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Kielbowicz, Richard B. "The Miller Center of Public Affairs". American Journalism 32, n.º 1 (2 de janeiro de 2015): 99–101. http://dx.doi.org/10.1080/08821127.2015.999634.
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Greenberg, D. "Presidential Recordings Program, http://www.whitehousetapes.org/. Created and maintained by the Miller Center of Public Affairs, University of Virginia, Charlottesville. Re-viewed Sept.-Nov. 2006". Journal of American History 94, n.º 3 (1 de dezembro de 2007): 1049–50. http://dx.doi.org/10.2307/25095311.
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Atkinson, David M., Bridget M. Doane, Paul D. Thuras, Mitch R. Leskela e Paulo R. Shiroma. "Mental Health Diagnoses in Veterans Referred for Outpatient Geriatric Psychiatric Care at a Veterans Affairs Medical Center". Military Medicine 185, n.º 3-4 (17 de outubro de 2019): e347-e351. http://dx.doi.org/10.1093/milmed/usz288.
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Abstract Introduction Nearly half of the U.S. veterans are over 65 years of age. Older veterans are at higher risk for mental health (MH) conditions, which are associated with increased mortality and health care costs. Given the deficit of specialty-trained geriatric providers, we are conducting a Quality Improvement initiative to improve MH services for older veterans at Minneapolis Veterans Affairs Health Care System. Our first step is to understand the demographic and diagnostic characteristics of veterans referred for geriatric MH specialty treatment. Materials and Method We conducted a retrospective chart review of demographics and psychiatric diagnoses in veterans seen for outpatient geriatric MH intake between May 1, 2011 and April 30, 2016. We used chi-square and Spearman’s rho tests to examine age, diagnoses, and service-time era variables. Results 1,059 veterans were evaluated, average age of 73.5 years. Depressive (47%), neurocognitive (42%), and anxiety disorders (22%) were the most common MH conditions. Vietnam veterans showed higher prevalence of depressive (56%), post-traumatic stress (11%), and alcohol use (10%) disorders. World War II veterans showed higher prevalence of neurocognitive disorders (71%). Neurocognitive disorder prevalence was significantly correlated with age. Conclusions Prevalence and comorbidity of major MH conditions is high in veterans referred for geriatric MH services. Future work will examine challenges faced by non-specialty providers in caring for older veterans, with the goal of developing targeted educational and clinical interventions to better address aging veterans’ MH needs.
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Coyle, Bonnie S., Diana L. Wolan e Andrea S. Van Horn. "The Prevalence of Physical and Sexual Abuse in Women Veterans Seeking Care at a Veterans Affairs Medical Center". Military Medicine 161, n.º 10 (1 de outubro de 1996): 588–93. http://dx.doi.org/10.1093/milmed/161.10.588.
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Sands, Philippe. "Functionalism and Interdependence. By John Eastby. Lanham, New York, London: University Press of America; Charlottesville: The White Burkett Miller Center of Public Affairs, University of Virginia, 1985. Pp. xiii, 118. $21, cloth; $8.50, paper." American Journal of International Law 81, n.º 2 (abril de 1987): 472–74. http://dx.doi.org/10.2307/2202434.
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Godiwalla, Roxana Y., M. Teresa Magone, Sandor B. Kaupp, Hoon Jung e John B. Cason. "Long-Term Outcomes of Refractive Surgery Performed During the Military". Military Medicine 184, n.º 11-12 (24 de maio de 2019): e808-e812. http://dx.doi.org/10.1093/milmed/usz096.
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Abstract Introduction To evaluate the long-term refractive results of laser in situ keratomileusis (LASIK) and photorefractive keratectomy (PRK) performed by the military in a veteran population. Materials and Methods Three Department of Veterans Affairs (VA) hospital sites (Puget Sound, Buffalo, and Washington D.C.) obtained IRB approval for this multi-center study. Comprehensive ophthalmologic assessment including refraction and keratometry were obtained at the time of the long-term VA examination and compared to the patients’ postoperative military records. Results Eighty patients (160 eyes) enrolled in this study. At the time of treatment, patients were 21–52 years of age. Long-term post-operative data was available from 4 to 17 years post-operatively. Fifteen percent of the treatment types were LASIK and 85% PRK. At the time of their military post-operative exam (range 3–14 months, mean 4 months), 82% of patients had uncorrected visual acuity (UCVA) of 20/20 or better, and their average manifest refraction was −0.08 D (SD ± 0.48 D). At the time of the long-term ophthalmological exam at the VA medical centers (range 4–11 years, mean of 8.2 years), 49% of patients had an UCVA of 20/20 or better and an average manifest refraction was −0.64 D (SD ± 0.69 D). Conclusion This is the first long-term study evaluating refractive surgery outcomes up to 17 years in a military population. Our study demonstrates safety after refractive surgery in the military with less than 0.1D increase in myopia per year and strong keratometric stability. Other changes in the eye may be the likely cause for this observed mild refractive shift.
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Flanagan, Gerald, Tom Velez, Weidong Gu e Eric Singman. "The Relationship Between Severe Visual Acuity Loss, Traumatic Brain Injuries, and Ocular Injuries in American Service Members From 2001 to 2015". Military Medicine 185, n.º 9-10 (6 de julho de 2020): e1576-e1583. http://dx.doi.org/10.1093/milmed/usaa154.
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ABSTRACT Introduction Although traumatic brain injury (TBI) is known to cause many visual problems, the correlation between the extent of severe visual acuity loss (SVAL) and severity of TBI has not been widely explored. In this retrospective analysis, combined information from Department of Defense (DoD)/Veterans Affairs ocular injury and TBI repositories were used to evaluate the relationship between chronic SVAL, TBI, ocular injuries, and associated ocular sequelae for U.S. service members serving between 2001 and 2015. Materials and Methods The Defense and Veterans Eye Injury and Vision Registry (DVEIVR) is an initiative led by the DoD and Veterans Affairs that consists of clinical and related data for service members serving in theater since 2001. The Defense and Veterans Brain Injury Center (DVBIC) is the DoD’s office for tracking TBI data in the military and maintains data on active-duty service members with a TBI diagnosis since 2000. Longitudinal data from these 2 resources for encounters between February 2001 and October 2015 were analyzed to understand the relation between SVAL, and TBI while adjusting for ocular covariates such as open globe injury (OGI), disorders of the anterior segment and disorders of the posterior segment in a logistic regression model. TBI cases in DVEIVR were identified using DVBIC data and classified according to International Statistical Classification of Diseases criteria established by DVBIC. Head trauma and other open head wounds (OOHW) were also included. SVAL cases in DVEIVR were identified using both International Statistical Classification of Diseases criteria for blindness and low vision as well as visual acuity test data recorded in DVEIVR. Results Data for a total of 25,193 unique patients with 88,996 encounters were recorded in DVEIVR from February, 2001 to November, 2015. Of these, 7,217 TBI and 1,367 low vision cases were identified, with 638 patients experiencing both. In a full logistic model, neither UTBI nor differentiated TBI (DTBI, ie, mild, moderate, severe, penetrating, or unclassified) were significant risk factors for SVAL although ocular injuries (disorders of the anterior segment, disorders of the posterior segment, and OGI) and OOHW were significant. Conclusion Any direct injury to the eye or head risks SVAL but the location and severity will modify that risk. After adjusting for OGIs, OOHW and their sequelae, TBI was found to not be a significant risk factor for SVAL in patients recorded in DVEIVR. Further research is needed to explore whether TBI is associated with more moderate levels of vision acuity loss.
