated the cerebral hemodynamic features of severe bilateral carotid stenosis by assessing and comparing cerebral vasomotor reactivity (VMR) in the middle cerebral (MCA) and vertebral arteries (VA) by transcranial Doppler and the Diamox (1 g acetazolamide i.v.) test. VMR was evaluated by recording the percentage differences in peak systolic blood flow velocity in each MCA and VA at baseline and by the Diamox test. Twenty-eight symptomatic (SCAS) and 31 asymptomatic (ACAS) patients with bilateral severe (>70%) internal carotid artery stenosis were studied. The mean MCA VMR% was 29 ± 26.9% in SCAS and 43.2 ± 26.8% in ACAS patients (P < 0.01). Their respective mean VA VMR% was 30.2 ± 36.5% and 39.6 ± 24.4% (P = NS). VMR% of the symptomatic MCA side in SCAS patients was significantly lower than the opposite side (20.5 ± 31.1% and 39.2 ± 37.9% respectively; P < 0.03). In contrast, the VA VMR% of both sides in SCAS patients remained similar (28.1 ± 39.3% and 34.6 ± 47.9% respectively; P = NS). VMR% of the MCA and VA in ACAS patients was also similar for both sides of bilateral carotid stenosis. The cerebral hemodynamic features differ between SCAS and ACAS patients with bilateral carotid occlusive disease in the anterior part of the circle of Willis. An independent cerebral vascular reserve capacity of the posterior circulation is proposed. [source] THE CHANGE IN QUANTITATIVE GENETIC VARIATION WITH INBREEDINGEVOLUTION, Issue 12 2006Josh Van Buskirk Abstract Inbreeding is known to reduce heterozygosity of neutral genetic markers, but its impact on quantitative genetic variation is debated. Theory predicts a linear decline in additive genetic variance (VA) with increasing inbreeding coefficient (F) when loci underlying the trait act additively, but a nonlinear hump-shaped relationship when dominance and epistasis are important. Predictions for heritability (h2) are similar, although the exact shape depends on the value of h2 in the absence of inbreeding. We located 22 published studies in which the level of genetic variation in [source] EFFECTS OF GENETIC DRIFT ON VARIANCE COMPONENTS UNDER A GENERAL MODEL OF EPISTASISEVOLUTION, Issue 10 2004N.H. Barton Abstract We analyze the changes in the mean and variance components of a quantitative trait caused by changes in allele frequencies, concentrating on the effects of genetic drift. We use a general representation of epistasis and dominance that allows an arbitrary relation between genotype and phenotype for any number of diallelic loci. We assume initial and final Hardy-Weinberg and linkage equilibrium in our analyses of drift-induced changes. Random drift generates transient linkage disequilibria that cause correlations between allele frequency fluctuations at different loci. However, we show that these have negligible effects, at least for interactions among small numbers of loci. Our analyses are based on diffusion approximations that summarize the effects of drift in terms of F, the inbreeding coefficient, interpreted as the expected proportional decrease in heterozygosity at each locus. For haploids, the variance of the trait mean after a population bottleneck is var(,z,) =where n is the number of loci contributing to the trait variance, VA(1)=VA is the additive genetic variance, and VA(k) is the kth-order additive epistatic variance. The expected additive genetic variance after the bottleneck, denoted (V*A), is closely related to var(,z,); (V*A) (1 ,F)Thus, epistasis inflates the expected additive variance above VA(1 ,F), the expectation under additivity. For haploids (and diploids without dominance), the expected value of every variance component is inflated by the existence of higher order interactions (e.g., third-order epistasis inflates (V*AA)). This is not true in general with diploidy, because dominance alone can reduce (V*A) below VA(1 ,F) (e.g., when dominant alleles are rare). Without dominance, diploidy produces simple expressions: var(,z,)==1 (2F) kVA(k) and (V*A) = (1 ,F)k(2F)k-1VA(k) With dominance (and even without epistasis), var(,z,)and (V*A) no longer depend solely on the variance components in the base population. For small F, the expected additive variance simplifies to (V*A)(1 ,F) VA+ 4FVAA+2FVD+2FCAD, where CAD is a sum of two terms describing covariances between additive effects and dominance and additive × dominance interactions. Whether population bottlenecks lead to expected increases in additive variance depends primarily on the ratio of nonadditive to additive genetic variance in the base population, but dominance precludes simple predictions based solely on variance components. We illustrate these results using a model in which genotypic values are drawn at random, allowing extreme and erratic epistatic interactions. Although our analyses clarify the conditions under which drift is expected to increase VA, we question the evolutionary importance of such increases. [source] CLIMATIC AND TEMPORAL EFFECTS ON THE EXPRESSION OF SECONDARY SEXUAL CHARACTERS: GENETIC AND ENVIRONMENTAL COMPONENTSEVOLUTION, Issue 3 2004Dany Garant Abstract Despite great interest in sexual selection, relatively little is known in detail about the genetic and environmental determinants of secondary sexual characters in natural populations. Such information is important for determining the way in which populations may respond to sexual selection. We report analyses of genetic and large-scale environmental components of phenotypic variation of two secondary sexual plumage characters (forehead and wing patch size) in the collared flycatcher Ficedula albicollis over a 22-year period. We found significant heritability for both characters but little genetic covariance between the two. We found a positive association between forehead patch size and a large-scale climatic index, the North Atlantic Oscillation (NAO) index, but not for wing patch. This pattern was observed in both cross-sectional and longitudinal data suggesting that the population response to NAO index can be explained as the result of phenotypic plasticity. Heritability of forehead patch size for old males, calculated under favorable conditions (NAO index median), was greater than that under unfavorable conditions (NAO index < median). These changes occurred because there were opposing changes in additive genetic variance (VA) and residual variance (VR) under favorable and unfavorable conditions, with VA increasing and VR decreasing in good environments. However, no such effect was detected for young birds, or for wing patch size in either age class. In addition to these environmental effects on both phenotypic and genetic variances, we found evidence for a significant decrease of forehead patch size over time in older birds. This change appears to be caused by a change in the sign of viability selection on forehead patch size, which is associated with a decline in the breeding value of multiple breeders. Our data thus reveal complex patterns of environmental influence on the expression of secondary sexual characters, which may have important implications for understanding selection and evolution of these characters. [source] THE EFFECT OF EPISTASIS ON THE EXCESS OF THE ADDITIVE AND NONADDITIVE VARIANCES AFTER POPULATION BOTTLENECKSEVOLUTION, Issue 5 2002Carlos López-Fanjul Abstract The effect of population bottlenecks on the components of the genetic variance generated by two neutral independent epistatic loci has been studied theoretically (VA, additive; VD, dominant; VAA, additive × additive; VAD, additive × dominant; VDD; dominant × dominant components of variance). Nonoverdominance and overdominance models were considered, covering all possible types of marginal gene action at the single locus level. The variance components in an infinitely large panmictic population (ancestral components) were compared with their expected values at equilibrium, after t consecutive bottlenecks of equal size N (derived components). Formulae were obtained in terms of allele frequencies and effects at each locus and the corresponding epistatic value. An excess of VA after bottlenecks can be assigned to two sources: (1) the spatiotemporal changes in the marginal average effects of gene substitution ai, which are equal to zero only for additive gene action within and between loci; and (2) the covariance between a2i and the heterozygosity at the loci involved, which is generated by dominance, with or without epistasis. Numerical examples were analyzed, indicating that an increase in VA after bottlenecks will only occur if its ancestral value is minimal or very small. For the nonoverdominance model with weak reinforcing epistasis, that increase has been detected only for extreme frequencies of the negative allele at one or both loci. With strong epistasis, however, this result can be extended to a broad range of intermediate frequencies. With no epistasis, the same qualitative results were found, indicating that dominance can be considered as the primary cause of an increase in VA following bottlenecks. In parallel, the derived total nonadditive variance exceeded its ancestral value (VNA= VD+ VAA+VAD+ VDD) for a range of combinations of allele frequencies covering those for an excess of VA and for very large frequencies of the negative allele at both loci. For the overdominance model, an increase in VA and VNA was respectively observed for equilibrium (intermediate) frequencies at one or both loci or for extreme frequencies at both loci. For all models, the magnitude of the change of VA and VNA was inversely related to N and t. At low levels of inbreeding, the between-line variance was not affected by the type of gene action. For the models considered, the results indicate that it is unlikely that the rate of evolution may be accelerated after population bottlenecks, in spite of occasional increments of the derived VA over its ancestral value. [source] On the mechanism of fatigue failure in the superlong life regime (N>107 cycles).FATIGUE & FRACTURE OF ENGINEERING MATERIALS AND STRUCTURES, Issue 11 2000Part 1: influence of hydrogen trapped by inclusions The fracture surfaces of specimens of a heat-treated hard steel, namely Cr,Mo steel SCM435, which failed in the regime of N,=,105 to 5,×,108 cycles, were investigated by optical microscopy and scanning electron microscopy (SEM). Specimens having a longer fatigue life had a particular morphology beside the inclusion at the fracture origin. The particular morphology looked optically dark when observed by an optical microscope and it was named the optically dark area (ODA). The ODA looks a rough area when observed by SEM and atomic force microscope (AFM). The relative size of the ODA to the size of the inclusion at the fracture origin increases with increase in fatigue life. Thus, the ODA is considered to have a crucial role in the mechanism of superlong fatigue failure. It has been assumed that the ODA is made by the cyclic fatigue stress and the synergetic effect of the hydrogen which is trapped by the inclusion at the fracture origin. To verify this hypothesis, in addition to conventionally heat-treated specimens (specimen QT, i.e. quenched and tempered), specimens annealed at 300 °C in a vacuum (specimen VA) and the specimens quenched in a vacuum (specimen VQ) were prepared to remove the hydrogen trapped by inclusions. The specimens VA and VQ, had a much smaller ODA than the specimen QT. Some other evidence of the influence of hydrogen on superlong fatigue failure are also presented. Thus, it is concluded that the hydrogen trapped by inclusions is a crucial factor which causes the superlong fatigue failure of high strength steels. [source] Characterization of a eukaryotic type serine/threonine protein kinase and protein phosphatase of Streptococcus pneumoniae and identification of kinase substratesFEBS JOURNAL, Issue 5 2005Linda Nováková Searching the genome sequence of Streptococcus pneumoniae revealed the presence of a single Ser/Thr protein kinase gene stkP linked to protein phosphatase phpP. Biochemical studies performed with recombinant StkP suggest that this protein is a functional eukaryotic-type Ser/Thr protein kinase. In vitro kinase assays and Western blots of S. pneumoniae subcellular fractions revealed that StkP is a membrane protein. PhpP is a soluble protein with manganese-dependent phosphatase activity in vitro against a synthetic substrate RRA(pT)VA. Mutations in the invariant aspartate residues implicated in the metal binding completely abolished PhpP activity. Autophosphorylated form of StkP was shown to be a substrate for PhpP. These results suggest that StkP and PhpP could operate as a functional pair in vivo. Analysis of phosphoproteome maps of both wild-type and stkP null mutant strains labeled in vivo and subsequent phosphoprotein identification by peptide mass fingerprinting revealed two possible substrates for StkP. The evidence is presented that StkP can phosphorylate in vitro phosphoglucosamine mutase GlmM which catalyzes the first step in the biosynthetic pathway leading to the formation of UDP- N -acetylglucosamine, an essential common precursor to cell envelope components. [source] Use of tag data to compare growth rates of Atlantic coast striped bass stocksFISHERIES MANAGEMENT & ECOLOGY, Issue 5 2003S. A. Welsh Abstract Migratory stocks of Atlantic coast striped bass, Morone saxatilis (Walbaum), range primarily from North Carolina (NC) northward to Canadian waters. Between 1986 and 2000, 267 045 wild striped bass were tagged and released from NC to Massachusetts as part of the Cooperative Striped Bass Tagging Program. Direct measurements of growth of individual fish can be obtained from tag data and are useful for understanding the dynamics of fish populations. Growth rates from regressions of length-increment vs. time-at-liberty were estimated for striped bass tagged and released in three southern states [NC, Virginia (VA) and Maryland (MD)] and three northern states (New Jersey, New York and Rhode Island). Striped bass tagged in waters of northern states grew faster (significantly steeper regression slopes) than those tagged in southern areas. Migratory patterns, stock mixing, and unmeasured biotic and abiotic influences on growth precluded conclusions that observed growth patterns are stock-specific. These results, however, indicate latitudinal differences in growth rates, and should be considered in future research and management of Atlantic coast striped bass. [source] Health care funding levels and patient outcomes: a national studyHEALTH ECONOMICS, Issue 4 2007Margaret M. Byrne Abstract Background: Health care funding levels differ significantly across geographic regions, but there is little correlation between regional funding levels and outcomes of elderly Medicare beneficiaries. Our goal was to determine whether this relationship holds true in a non-Medicare population cared for in a large integrated health care system with a capitated budget allocation system. Methods: We explored the association between health care funding and risk-adjusted mortality in the 22 Veterans Affairs (VA) geographic Networks over a six-year time period. Allocations to Networks were adjusted for illness burden using Diagnostic Cost Groups. To test the association between funding and risk-adjusted three-year mortality, we ran logistic regressions with single-year patient cohorts, as well as hierarchical regressions on a six year longitudinal data set, clustering on VA Network. Results: A $1000 increase in funding per unit of patient illness burden was associated with a 2,8% reduction in three-year mortality in cross sectional regressions. However, in longitudinal hierarchical regressions clustering on Network, the significant effect of funding level was eliminated. Conclusions: When longitudinal data are used, the significant cross sectional effect of funding levels on mortality disappear. Thus, the factors driving differences in mortality are Network effects, although part of the Network effect may be due to past levels of funding. Our results provide a caution for cross sectional examinations of the association between regional health care funding levels and health outcomes. Copyright © 2006 John Wiley & Sons, Ltd. [source] Use of Outpatient Care in Veterans Health Administration and Medicare among Veterans Receiving Primary Care in Community-Based and Hospital Outpatient ClinicsHEALTH SERVICES RESEARCH, Issue 5p1 2010Chuan-Fen Liu Objective. To examine differences in use of Veterans Health Administration (VA) and Medicare outpatient services by VA primary care patients. Data Sources/Study Setting. VA administrative and Medicare claims data from 2001 to 2004. Study