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Elbogen, Eric B., H. Ryan Wagner, Mira Brancu, Nathan A. Kimbrel, Jennifer C. Naylor, Cindy M. Swinkels e John A. Fairbank. "Psychosocial Risk Factors and Other Than Honorable Military Discharge: Providing Healthcare to Previously Ineligible Veterans". Military Medicine 183, n.º 9-10 (14 de março de 2018): e532-e538. http://dx.doi.org/10.1093/milmed/usx128.
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Abstract Introduction In response to a strong focus on suicide prevention for all veterans, the Department of Veterans Affairs (VA) recently revised policy to provide emergency mental healthcare for veterans who received Other Than Honorable (OTH) discharges from the military. This current study takes a preliminary step toward identifying demographic, historic, military, clinical, and social characteristics of veterans with OTH discharges. Materials and Methods N = 1,172 Iraq/Afghanistan-era veterans were evaluated between 2005 and 2016 in the multi-site VA Mid-Atlantic Mental Illness, Research, Education and Clinical Center (MIRECC) Study of Post-Deployment Mental Health (PDMH Study). Results Veterans with OTH discharges constituted 2.7% of our sample, approximating the estimated rate in the overall U.S. veteran population. Compared to veterans discharged under honorable conditions, veterans with OTH discharges were more likely to be younger and have greater odds of reporting family history of drug abuse and depression. Further, veterans with OTH discharges reported a lower level of social support and were more likely to be single, endorse more sleep problems, score higher on measures of drug misuse, have a history of incarceration, and meet diagnostic criteria for major depressive disorder. A subsequent matching analysis provided further evidence of the association between OTH discharge and two risk factors: drug misuse and incarceration. Conclusion These findings elucidate potential factors associated with veterans with OTH discharges, particularly substance abuse and criminal justice involvement. Results also indicate higher incidence of risk factors that often accompany suicidal ideation and should be a highlighted component of healthcare delivery to this vulnerable cohort of veterans.
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Magone, M. Teresa, Laura Kueny, Gemini A. Singh, Katrina Chin Loy, Caroline H. Kim, Will Grover e Soo Y. Shin. "Eleven Years of Cataract Surgery in Veterans Without Pre-existing Ocular Comorbidities". Military Medicine 184, n.º 7-8 (24 de janeiro de 2019): e191-e195. http://dx.doi.org/10.1093/milmed/usy375.
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Abstract Introduction In 2017, over 75,000 cataract surgeries were performed within the Veterans Health Administration System (VHA). Previous reports of outcomes of cataract surgery in veterans include patients with pre-existing ocular disease, which can affect vision. To exclude the confounding factor of pre-existing ocular comorbidities, we investigated the long-term visual outcomes and complications associated with small incision cataract surgery performed on veterans without any pre-existing eye disease. Materials and Methods Institutional Review Board approved cohort study with detailed retrospective chart review of all phacoemulsification (small incision) cataract surgeries performed at the Veterans Affairs Medical Center in Washington D.C. over 11 years, including all pre-and postoperative visits until postoperative month 12. Results A total of 1,513 consecutive surgical cases without any pre-existing ocular disease except the cataract were included. Vision improved significantly after cataract surgery compared to the preoperative best-corrected visual acuity (BCVA) (p = 0.0001) and remained stable over the first intra- and postoperative year. All eyes without complicated surgery and 99.1% of eyes with complications achieved 20/40 or better final vision postoperatively. The most common intra-and postoperative complications were vitreous loss (3.1%) and cystoid macular edema (CME; 1.4%). Patients with complications achieved final mean BCVA of 0.04 (20/22, vitreous loss) and 0.06 (20/23, CME) mean logMAR (Snellen). Conclusion Analysis of 11 years of small incision cataract surgery in eyes without pre-existing ocular disease within the VHA showed significant improvement in vision and stability 12 months after uncomplicated and complicated surgery in veterans.
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Wade, Sean M., Leon J. Nesti, Glen A. Cook, Jonathan S. Bresner, Joseph P. Happel, Alexander J. Villahermosa, Angelica M. Melendez-Munoz et al. "Managing Complex Peripheral Nerve Injuries Within the Military Health System: A Multidisciplinary Approach to Treatment, Education, and Research at Walter Reed National Military Medical Center". Military Medicine 185, n.º 5-6 (30 de novembro de 2019): e825-e830. http://dx.doi.org/10.1093/milmed/usz415.
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Abstract Introduction Peripheral nerve injuries are a leading cause of disability within the Military Health System (MHS) patient population. Many peripheral nerve injuries (PNIs) are amenable to therapeutic intervention but require a timely diagnosis and prompt referral to a specialty center capable of intervention, as functional outcomes are directly related to the duration between injury and intervention. Even when appropriately identified, PNI management in the MHS is often challenged by the lack of an established pathway for care coordination and a limited awareness of available diagnostic and therapeutic resources. To address these potential shortcomings, the Walter Reed National Military Medical Center Peripheral Nerve Program (WRNMMC PNP) in Bethesda, MD, has been established to provide comprehensive, multidisciplinary care to peripheral nerve-injured patients across the MHS. Additionally, the WRNMMC PNP provides graduate medical education training in PNI management for multiple residency and fellowship programs, and it facilitates critical peripheral nerve research to advance knowledge within the field. Materials and Methods A retrospective review of all patients evaluated by the WRNMMC PNP between December 2015 and April 2019 was conducted in order to identify pertinent patient demographic information, referral patterns, and PNI etiology data. Results The WRNMMC PNP evaluated 356 patients consisting of active duty, dependents, retirees, and Veterans Affairs patients during the designated study period. These patients were referred by providers from more than nine different specialties from 78 commands across eight countries. The majority of these patients (222 patients) were referred for traumatic PNI. The WRNMMC PNP has also evaluated and treated patients with PNIs stemming from congenital and compressive etiologies. One hundred and one patients referred during this period were treated with surgery, while the remainder were managed through nonoperative means. Conclusions The WRNMMC PNP facilitates comprehensive, patient-centered care for PNI patients within the MHS. Moreover, the program helps to prepare the next generation of providers for evaluating and treating PNI patients through its involvement with graduate medical education training. It also conducts critical peripheral nerve research and lays the foundation for collaborations with other institutions involved with peripheral nerve research. In the years ahead, the WRNMMC PNP aims to expand its outreach and capabilities within the MHS through more expansive use of telemedicine consultation and the establishment of satellite peripheral nerve clinic sites.
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Flanagan, Gerald, Tom Velez, Weidong Gu e Eric Singman. "Contact Lens Wear, Corneal Complications, and U.S. Service Member Readiness". Military Medicine 185, n.º 11-12 (1 de novembro de 2020): e2071-e2075. http://dx.doi.org/10.1093/milmed/usaa187.