Design. Retrospective cohort study of outpatient service use by 8,964 community-based and 6,556 hospital-based VA primary care patients. Principal Findings. A significant proportion of VA patients used Medicare-reimbursed primary care (>30 percent) and specialty care (>60 percent), but not mental health care (3,4 percent). Community-based patients had 17 percent fewer VA primary care visits (p<.001), 9 percent more Medicare-reimbursed visits (p<.001), and 6 percent fewer total visits (p<.05) than hospital-based patients. Community-based patients had 22 percent fewer VA specialty care visits (p<.0001) and 21 percent more Medicare-reimbursed specialty care visits (p<.0001) than hospital-based patients, but no difference in total visits (p=.80). Conclusions. Medicare-eligible VA primary care patients followed over 4 consecutive years used significant primary care and specialty care outside of VA. Community-based patients offset decreased VA use with increased service use paid by Medicare, suggesting that increasing access to VA primary care via community clinics may fragment veteran care in unintended ways. Coordination of care between VA and non-VA providers and health care systems is essential to improve the quality and continuity of care. [source] Comparing Safety Climate between Two Populations of Hospitals in the United StatesHEALTH SERVICES RESEARCH, Issue 5p1 2009Sara J. Singer Objective. To compare safety climate between diverse U.S. hospitals and Veterans Health Administration (VA) hospitals, and to explore the factors influencing climate in each setting. Data Sources. Primary data from surveys of hospital personnel; secondary data from the American Hospital Association's 2004 Annual Survey of Hospitals. Study Design. Cross-sectional study of 69 U.S. and 30 VA hospitals. Data Collection. For each sample, hierarchical linear models used safety-climate scores as the dependent variable and respondent and facility characteristics as independent variables. Regression-based Oaxaca,Blinder decomposition examined differences in effects of model characteristics on safety climate between the U.S. and VA samples. Principal Findings. The range in safety climate among U.S. and VA hospitals overlapped substantially. Characteristics of individuals influenced safety climate consistently across settings. Working in southern and urban facilities corresponded with worse safety climate among VA employees and better safety climate in the U.S. sample. Decomposition results predicted 1.4 percentage points better safety climate in U.S. than in VA hospitals: ,0.77 attributable to sample-characteristic differences and 2.2 due to differential effects of sample characteristics. Conclusions. Results suggest that safety climate is linked more to efforts of individual hospitals than to participation in a nationally integrated system or measured characteristics of workers and facilities. [source] Short- and Long-Term Mortality after an Acute Illness for Elderly Whites and BlacksHEALTH SERVICES RESEARCH, Issue 4 2008Daniel Polsky Objective. To estimate racial differences in mortality at 30 days and up to 2 years following a hospital admission for the elderly with common medical conditions. Data Sources. The Medicare Provider Analysis and Review File and the VA Patient Treatment File from 1998 to 2002 were used to extract patients 65 or older admitted with a principal diagnosis of acute myocardial infarction, stroke, hip fracture, gastrointestinal bleeding, congestive heart failure, or pneumonia. Study Design. A retrospective analysis of risk-adjusted mortality after hospital admission for blacks and whites by medical condition and in different hospital settings. Principal Findings. Black Medicare patients had consistently lower adjusted 30-day mortality than white Medicare patients, but the initial survival advantage observed among blacks dissipated beyond 30 days and reversed by 2 years. For VA hospitalizations similar patterns were observed, but the initial survival advantage for blacks dissipated at a slower rate. Conclusions. Racial disparities in health are more likely to be generated in the posthospital phase of the process of care delivery rather than during the hospital stay. The slower rate of increase in relative mortality among black VA patients suggests an integrated health care delivery system like the VA may attenuate racial disparities in health. [source] The Impact of Private Insurance Coverage on Veterans' Use of VA Care: Insurance and Selection EffectsHEALTH SERVICES RESEARCH, Issue 1p1 2008Yujing Shen Objective. To examine private insurance coverage and its impact on use of Veterans Health Administration (VA) care among VA enrollees without Medicare coverage. Data Sources. The 1999 National Health Survey of Veteran Enrollees merged with VA administrative data, with other information drawn from American Hospital Association data and the Area Resource File. Study Design. We modeled VA enrollees' decision of having private insurance coverage and its impact on use of VA care controlling for sociodemographic information, patients' health status, VA priority status and access to VA and non-VA alternatives. We estimated the true impact of insurance on the use of VA care by teasing out potential selection bias. Bias came from two sources: a security selection effect (sicker enrollees purchase private insurance for extra security and use more VA and non-VA care) and a preference selection effect (VA enrollees who prefer non-VA care may purchase private insurance and use less VA care). Principal Findings. VA enrollees with private insurance coverage were less likely to use VA care. Security selection dominated preference selection and naïve models that did not control for selection effects consistently underestimated the insurance effect. Conclusions. Our results indicate that prior research, which has not controlled for insurance selection effects, may have underestimated the potential impact of any private insurance policy change, which may in turn affect VA enrollees' private insurance coverage and consequently their use of VA care. From the decline in private insurance coverage from 1999 to 2002, we projected an increase of 29,400 patients and 158 million dollars for VA health care services. [source] Clinical Practice Guideline Implementation Strategy Patterns in Veterans Affairs Primary Care ClinicsHEALTH SERVICES RESEARCH, Issue 1p1 2007Sylvia J. Hysong Background. The Department of Veterans Affairs (VA) mandated the system-wide implementation of clinical practice guidelines (CPGs) in the mid-1990s, arming all facilities with basic resources to facilitate implementation; despite this resource allocation, significant variability still exists across VA facilities in implementation success. Objective. This study compares CPG implementation strategy patterns used by high and low performing primary care clinics in the VA. Research Design. Descriptive, cross-sectional study of a purposeful sample of six Veterans Affairs Medical Centers (VAMCs) with high and low performance on six CPGs. Subjects. One hundred and two employees (management, quality improvement, clinic personnel) involved with guideline implementation at each VAMC primary care clinic. Measures. Participants reported specific strategies used by their facility to implement guidelines in 1-hour semi-structured interviews. Facilities were classified as high or low performers based on their guideline adherence scores calculated through independently conducted chart reviews. Findings. High performing facilities (HPFs) (a) invested significantly in the implementation of the electronic medical record and locally adapting it to provider needs, (b) invested dedicated resources to guideline-related initiatives, and (c) exhibited a clear direction in their strategy choices. Low performing facilities exhibited (a) earlier stages of development for their electronic medical record, (b) reliance on preexisting resources for guideline implementation, with little local adaptation, and (c) no clear direction in their strategy choices. Conclusion. A multifaceted, yet targeted, strategic approach to guideline implementation emphasizing dedicated resources and local adaptation may result in more successful implementation and higher guideline adherence than relying on standardized resources and taxing preexisting channels. [source] Photogeneration of High Pretilt Angles of Nematic Liquid Crystals by Non-Polarized Light Irradiation of Azobenzene-Containing Polymer Films,ADVANCED FUNCTIONAL MATERIALS, Issue 3 2004S. Furumi Abstract A vertical-alignment (VA) cell of nematic liquid crystals (LCs) was prepared using photoirradiated thin films of a poly(methacrylate) with mesogenic moieties of 4-trifluoromethoxyazobenzene as the side chains. Optical anisotropy was generated by oblique irradiation of the azobenzene-containing polymer films with non-polarized UV light, followed by annealing treatment to enhance the photodichroism, which displayed thermal stability. The combination of oblique exposure to non-polarized UV light and subsequent annealing treatment brought about high pretilt angles of nematic LCs so that a photoaligned VA LC cell was fabricated. The photopatterned LC cell exhibited electro-optical properties with excellent optical quality when a voltage was applied even after heating at 100,°C for several hours. [source] Mothers' Trait Verbal Aggressiveness as a Predictor of Maternal and Child Behavior During Playtime InteractionsHUMAN COMMUNICATION RESEARCH, Issue 3 2008Steven R. Wilson This article explores associations between mothers' trait verbal aggressiveness (VA) and maternal and child behavior during playtime interactions. Forty mothers completed a 10-minute play period with one of their children (range = 3,8 years) and then responded to D. A. Infante and C. J. Wigley's (1986) trait VA scale. Mothers' trait VA was associated positively (r = .48) with their rate of directing and inversely (r =,.44) with their child's rated cooperation. Qualitative analyses of a subset (n = 8) of interactions suggest that mothers high in trait VA used directives to control the choice, rate, and duration of activities, and used physical negative touch along with directives, more than low-VA mothers. Behaviors associated with trait VA occur even during brief mother,child interactions in which triggers for aggressive behavior largely are absent. Résumé Le trait d,agressivité verbale des mères comme variable explicative des comportements maternels et infantiles lors d'interactions de jeu Cet article explore les associations entre le trait d,agressivité verbale (AV) des mères et le comportement maternel et infantile lors d'interactions de jeu. 40 mères ont participéà une période de jeu de 10 minutes avec l,un de leurs enfants (tranche d'âge = 3-8 ans) puis ont répondu à l'échelle de trait d'AV d,Infante et Wigley (1986). Le trait d'AV des mères fut associé positivement (r= 0,48) à leur taux de contrôle et inversement (r= -0,44) au taux de coopération de leur enfant. Des analyses qualitatives d,un sous-ensemble (n= 8) d'interactions donnent à penser que les mères au trait d,AV élevé ont fait usage de directives pour contrôle le choix, le rythme et la durée des activités et qu'elles ont utilisé le toucher physique négatif en même temps que les directives, plus que ne l,ont fait les mères au trait d'AV faible. Les comportements associés au trait d'AV surviennent même lors de brèves interactions mère-enfant au cours desquelles les déclencheurs de comportements agressifs étaient largement absents. Abstract Das Müttermerkmal verbale Aggression als Prädiktor für Mutter-Kind-Verhalten in spielerischen Interaktionen Dieser Artikel untersucht den Zusammenhang zwischen dem Müttermerkmal verbale Aggression (VA) und dem Mutter-Kind-Verhalten in spielerischen Interaktionen. 