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Abstract Introduction Ulcerative keratitis (UK), or corneal ulcer, is a sight-threatening and readiness-lowering medical condition that begins with a corneal infiltrative event (CIE). Contact lens (CL) wear poses a particular risk for a CIE and therefore is restricted for most active duty service members (SMs). In this study, we explored a large Department of Defense/Veterans Affairs (DoD/VA) database to estimate the prevalence of UK and CIE and their association with CL wear. Materials and Methods The DoD/VA Defense and Veterans Eye Injury Vision Registry, an initiative of the DoD/VA Vision Center of Excellence, was explored using natural language processing software to search for words and diagnostic codes that might identify cornea injuries and CL wear. The effect of UK and CIE on readiness was explored by evaluating the duration between the first and final visits noted in the database. Results A total of 213 UK cases were identified among the 27,402 SMs for whom data were recorded in Defense and Veterans Eye Injury Vision Registry. The odds ratios of UK and CIE being associated with CL wear were 13.34 and 2.20, respectively. A less specific code (superficial corneal injury) was found to be the most commonly used diagnosis in the database, and the odds ratio of CL wearers having that diagnosis was 2.25. CL-wearing patients with corneal disease also required more clinic encounters than those who did not wear CLs. Conclusions This study supports the current restriction on CL wear among nonpilot active duty SMs and quantifies the significantly enhanced risk of developing corneal ulcers posed by that habit.
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Scarton, Dylan V., William T. Roddy, Jerika A. Taylor, Mary Geda, Cynthia A. Brandt, Peter Peduzzi, Robert D. Kerns e Paul F. Pasquina. "Development and Implementation of the Military Treatment Facility Engagement Committee (MTFEC) to Support Pragmatic Clinical Trials in the Military Health System". Military Medicine 186, Supplement_1 (1 de janeiro de 2021): 70–75. http://dx.doi.org/10.1093/milmed/usaa368.
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ABSTRACT Introduction Within the population of military service members and veterans, chronic pain is highly prevalent, often complex, and frequently related to traumatic experiences that are more likely to occur to members of this demographic, such as individuals with traumatic brain injury or limb loss. In September 2017, the National Institutes of Health (NIH), Department of Defense (DOD), and Department of Veterans Affairs (VA) Pain Management Collaboratory (PMC) was formed as a significant and innovative inter-government agency partnership to support a multicomponent research initiative focusing on nonpharmacological approaches for pain management addressing the needs of service members, their dependents, and veterans. Methods A Pain Management Collaboratory Coordinating Center (PMC3) was also established to facilitate collective learning across 11 individually funded pragmatic clinical trials (PCTs) designed to optimize the impact of the PMC as an integrated whole. Although the DOD and VA health care systems are ideal sites for the enactment of PCTs, executing these trials within the local context of DOD military treatment facilities (MTFs) can present unique challenges. The Military Treatment Facility Engagement Committee (MTFEC) was created to support the efforts of the PMC3 in its role as a national resource for development and refinement of innovative tools, best practices, and other resources in the conduct of high impact PCTs. Results The MTFEC is composed of experts from each service who bring experiences in executing clinical pain management trials that can enhance the planning and execution of the PCTs. It provides expertise and leadership in the execution of research studies at within MTFs and within the DOD health care system, with guidance from PMC3 Directors and in collaboration with NIH, DOD, and VA program and scientific officers. Discussion/Conclusion Considering the importance of enacting large-scale, pragmatic studies to implement effective strategies in clinical practice for chronic pain management, the MTFEC has begun to actualize its purpose by identifying potential barriers and challenges to study implementation and exploring how the PMC can support and aid in the execution of PCTs by applying similar approaches to stakeholder and subject matter engagement for their research.
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Evans-Hudnall, Gina, Mary O. Odafe, Adrienne Johnson, Nicholas Armenti, Jennifer O’Neil, Evan Lawson, Lisa H. Trahan e Fenan S. Rassu. "Using an Adjunctive Treatment to Address Psychological Distress in a National Weight Management Program: Results of an Integrated Pilot Study". Military Medicine 185, n.º 9-10 (30 de julho de 2020): e1662-e1670. http://dx.doi.org/10.1093/milmed/usaa145.
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Abstract Introduction Obesity is highly comorbid with psychological symptoms in veterans, particularly post-traumatic stress disorder (PTSD), depression, and anxiety. Obese veterans with comorbid psychological symptoms often display suboptimal weight loss and poor physical functioning when participating in weight management programs. The MOVE! program aims to increase healthy eating and physical activity to promote weight loss in obese veterans. Adequately addressing psychological barriers is necessary to maximize outcomes in MOVE! for veterans with PTSD, depression, and anxiety. We examined the preliminary outcomes of administering the Healthy Emotions and Improving Health BehavioR Outcomes (HERO) intervention. HERO is adjunctive cognitive-behavioral therapy to MOVE! that addresses PTSD, depression, and anxiety symptom barriers to engagement in physical activity. Materials and Methods All recruitment and study procedures were approved by the institutional review board and research and development committees of the Michael E. DeBakey Veterans Affairs Medical Center and Baylor College of Medicine in Houston, Texas. Participants gave written informed consent before enrollment. Thirty-four obese veterans with a diagnosis of PTSD, depression, and/or anxiety who were attending MOVE! were assigned to the 8-session HERO group or the usual care (UC) group. Veterans completed assessments of PTSD, depression and anxiety symptoms, physical activity, physical functioning, and weight at baseline, 8 and 16 weeks post treatment. Changes from baseline to 8- and 16-week follow-up on the self-report and clinician-rated measures were assessed, using independent samples t-tests and analyses of covariance. Results At 8 weeks post treatment, participants in the HERO group had significantly higher step counts per day than participants in the UC group. Similarly, at 16 weeks post-treatment, participants in the HERO group continued to experience a significant increase in daily steps taken per day, as well as statistically and clinically significantly lower scores on the depression symptom and PTSD symptom severity. Participants in the HERO group also demonstrated significantly higher scores on the physical functioning inventory than participants in the UC group (44.1 ± 12.1 vs. 35.7 ± 10.7, P = 0.04) at 16 weeks post treatment. Conclusions Findings of this small trial have important implications pending replication in a more rigorously designed large-scale study. Providing an adjunctive treatment to MOVE! that addresses psychological distress has potential benefits for psychological symptom reduction, engagement in healthy dietary habits, and greater physical activity for individuals who traditionally experience barriers to making positive weight management changes.
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Matsumoto, Rachel A., Bryant R. England, Ginnifer Mastarone, J. Steuart Richards, Elizabeth Chang, Patrick R. Wood e Jennifer L. Barton. "Rheumatology Clinicians’ Perceptions of Telerheumatology Within the Veterans Health Administration: A National Survey Study". Military Medicine 185, n.º 11-12 (1 de novembro de 2020): e2082-e2087. http://dx.doi.org/10.1093/milmed/usaa203.