40 Mütter spielten 10 Minuten lang mit einem ihrer Kinder (zwischen 3-8 Jahren) und beantworteten dann die VA-Eigenschaftsskala nach Infante & Wigley (1986). Das Müttermerkmal VA war positiv assoziiert (r= .48) mit der Häufigkeit des führenden Eingreifens und umgekehrt assoziiert (r= -.44) mit der vom Kind beurteilten Kooperation. Qualitative Analysen eines Teils (n= 8) der Interaktionen deuten darauf hin, dass Mütter mit hoher VA führendes Eingreifen nutzen, um die Wahl, Häufigkeit und Dauer von Aktivitäten zu kontrollieren. Sie nutzten außerdem häufiger physisch negative Berührungen zusammen mit dem führenden Eingreifen als Mütter mit niedriger VA. Mit dem Merkmal VA verbundene Verhaltensweisen finden sogar in kurzen Mutter-Kind-Interaktionen statt bei denen Auslöser für aggressives Verhalten weitestgehend fehlen. Resumen El Rasgo de la Agresividad Verbal de las Madres como Vaticinador del Comportamiento Materno y del Niño Durante las Interacciones en el Recreo Este artículo explora la asociación entre el rasgo de agresividad verbal de las madres (VA) y el comportamiento maternal y del niño durante las interacciones en el recreo. Cuarenta madres completaron un período de 10-minutos de juego con uno de sus hijos (oscilando = 3-8 años) y luego respondieron a la escala sobre el rasgo VA de Infante y Wigley (1986). El rasgo VA de las madres fue asociado positivamente (r= .48) con el grado de direccionamiento e inversamente (r= -.44) con el grado de cooperación de su niño. Los análisis cualitativos de un subset (n= 8) de interacciones sugieren que las madres con rasgos altos de VA usaron directivas para controlar la selección, el tipo, y la duración de las actividades, y usaron el contacto físico negativo junto con directivas, más que las madres con rasgos bajos de VA. Los comportamientos asociados con el rasgo VA durante las interacciones breves entre la madre y su niño que provocan el comportamiento agresivo se encuentran mayormente ausentes. ZhaiYao Yo yak [source] Financial distress, reorganization and corporate performanceACCOUNTING & FINANCE, Issue 3 2000James Routledge Prospects for financially distressed companies in Australia have improved since the introduction of voluntary administration (VA) as an alternative to liquidation. This paper investigates whether companies that reorganise can be distinguished from those that liquidate under VA. In addition, performance of reorganised companies is examined to determine variables that distinguish ,successful' from ,unsuccessful' reorganisations. Significant variables in the logistic regression models developed differ between the analyses. The results of the analyses have implications for policy makers regarding efficiency of the VA procedure, as it appears the reorganisation decision is biased toward permitting inefficient firms to reorganise. [source] Retinoid- and carotenoid-enriched diets influence the ontogenesis of the immune system in miceIMMUNOLOGY, Issue 2 2003Ada L. Garcia Summary Vitamin A (VA) has been identified as an important factor for the development of the immune system, especially during ontogenesis. It has been shown that antibody secretion and proliferation of lymphocyte populations depend on retinoids. In the present study we investigated the influence of a base VA diet and diets enriched with VA, ,-carotene and lycopene, on the ontogenesis of the immune system in mice. We examined the absolute and relative concentrations of splenic B lymphocytes (CD45R/B220), T lymphocytes (CD3+) and their subpopulations (CD4+ and CD8+), and measured serum immunoglobulin G (IgG) concentrations in the offspring of supplemented dams at different ages (1, 3, 5, 7, 14, 21 and 65 days). The experimental diets resulted in higher numbers of T and B lymphocytes after VA and carotenoid enrichment, when compared, at various time-points, with the base diet. Higher values of total serum IgG were found in the ,-carotene-enriched diet group on day 7. On days 7 and 14, the enriched diets induced significant alterations in the percentages and total numbers of splenic lymphocytes in comparison to the base diet. Our results confirm that supplementation with VA and carotenoids affect the immune-cell function during ontogenesis and suggest a possible role of these nutritional factors on the development of the immune system. [source] Bifidobacterium animalis causes extensive duodenitis and mild colonic inflammation in monoassociated interleukin-10-deficient miceINFLAMMATORY BOWEL DISEASES, Issue 7 2009James P. Moran PhD Abstract Background: We recently showed that Bifidobacterium animalis is more prevalent within the colons of interleukin (IL)-10-deficient (,/,) mice than in wildtype (WT) animals colonized with the same specific pathogen-free (SPF) fecal contents. Here we tested the ability of this organism to cause T-cell-mediated intestinal inflammation by introducing it into germ-free (GF) IL-10,/, mice. Methods: GF IL-10,/, or WT mice were monoassociated with Bifidobacterium animalis subsp. animalis ATCC (American Type Culture Collection, Manassas, VA) 25527T or with B. infantis ATCC 15697T. Inflammation was measured by blinded histologic scores of the duodenum, cecum, and colon and by spontaneous secretion of IL-12/IL-23 p40 from colonic explants. Bacterial antigen-specific CD4+ mesenteric lymph node (MLN) T-cell recall responses were measured in response to antigen-presenting cells (APC) pulsed with bacterial lysates. Results:B. animalis caused marked duodenal inflammation and mild colitis in monoassociated IL-10,/, mice, whereas the intestinal tracts of WT animals remained free of inflammation. B. infantis colonization resulted in mild inflammation in the duodena of IL-10,/, mice. CD4+ MLN T cells from B. animalis monoassociated IL-10,/, mice secreted high levels of IFN-, and IL-17 in response to B. animalis lysate. B. animalis equally colonized the different intestinal regions of WT and IL-10,/, mice. Conclusions:B. animalis, a traditional probiotic species that is expanded in experimental colitis in this model, induces marked duodenal and mild colonic inflammation and TH1/TH17 immune responses when introduced alone into GF IL-10,/, mice. This suggests a potential pathogenic role for this commensal bacterial species in a susceptible host. (Inflamm Bowel Dis 2009) [source] Use of vibrational spectroscopy to study protein and DNA structure, hydration, and binding of biomolecules: A combined theoretical and experimental approachINTERNATIONAL JOURNAL OF QUANTUM CHEMISTRY, Issue 5 2006K. J. Jalkanen Abstract We report on our work with vibrational absorption, vibrational circular dichroism, Raman scattering, Raman optical activity, and surface-enhanced Raman spectroscopy to study protein and DNA structure, hydration, and the binding of ligands, drugs, pesticides, or herbicides via a combined theoretical and experimental approach. The systems we have studied systematically are the amino acids (L -alanine, L -tryptophan, and L -histidine), peptides (N -4271 acetyl L -alanine N,-methyl amide, N -acetyl L -tryptophan N,-methyl amide, N -acetyl L -histidine N,-methyl amide, L -alanyl L -alanine, tri- L -serine, N -acetyl L -alanine L -proline L -tyrosine N,-methyl amide, Leu-enkephalin, cyclo-(gly- L -pro)3, N -acetyl (L -alanine)nN,-methyl amide), 3-methyl indole, and a variety of small molecules (dichlobenil and 2,6-dochlorobenzamide) of relevance to the protein systems under study. We have used molecular mechanics, the SCC-DFTB, SCC-DFTB+disp, RHF, MP2, and DFT methodologies for the modeling studies with the goal of interpreting the experimentally measured vibrational spectra for these molecules to the greatest extent possible and to use this combined approach to understand the structure, function, and electronic properties of these molecules in their various environments. The application of these spectroscopies to biophysical and environmental assays is expanding, and therefore a thorough understanding of the phenomenon from a rigorous theoretical basis is required. In addition, we give some exciting and new preliminary results which allow us to extend our methods to even larger and more complex systems. The work presented here is the current state of the art to this ever and fast changing field of theoretical spectroscopic interpretation and use of VA, VCD, Raman, ROA, EA, and ECD spectroscopies. © 2005 Wiley Periodicals, Inc. Int J Quantum Chem, 2006 [source] Comparative Effectiveness Research Priorities at Federal Agencies: The View from the Department of Veterans Affairs, National Institute on Aging, and Agency for Healthcare Research and QualityJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 6 2010Timothy J. O'Leary MD In the last year, attention has been focused on translating federally sponsored health research into better health for Americans. Since the passage of the American Recovery and Reinvestment Act (ARRA) on February 17, 2009, ARRA funds to support Comparative Effectiveness Research (CER) have increased this focus. A large proportion of topical areas of interest in CER affects the older segment of the population. The Department of Veterans Affairs (VA), the National Institute on Aging (NIA), and the Agency for Healthcare Research and Quality (AHRQ) have supported robust research portfolios focused on aging populations that meet the varying definitions of CER. This short article briefly describes the research missions of the AHRQ, NIA, and VA. The various definitions of CER as the Congressional Budget Office, the Institute of Medicine, and the ARRA-established Federal Coordinating Council have put forward, as well as important topics for which CER is particularly needed, are then reviewed. Finally, approaches in which the three agencies support CER involving the aging population are set forth and opportunities for future CER research outlined. [source] Use of Medicare and Department of Veterans Affairs Health Care by Veterans with Dementia: A Longitudinal AnalysisJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 10 2009Carolyn W. Zhu PhD The objectives of this study were to examine longitudinal patterns of Department of Veterans Affairs (VA),only use, dual VA and Medicare use, and Medicare-only use by veterans with dementia. Data on VA and Medicare use were obtained from VA administrative datasets and Medicare claims (1998,2001) for 2,137 male