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Abstract Introduction The Department of Veterans Affairs Veterans Health Administration (VA) Strategic Plan (Fiscal Year 2018–2024) identified four priorities for care including easy access, timely and integrated care, accountability, and modernization, all of which can be directly or indirectly impacted by telemedicine technologies. These strategic goals, coupled with an anticipated rheumatology workforce shortage, has created a need for additional care delivery methods such as clinical video telehealth application to rheumatology (ie, telerheumatology). Rheumatology clinician perceptions of clinical usefulness telerheumatology have received limited attention in the past. The present study aimed to evaluate rheumatologists’ perceptions of and experiences with telemedicine, generally, and telerheumatology, specifically, within the VA. Materials and Methods A 38-item survey based on an existing telehealth providers’ satisfaction survey was developed by two VA rheumatologists with experience in telemedicine as well as a social scientist experienced in survey development and user experience through an iterative process. Questions probed VA rheumatology clinician satisfaction with training and information technology (IT) supports, as well as barriers to using telemedicine. Additionally, clinician perceptions of the impact and usefulness of and appropriate clinical contexts for telerheumatology were evaluated. The survey was disseminated online via VA REDCap to members of the VA Rheumatology Consortium (VARC) through a LISTSERV. The study protocol was approved by the host institution IRB through expedited review. Survey responses were analyzed using descriptive statistics. Results Forty-five anonymous responses (20% response rate) were collected. Of those who responded, 47% were female, 98% were between 35 and 64 years old, 71% reported working at an academic center, and the majority was physician-level practitioners (98%). Respondents generally considered themselves to be tech savvy (58%). Thirty-six percent of the sample reported past experience with telemedicine, and, of those, 29% reported experience with telerheumatology specifically. Clinicians identified the greatest barrier to effective telerheumatology as the inability to perform a physical exam (71%) but agreed that telerheumatology is vital to increasing access to care (59%) and quality of care (40%) in the VA. Overall, regardless of experience with telemedicine, respondents reported that telerheumatology was more helpful for management of rheumatologic conditions rather than initial diagnosis. Conclusions While the majority of rheumatology clinicians did not report past experience with telerheumatology, they agreed that it has potential to further the VA mission of improved access and quality of care. Rheumatology clinicians felt the suitability of telerheumatology is dependent on the phase of care. As remote care technologies continue to be rapidly adopted into clinic, clinician perceptions of and experiences with telemedicine will need to be addressed in order to maintain high-quality and clinician- and patient-centric care within VA rheumatology.
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Williams, M. Wright, David Graham, Nicole A. Sciarrino, Matt Estey, Katherine L. McCurry, Pearl Chiu e Brooks King-Casas. "Does Validity Measure Response Affect CPT Group Outcomes in Veterans with PTSD?" Military Medicine 185, n.º 3-4 (18 de novembro de 2019): e370-e376. http://dx.doi.org/10.1093/milmed/usz385.
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Abstract Introduction There is a dearth of research on the impact of pre-treatment assessment effort and symptom exaggeration on the treatment outcomes of Veterans engaging in trauma-focused therapy, handicapping therapists providing these treatments. Research suggests a multi-method approach for assessing symptom exaggeration in Veterans with posttraumatic stress disorder (PTSD), which includes effort and symptom validity tests, is preferable. Symptom exaggeration has also been considered a “cry for help,” associated with increased PTSD and depressive symptoms. Recently, research has identified resilience as a moderator of PTSD and depressive symptom severity and an important predictor of treatment response among individuals with PTSD. Thus, it is important to examine the intersection of symptom exaggeration, resilience, and treatment outcome to determine whether assessment effort and symptom exaggeration compromise treatment response. Materials and Methods We recruited Veterans, aged 18–50 who served during the Operation Enduring Freedom/Operation Iraqi Freedom/Operation New Dawn (OEF/OIF/OND) era, from mental health clinics and fliers posted in a large Veterans Affairs Medical Center. Veterans met inclusion criteria if they were diagnosed with PTSD via a clinician-administered assessment. Sixty-one Veterans consented to participate and self-selected into a cognitive processing therapy (CPT) group or treatment-as-usual. We offered self-selection because low recruitment rates delayed treatment start dates and were consistent with a Veteran-centered care philosophy. Veterans were assessed before and after treatment to determine the impact of assessment effort and symptom exaggeration scores on measures of PTSD and depressive symptoms and resilience. This study examined whether assessment effort failure and symptom exaggeration were associated with compromised psychotherapy outcomes in Veterans with PTSD undergoing CPT group. We hypothesized that a pattern of responding consistent with both effort and symptom exaggeration would result in higher (ie, more severe) pre- and post-treatment scores on PTSD and depressive symptom outcome measures and lower resiliency when compared to Veterans providing good effort and genuine responding. Hypotheses were evaluated using bivariate correlation analyses, analysis of variance, and chi-square analyses. Results Pre-treatment scores on measures of PTSD and depressive symptoms were higher among Veterans whose pattern of responding was consistent with poor assessment effort and symptom exaggeration; these Veterans also scored lower on a measure of resiliency. At post-treatment, there were no differences between Veterans displaying good and failed effort testing on measures of PTSD and depressive symptoms or in whether they completed treatment. Post-treatment resiliency scores remained significantly lower in those with failed effort testing. Conclusion These results suggest that Veterans with PTSD whose validity testing scores are indicative of poor effort and symptom exaggeration may be less resilient but may still complete a CPT group treatment and benefit from treatment at a rate comparable to Veterans who evidence good assessment effort and genuine symptom reporting pre-treatment. These findings also challenge the assumption that pre-treatment assessment effort failure and symptom exaggeration accurately predict poor effort in trauma-focused psychotherapy.
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Weiker, Walter F. "The Superpowers and the Third World: Turkish-American Relations and Cyprus, by Suha Bolukbasi. 259 pages, bibliography. Miller Center for Public Affairs, University of Virginia; University Press of America, Lanham, Md.1988. $27.50 pb (student text edition $14.75). - Greek-Turkish Relations Since 1955, by Tozun Bahcheli. 194 pages, maps, appendices, bibliography, index. Westview Press, Boulder1990. $28.50 pb." Middle East Studies Association Bulletin 25, n.º 1 (julho de 1991): 74–75. http://dx.doi.org/10.1017/s0026318400023877.
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Tribble, David R., Clinton K. Murray, Bradley A. Lloyd, Anuradha Ganesan, Katrin Mende, Dana M. Blyth, Joseph L. Petfield e Jay McDonald. "After the Battlefield: Infectious Complications among Wounded Warriors in the Trauma Infectious Disease Outcomes Study". Military Medicine 184, Supplement_2 (1 de novembro de 2019): 18–25. http://dx.doi.org/10.1093/milmed/usz027.
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Abstract Introduction During recent wars in Iraq and Afghanistan, improved survivability in severe trauma corresponded with a rise in the proportion of trauma-related infections, including those associated with multidrug-resistant organisms (MDROs). Significant morbidity was reported in association with the infections. There is also concern regarding potential long-term impacts of the trauma-related infectious complications. Therefore, to meet the critical need of prospective collection of standardized infection-related data to understand the disease burden and improve outcomes of wounded personnel, the Trauma Infectious Disease Outcomes Study (TIDOS) was developed. Herein, we review accomplishments and key peer-reviewed findings of TIDOS. Methods The TIDOS project is a multicenter observational study of short- and long-term infectious complications following deployment-related trauma. Wounded military personnel medevac’d to Landstuhl Regional Medical Center (LRMC; Germany) before transfer to a participating US military hospital between June 2009 and December 2014 were eligible for inclusion. An infectious disease module to supplement the Department of Defense Trauma Registry by collecting infection-related data from all trauma patients admitted to participating hospitals was developed. Specimens from trauma patients were also collected and retained in a microbiological isolate repository. During the initial hospitalization, patients were given the opportunity to enroll in a prospective follow-up cohort study. Patients who received Department of Veterans Affairs (VA) care were also given the opportunity to consent to ongoing VA follow-up Results A total of 2,699 patients transferred to participating military hospitals in the USA, of which 1,359 (50%) patients enrolled in the TIDOS follow-up cohort. In addition, 638 enrolled in the TIDOS-VA cohort (52% of TIDOS enrollees who entered VA healthcare). More than 8,000 isolates were collected from infection control surveillance and diagnostic evaluations and retained in the TIDOS Microbiological Repository. Approximately 34% of the 2,699 patients at US hospitals developed a trauma-related infection during their initial hospitalization with skin and soft-tissue infections being predominant. After discharge from the US hospitals, approximately one-third of TIDOS cohort enrollees developed a new trauma-related infection during follow-up and extremity wound infections (skin and soft-tissue infections and osteomyelitis) continued to be the majority. Among TIDOS cohort enrollees who received VA healthcare, 38% developed a new trauma-related infection with the incident infection being diagnosed a median of 88 days (interquartile range: 19–351 days) following hospital discharge. Data from TIDOS have been used to support the development of Joint Trauma System clinical practice guidelines for the prevention of combat-related infections, as well as the management of invasive fungal wound infections. Lastly, due to the increasing proportion of infections associated with MDROs, TIDOS investigators have collaborated with investigators across military laboratories as part of the Multidrug-Resistant and Virulent Organisms Trauma Infections Initiative with the objective of improving the understanding of the complex wound microbiology in order to develop novel infectious disease countermeasures. Conclusions The TIDOS project has focused research on four initiatives: (1) blast-related wound infection epidemiology and clinical management; (2) DoD-VA outcomes research; (3) Multidrug- Resistant and other Virulent Organisms Trauma Infections Initiative; and (4) Joint Trauma System clinical practice guidelines and antibiotic stewardship. There is a continuing need for longitudinal data platforms to support battlefield wound research and clinical practice guideline recommendation refinement, particularly to improve care for future conflicts. As such, maintaining a research platform, such as TIDOS, would negate the lengthy time needed to initiate data collection and analysis.
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Prasada, Sahil, Cecil Rambarat, David Winchester e Ki Park. "Implementation and Impact of Home-Based Cardiac Rehabilitation in a Veterans Affair Medical Center". Military Medicine 185, n.º 5-6 (28 de outubro de 2019): e859-e863. http://dx.doi.org/10.1093/milmed/usz366.
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Abstract Introduction In patients with prior myocardial infarction (MI), cardiac rehabilitation (CR) has been shown to reduce all-cause mortality, cardiac mortality, and risk of recurrent MI. Medically supervised cardiac rehab has challenges such as increased patient and center cost, patient transportation issues, patient time commitment, and increased need for resources. Home-based cardiac rehabilitation (HBCR) is an innovative alternative to medically supervised CR which can help to address some of the aforementioned issues. HBCR has been shown to have similar patient outcomes when compared to medically supervised CR; however, implantation efforts and experiences within Veteran Affair (VA) facilities were limited. Thus, we sought to describe our implementation efforts and outcomes of HBCR at our VA medical center, since our VA medical center does not offer an on-site medically supervised CR program. Materials and Methods The project was not reviewed by our institutional review board as this quality improvement project was determined by our VA medical service chief to not qualify as human subjects research. Veterans eligible for CR in our VA medical system were enrolled in a 12-week HBCR program. Veterans performed exercise training at home with equipment provided at no cost. In addition, participating veterans received nutrition counseling, smoking cessation encouragement, stress management, and psychosocial consultation through weekly telephone calls performed by registered nurses. Progress was measured using Life’s Simple 7, Duke Activity status index, 6-minute walk test, and Short Form Health Survey (SF-36) before and after HBCR. Medical records were monitored for death, MI, and readmission to the hospital for CHF within the VA medical system for 1 year after the program was complete. SAS and R were used for data input and analysis. Results Data from 213 veterans were available for analysis and 136 of these veterans completed the HBCR program; the 95 veterans who did not complete the program either declined enrollment, discontinued follow-up with this program, or failed to actively participate and thus were removed from the program. Veterans who completed the 12-week HBCR program reported significant improvement, when compared before and after HBCR program, in Simple 7, Duke Activity status index metabolic equivalent of tasks, 6-minute walk test, SF-36 physical functioning, SF-36 bodily pain, and SF-36 vitality. Overall survival and recurrent MIs were similar between the veterans who completed and the veterans who did not complete the HBCR program in the 1 year follow-up. Hospital admission for heart failure in the 1-year follow-up was lower among veterans who completed the HBCR program when compared to the veterans who did not complete the HBCR program. Conclusions HBCR is an effective alternative to facility-based CR. Veterans who completed the program showed improvement in physical capacity and functional status. Compared to those who were eligible but did not complete the program, hospitalization for heart failure was reduced after completing HBCR.
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Петров, С. Є. "THE PLACE OF THE MAIN SERVICE CENTER OF THE MINISTRY OF INTERNAL AFFAIRS IN THE SYSTEM OF SERVICES OF THE MINISTRY OF INTERNAL AFFAIRS OF UKRAINE". Juridical science, n.º 1(103) (19 de fevereiro de 2020): 218–29. http://dx.doi.org/10.32844/2222-5374-2020-103-1.26.
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The relevance of the article is that the need to determine the place of the Main Service Center in the service system of the Ministry of Internal Affairs is due to a number of factors. Among them is the introduction of the concept of transition of public administration, mostly on the basis of the provision of administrative services, based on dialogue between the public authority the subject of the request for administrative services. The purpose of the article is to determine the place of the Main Service Center of the Ministry of Internal Affairs in the system of administrative law entities and the service system of the Ministry of Internal Affairs, which will improve public administration legislation on road safety and vehicle operation. The article examines the question of the place of the Main Service Center of the Ministry of Internal Affairs in the service system of the Ministry of Internal Affairs. The necessity to move away from the seizure of «administrative services» and perform the administrative functions of public administration is substantiated. It is determined that the provision of services of the Ministry of Internal Affairs is based on permitting and registration powers, which determine the permitting and registration activities for facilities whose operation is characterized by increased danger, which determines the task of the Main Service Center of the Ministry of Internal Affairs to control hazards. through risk management. The service should not be limited to the provision of a document on the request of the subject of the request. This should be understood as risk management activities through the implementation of procedures in the process of providing services to the Ministry of Internal Affairs. This determines the broad law enforcement nature of the services of the Ministry of Internal Affairs, which, in turn, determine the administrative and legal status of the Main Service Center of the Ministry of Internal Affairs to ensure its tasks in the process of providing services. In addition, it is necessary to clearly understand that the service can be provided only if it meets the criteria that determine the admissibility of its provision in compliance with the conditions of security and protection of human rights, freedoms and interests, society as a whole.
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Qi, Zhi Juan, e Gui Ping Sun. "A Study on Public Satisfaction of County Electronic Government Affairs: Taking Linzhang County in Hebei Province for Example". Applied Mechanics and Materials 602-605 (agosto de 2014): 3438–42. http://dx.doi.org/10.4028/www.scientific.net/amm.602-605.3438.