veterans who, in 1997, used some VA services, had a formal diagnosis of Alzheimer's disease or vascular dementia in the VA, and were aged 65 and older. Generalized ordered logit models were used to estimate the effects of patient characteristics on use group over time. In 1998, 41.7% of the sample were VA-only users, 55.4% were dual users, and 2.9% were Medicare-only users. By 2001, 30.4% were VA-only users, 51.5% were dual users, and 18.1% were Medicare-only users. Multivariate results show that greater likelihood of Medicare use was associated with older age, being white, being married, having higher education, having private insurance or Medicaid, having low VA priority level, and living in a nursing home or dying during the year. Higher comorbidities were associated with greater likelihood of dual use as opposed to any single system use. Alternatively, number of functional limitations was associated with greater likelihood of Medicare-only use and less likelihood of VA-only use. These results imply that different aspects of veterans' needs have differential effects on where they seek care. Efforts to coordinate care between VA and Medicare providers are necessary to ensure that patients receive high-quality care, especially patients with multiple comorbidities. [source] Do Palliative Consultations Improve Patient Outcomes?JOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 4 2008David Casarett MD OBJECTIVES: To determine whether inpatient palliative consultation services improve outcomes of care. DESIGN: Retrospective telephone surveys conducted with family members of veterans who received inpatient or outpatient care from a Department of Veterans Affairs (VA) medical facility in the last month of life. SETTING: Five VA Medical Centers or their affiliated nursing homes and outpatient clinics. PARTICIPANTS: Veterans had received inpatient or outpatient care from a participating VA in the last month of life. One family member completed each survey. MEASUREMENTS: The telephone survey assessed nine aspects of the care the patient received in his or her last month of life: the patient's well-being and dignity (4 items), adequacy of communication (5 items), respect for treatment preferences (2 items), emotional and spiritual support (3 items), management of symptoms (4 items), access to the inpatient facility of choice (1 item), care around the time of death (6 items), access to home care services (4 items), and access to benefits and services after the patient's death (3 items). RESULTS: Interviews were completed with 524 respondents. In a multivariable linear regression model, after adjusting for the likelihood of receiving a palliative consultation (propensity score), palliative care patients had higher overall scores: 65 (95% confidence interval (CI)=62,66) versus 54 (95% CI=51,56; P<.001) and higher scores for almost all domains. Earlier consultations were independently associated with better overall scores (,=0.003; P=.006), a difference that was attributable primarily to improvements in communication and emotional support. CONCLUSION: Palliative consultations improve outcomes of care, and earlier consultations may confer additional benefit. [source] Guidelines Abstracted from the Department of Veterans Affairs/Department of Defense Clinical Practice Guideline for the Management of Stroke RehabilitationJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 1 2006Miriam Rodin MD OBJECTIVES: To assist facilities in identifying those evidence-based processes of poststroke care that enhance measurable patient outcomes. The guideline(s) should be used by facilities (hospitals, subacute-care units and providers of long-term care) to implement a structured approach to improve rehabilitative practices and by clinicians to determine best interventions to achieve improved patient outcomes. OPTIONS: The guideline considers five elements of poststroke rehabilitation care: interdisciplinary teams; use of standardized assessments; intensity, timing, and duration of therapy; involvement of patients' families and caregivers in decision-making; and educational interventions for patients, families, and caregivers. Evidence, benefits, harms, and recommendations for each of the five designated elements and specific annotated recommendations for poststroke managements are presented separately. OUTCOMES: The overall guideline considers improvement in functional status measures as the primary outcome. Achieving community-dwelling status and preventing complications, death, and rehospitalization are also important outcomes. Costs are not specifically addressed. PARTICIPANTS: The Department of Veterans Affairs/Department of Defense (VA/DoD) Stroke Rehabilitation Working Group consisted of 28, largely VA and military hospital, representatives of medical and allied professions concerned with stroke diagnosis, management, and rehabilitation. Nine additional members with similar credentials served as the editorial committee. Technical consultation was contracted from ACS Federal Health Care, Inc., and the Center for Evidence-Based Practice, State University of New York,Upstate Medical University, Department of Family Medicine conducted evidence appraisal. Consensus was achieved over several years of facilitated group discussion and iterative evaluation of draft documents and supporting evidence. SPONSOR: The guideline was prepared under the auspices of the VA/DoD. No other source of support was identified in the document, or supporting documents. [source] | ||||||||||||||||||||||||||||||||||||||||