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With the thorough development of electronic government affairs , the key point of the study has been the electronic government affairs in the county regions. This paper will start with the characteristics of electronic government affairs in the county regions , grasp the core of electronic government affairs which is taking the public as the center, and put forward an evaluating model of public satisfaction in county electronic government affairs. Then with the basis of this indicator , a questionnaire survey will be conducted. And finally with the practical data , the AHP method will be adopted to carry out an empirical study on public satisfaction of electronic government affairs.
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Biggs, Jeff. "The Center: A Look at the Centennial Center for Political Science & Public Affairs". PS: Political Science & Politics 45, n.º 01 (janeiro de 2012): 158–59. http://dx.doi.org/10.1017/s1049096511001971.
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You could call it serendipity or a mutually felicitous target of opportunity, but the APSA Congressional Fellowship Program and the Centennial Center for Political Science & Public Affairs—now under my and Veronica Jones' direction—found productive common ground in November 2011 that will continue into the programs' future. In addition to physical proximity—the two programs share the same floor at APSA—the similar content areas and background shared by Centennial Scholars and Congressional Fellows Program has overlapped since the center's founding seven years ago. Centennial Center scholars have been routinely invited to participate in any segment of the fellowship's six-week orientation program that was of interest to them. And, over the years, several of the scholars later became congressional fellows.
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Harada, Nancy D., Valentine M. Villa, JoAnn Damron-Rodriguez, Donna Washington, Takashi Makinodan, Shawkat Dhanani, Herbert Shon, Honghu Liu e Ronald Andersen. "The Influence of Military Service on Outpatient Care Use among Racial/Ethnic Groups in Department of Veterans Affairs Medical Centers". Military Medicine 167, n.º 7 (1 de julho de 2002): 525–31. http://dx.doi.org/10.1093/milmed/167.7.525.
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Alexander, Brian. "The Center Page: A Look at the Centennial Center for Political Science & Public Affairs". PS: Political Science & Politics 49, n.º 01 (janeiro de 2016): 162–63. http://dx.doi.org/10.1017/s1049096515001456.
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Biggs, Jeff. "APSA Centennial Center: A Look Back and Ahead". PS: Political Science & Politics 46, n.º 04 (30 de setembro de 2013): 879–84. http://dx.doi.org/10.1017/s1049096513001340.
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On the 10th anniversary of the APSA Centennial Center for Political Science and Public Affairs, it seems appropriate to go back to the genesis—to the decisions made by the 1998 APSA Council—to remind ourselves of their expectations.
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Palmer, David. "The Arthur Miller Writing Studio Project: Roxbury, Connecticut". Arthur Miller Journal 19, n.º 1 (2024): 29–38. http://dx.doi.org/10.5325/arthmillj.19.1.0029.
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abstract This article provides coverage of an event in Roxbury, Connecticut, on 14 October 2023, the first public event in a project to move Arthur Miller’s writing studio from its original site on his property at 323 Tophet Road to a site near the Minor Memorial Library in Roxbury, where it will be the focal point of a newly established Arthur Miller study center.
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Byrne, Thomas, Lara Troszak, Amanda M. Midboe, B. Graeme Fincke, Michael Shwartz, Allen L. Gifford e D. Keith McInnes. "A Novel Measure to Assess Variation in Hepatitis C Prevalence Among Homeless and Unstably Housed Veterans, 2011-2016". Public Health Reports 134, n.º 2 (30 de janeiro de 2019): 126–31. http://dx.doi.org/10.1177/0033354918821071.
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We constructed a novel measure of homelessness to examine differences in hepatitis C virus (HCV) prevalence across 3 categories of unstably housed and homeless veterans and across US Department of Veterans Affairs Medical Center facilities. We used Veterans Affairs administrative data to classify a cohort of 434 240 veterans as at risk of homelessness, currently homeless, or formerly homeless, and we examined variation in HCV prevalence by using descriptive measures and mixed-effect logistic regression models. HCV prevalence was highest among veterans who were formerly homeless (16.7%; 32 490 of 195 000), followed by currently homeless (12.4%; 22 050 of 178 056) and at risk of homelessness (8.2%; 5015 of 61 184). Veterans Affairs Medical Center–level prevalence ranged from 5.4% to 21.5%. Differences in HCV prevalence were significant by sex, race/ethnicity, and age. Targeting specific populations of homeless veterans for tailored HCV interventions and allocating additional resources to certain Veterans Affairs Medical Centers may be warranted.
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Dittman, James M., Wayne Tse e Michael F. Amendola. "Optimizing Peripandemic Care for Veteran Major Non-Traumatic Lower Extremity Amputees: A Proposal Informed by a National Retrospective Descriptive Analysis of COVID-19 Risk Factor Prevalence". Military Medicine 185, n.º 11-12 (1 de novembro de 2020): e2124-e2130. http://dx.doi.org/10.1093/milmed/usaa180.
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Abstract Introduction In response to the Coronavirus 2019 (COVID-19) pandemic, vascular surgeons in the Veteran Affairs Health Care System have been undertaking only essential cases, such as advanced critical limb ischemia. Surgical risk assessment in these patients is often complex, considers all factors known to impact short- and long-term outcomes, and the additional risk that COVID-19 infection could convey in this patient population is unknown. The European Centre for Disease Prevention and Control (ECDC) published risk factors (ECDC-RF) implicated in increased COVID-19 hospitalization and case-fatality which have been further evidenced by initial reports from the United States Centers for Disease Control and Prevention. CDC reports additionally indicate that African American (AA) patients have incurred disparate infection outcomes in the United States. We set forth to survey the Veterans Affairs Surgical Quality Improvement Program (VASQIP) database over a nearly 20 year span to inform ongoing risk assessment with an estimation of the prevalence of ECDC-RF in our veteran critical limb ischemia population and investigate whether an increased COVID-19 comorbidity burden exists for AA veterans presenting for major non-traumatic amputation. Materials and Methods The VASQIP database was queried for all above knee amputation (AKA) and below knee amputation (BKA) completed 1999–2018 after IRB approval (MIRB:#02507). Patient race and ECDC-RF including male gender, age > 60 years, smoking status, hypertension, diabetes, chronic obstructive pulmonary disease, cancer, and cardiovascular disease were recorded from preoperative patient history. AKA and BKA cohorts were compared via χ2-test with Yates correction or unpaired t-test and a subgroup analysis was conducted between AA and all other race patients for COVID-19 comorbidities in each cohort. Results VASQIP query returned 50,083 total entries. Average age was 65.1 ± 10.4 years and 68.2 ± 10.5 years for BKA and AKA cohorts, respectively, (P < .0001) and nearly all patients were male (99%). At least one ECDC-RF comorbidity was present in 25,526 (88.7%) of BKA and 17,558 (82.4%) of AKA patients (P < .0001). AA BKA patients were significantly more likely than non-AA BKA patients to present with at least one ECDC-RF comorbidity (P = .01). Conclusions According to a large national Veterans Affairs database, there are high rates of ECDC-RF in veteran amputees. During the present crisis, management of these patients should incorporate telehealth, expedient discharge, and ongoing COVID-19 transmission precautions.
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Media and Public Affairs, Center for. "Changing Images of Government in TV Entertainment Executive Summary and Analysis". Public Voices 6, n.º 2-3 (11 de janeiro de 2017): 70. http://dx.doi.org/10.22140/pv.255.
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The Council for Excellence in Government and its Partnership for Trust in Government, with support from the Ford Foundation, commissioned the Center for Media and Public Affairs to study how television entertainment had depicted the public sector and people in government.
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Zhang, J. H., J. Yang e Y. S. Sun. "The Research of Spatial-Temporal Analysis and Decision-Making Assistant System for Disabled Person Affairs Based on Mapworld". ISPRS - International Archives of the Photogrammetry, Remote Sensing and Spatial Information Sciences XL-7/W4 (26 de junho de 2015): 215–20. http://dx.doi.org/10.5194/isprsarchives-xl-7-w4-215-2015.
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This system combines the Mapworld platform and informationization of disabled person affairs, uses the basic information of disabled person as center frame. Based on the disabled person population database, the affairs management system and the statistical account system, the data were effectively integrated and the united information resource database was built. Though the data analysis and mining, the system provides powerful data support to the decision making, the affairs managing and the public serving. It finally realizes the rationalization, normalization and scientization of disabled person affairs management. It also makes significant contributions to the great-leap-forward development of the informationization of China Disabled Person's Federation.
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Jernberg, James E. "George Albro Warp". PS: Political Science & Politics 42, n.º 04 (25 de setembro de 2009): 789–90. http://dx.doi.org/10.1017/s1049096509990382.
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A life of service to others ended on March 26, 2009, when professor emeritus George A. Warp of the Humphrey Institute of Public Affairs of the University of Minnesota passed away at age 95. George was born on June 12, 1913, in Northfield, Ohio, and graduated from Bedford High School in Ohio. Prior to being associated with the University of Minnesota for the past 60 years, he graduated from Oberlin College, Case Western University, and Columbia University, earning degrees in political science, public administration, international administration, as well as law. George served briefly as a political science faculty member at the University of Minnesota, where he met and married his late wife, Lois, in 1940 before entering the U.S. Navy following the entry of the United States into World War II. His service in the Pacific theater led to his postwar appointment as a civilian advisor under General MacArthur in Japan from 1946–1948. Upon completion of that assignment, George returned to the University of Minnesota in 1948 as a professor of political science and served first as associate director and then director of the graduate program in public administration in the department's Public Administration Center until 1965 when the center became a self-standing unit of the College of Liberal Arts. He remained director through 1968 when the center was succeeded by the School of Public Affairs and recreated as the Humphrey Institute of Public Affairs in 1978 as a collegiate unit named as a memorial honoring the late vice president and Minnesota's senator. George served as a professor and chair of graduate admissions until his retirement in 1982.
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Rosenheck, Robert, e Alan Fontana. "Changing Patterns of Care for War-Related Post-Traumatic Stress Disorder at Department of Veterans Affairs Medical Centers: The Use of Performance Data to Guide Program Development". Military Medicine 164, n.º 11 (1 de novembro de 1999): 795–802. http://dx.doi.org/10.1093/milmed/164.11.795.
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Hunsinger, George. "The Politics of the Nonviolent God: Reflections on René Girard and Karl Barth". Scottish Journal of Theology 51, n.º 1 (fevereiro de 1998): 61–85. http://dx.doi.org/10.1017/s0036930600050018.
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Doctrines of the atonement in Christian theology, as Marlin E. Miller has pointed out, ‘usually limit their concern to reconciliation with God and, at most, consider reconciliation with others a secondary consequence of reconciliation with God’. Too often, in other words, the vertical aspect of reconciliation is allowed to overshadow its horizontal aspect. The vertical aspect of the atonement as it pertains directly to God is often treated in isolation as if its ethical implications were of no great importance. The reverse defect, however, would also appear to be widespread. Christian ethics as we know it today often seems to proceed as if the atoning work of Christ were of little or no relevance to its deliberations on human affairs. The social or horizontal aspect of reconciliation thereby eclipses its vertical aspect. Yet if the cross of Christ is indeed the very center of the center of the Christian gospel, as the church has historically believed, then how can it fail to determine the substance of Christian ethics as well as that of Christian theology? Moreover, how can the centrality of the cross fail to orient them both in any attempt to specify their inner unity, order and differentiation?
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Mudrenko, Natalia. "COORDINATION IN FOREIGN AFFAIRS OF UKRAINE: REGULATORY LEGAL MECHANISM". International Journal of Legal Studies ( IJOLS ) 6, n.º 2 (31 de dezembro de 2019): 99–111. http://dx.doi.org/10.5604/01.3001.0013.7411.
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Swift global transformations in international relations; the emergence of new communications that provide instant dissemination and transfer of information; increase number of international actors - all above mentioned put on the agenda further search for more effective forms and mechanisms for coordinating activities of public authorities in foreign relations for both Ukraine as well as any other country. Research of the regulatory legal mechanism of coordination of the activities of public authorities of Ukraine in foreign relations shows that Ukraine belongs to a group of countries with a "rigid" form of coordination, that is characterized by stringently regulated sphere of foreign relations, broad powers conferred on the center of coordination as well as the mandatory accountability of all authorities to this center. It was also found that the vast majority of regulations are a post factum reaction to certain violations made by the authorities whose international activity was not agreed with the Ministry of Foreign Affairs and caused negative consequences for Ukraine's image on the international arena. The above indicates that the current level of coordination of activity of state authorities of Ukraine in the sphere of foreign relations is characterized (by a scale developed by Professor of the University of Lausanne Dietmar Brown) as "negative" administrative coordination.
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Suherman, Suherman, Jono M. Munandar e Sukiswo Dirdjosuparto. "Pengaruh Kepemimpinan dan Motivasi Kerja terhadap Komitmen Organisasional Pegawai Pusat Pendidikan Kelautan dan Perikanan". Jurnal Manajemen dan Organisasi 8, n.º 2 (7 de fevereiro de 2018): 144–56. http://dx.doi.org/10.29244/jmo.v8i2.19994.
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Improving public sevice can be achieved by having employees who have high organizational commitment. The purpose of this research is to determine the effect of leadership style and work motivation to organizational commitment on employee of maritime affairs and fisheries education center. The effects were directed to diffrerentiate between transactional & transformational leadership. The sample in this reseach consist of 35 employee of maritime affairs an fisheries education center. The sampling used purposive sampling, data collection methods with questionaires. The data was processed by using Smart PLS with relation of reflective indicator at 95% confidence level. The result shows that the leadership is not significant enough to effect the organizational commitment. Leadership has significantly effect on work motivation, while work motivation has significantly effect on organizational commitment.
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Schmitz, Susan, Tamar Wyte-Lake e Aram Dobalian. "Facilitators and Barriers to Preparedness Partnerships: A Veterans Affairs Medical Center Perspective". Disaster Medicine and Public Health Preparedness 12, n.º 4 (13 de setembro de 2017): 431–36. http://dx.doi.org/10.1017/dmp.2017.92.
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AbstractObjectiveThis study sought to understand facilitators and barriers faced by local US Department of Veterans Affairs Medical Center (VAMC) emergency managers (EMs) when collaborating with non-VA entities.MethodsTwelve EMs participated in semi-structured interviews lasting 60 to 90 minutes discussing their collaboration with non-VAMC organizations. Sections of the interview transcripts concerning facilitators and barriers to collaboration were coded and analyzed. Common themes were organized into 2 categories: (1) internal (ie, factors affecting collaboration from within VAMCs or by VA policy) and (2) external (ie, interagency or interpersonal factors).ResultsRespondents reported a range of facilitators and barriers to collaboration with community-based agencies. Internal factors facilitating collaboration included items such as leadership support. An internal barrier example included lack of clarity surrounding the VAMC’s role in community disaster response. External factors noted as facilitators included a shared goal across organizations while a noted barrier was a perception that potential partners viewed a VAMC partnership with skepticism.ConclusionFederal institutions are important partners for the success of community disaster preparedness and response. Understanding the barriers that VAMCs confront, as well as potential facilitators to collaboration, should enhance the development of VAMC–community partnerships and improve community health resilience. (Disaster Med Public Health Preparedness. 2018;12:431–436)
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Koorey, Stefani. "“Because It Is My Name!”: Arthur Miller’s Moral Imperative—The Crucible and Miller’s HUAC Testimony". Arthur Miller Journal 17, n.º 1 (2022): 30–38. http://dx.doi.org/10.5325/arthmillj.17.1.0030.
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abstract The chief allegorical correlation between the text of The Crucible and Miller’s testimony before HUAC three years later in 1956 seems to center around the refusal of both the fabricated John Proctor and the real Arthur Miller to name names. This parallel has been cited by critics and scholars alike as one of the most ironic moments in the history of HUAC’s twenty-two-year existence. Each man, in his own era, publicly questioned the authority of the governmental agency entrusted with determining the guilt or innocence of members of the community. Each also defined themselves as martyrs in terms of their opposition to that authority. For Miller and Proctor, the moral dilemma involved a refusal to falsely confess and betray a sense of oneself to escape punishment. Forced to expose their private selves in a public arena, both felt the need to criticize the public challenge to their private consciousness.
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Chung, Ji Tae, Faruk Faruk e Oki Rahadianto Sutopo. "Public Diplomacy Activities of Korean Cultural Center in Contemporary Theory Perspective". kata 25, n.º 00 (20 de março de 2023): 42–48. http://dx.doi.org/10.9744/kata.25.00.42-48.
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This paper focuses on activities of Korean Cultural Center Indonesia (KCCI) through the analysis of Korean government policies regarding public diplomacy by Ministry of Foreign Affairs (MOFA). KCC is affiliated organization under the Korean Culture and Information Service (KOCIS) under Ministry of Culture, Sports and Tourism (MCST). KCC is established in foreign countries to spread Korean culture and enhance national image through political communication with public. Since the beginning, KCCI has shown contradictory tendencies. On one hand, their mission is to show Korea's strength, but on the other hand, they organize cultural exchange programs that imply equality between the Korean side and its partners. By using a public diplomacy 3.0 theory which is based on cosmopolitanism to evaluate KCCI’s practices, this paper finds that practice of public diplomacy by KCCI is still consisted within public diplomacy 2.0 which is focus on enhancement of national image and creation of a favorable diplomatic environment due to holding hegemony in global soft power competition.
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Brooks∗, K., S. Dauenhauer, R. Washburn e C. Mitchell. "Outbreak of Clostridium difficile Colitis at a Veterans Affairs Medical Center". American Journal of Infection Control 32, n.º 3 (maio de 2004): E64—E65. http://dx.doi.org/10.1016/j.ajic.2004.04.097.
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Olivieri, Daniel J., Mary G. Lynch, Glenn C. Cockerham e Paul B. Greenberg. "A Survey of Glaucoma Surgery Practice Patterns in the Veterans Health Administration". Military Medicine 185, n.º 7-8 (15 de maio de 2020): e972-e976. http://dx.doi.org/10.1093/milmed/usaa033.
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Abstract Introduction Glaucoma surgical practice patterns are not well described in the United States (US). This study aims to evaluate the indications for and potential barriers to glaucoma surgery in the Veterans Health Administration (VHA). Materials and Methods An anonymous 10-question survey using REDCap (Nashville, TN) software was sent by mail (with web link) and email to ophthalmology chiefs at the 86 academically affiliated Veterans Affairs Medical Centers (VAMCs). Academic-affiliated VAMCs were selected because of their patient range and role in ophthalmic education. Non-responders received two reminder e-mails and two phone calls; the survey was closed after 6 weeks. The data were analyzed using descriptive statistics. Results The response rate was 45% (39/86). Most respondents (92%) worked in an integrated eye clinic with both ophthalmology and optometry services. Almost half of the respondents (49%; 19/39) believed that laser trabeculoplasty (LTP) was an option for initial glaucoma therapy. Noncompliance was a commonly reported indication for LTP (95%), tube shunt procedures (65%), micro-invasive glaucoma surgery (59%), and trabeculectomy (48.7%). One third of the respondents believed that there were delays in glaucoma care. The respondents noted that significant barriers in access to surgery included lack of transportation (69%), scheduling challenges (62%), and delayed referral (62%). Conclusion This survey of glaucoma surgery practice patterns highlights the growing role of LTP and suggests that non-compliance and access remain significant barriers to glaucoma surgical care within the VHA.
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Weiss, MA, e M. McCollum. "MHA2 Cost Impact of Using Olanzapine at A Veterans Affairs Medical Center". Value in Health 1, n.º 1 (maio de 1998): 25. http://dx.doi.org/10.1046/j.1524-4733.1998.1100252.x.
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Balbale, Salva N., Lishan Cao, Itishree Trivedi, Jonah J. Stulberg, Katie J. Suda, Walid F. Gellad, Charlesnika T. Evans, Bruce L. Lambert, Laurie A. Keefer e Neil Jordan. "Characteristics of Opioid Prescriptions to Veterans With Chronic Gastrointestinal Symptoms and Disorders Dually Enrolled in the Department of Veterans Affairs and Medicare Part D". Military Medicine 186, n.º 9-10 (28 de agosto de 2021): 943–50. http://dx.doi.org/10.1093/milmed/usab095.
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ABSTRACT Introduction Gastrointestinal (GI) symptoms and disorders affect an increasingly large group of veterans. Opioid use may be rising in this population, but this is concerning from a patient safety perspective, given the risk of dependence and lack of evidence supporting opioid use to manage chronic pain. We examined the characteristics of opioid prescriptions and factors associated with chronic opioid use among chronic GI patients dually enrolled in the DVA and Medicare Part D. Materials and Methods In this retrospective cohort study, we used linked, national patient-level data (from April 1, 2011, to December 31, 2014) from the VA and Centers for Medicare & Medicaid Services to identify chronic GI patients and observe opioid use. Veterans who had a chronic GI symptom or disorder were dually enrolled in VA and Part D and received ≥1 opioid prescription dispensed through the VA, Part D, or both. Chronic GI symptoms and disorders included chronic abdominal pain, chronic pancreatitis, inflammatory bowel diseases, and functional GI disorders. Key outcome measures were outpatient opioid prescription dispensing overall and chronic opioid use, defined as ≥90 consecutive days of opioid receipt over 12 months. We described patient characteristics and opioid use measures using descriptive statistics. Using multiple logistic regression modeling, we generated adjusted odds ratios and 95% CIs to determine variables independently associated with chronic opioid use. The final model included variables outlined in the literature and our conceptual framework. Results We identified 141,805 veterans who had a chronic GI symptom or disorder, were dually enrolled in VA and Part D, and received ≥1 opioid prescription dispensed from the VA, Part D, or both. Twenty-six percent received opioids from the VA only, 69% received opioids from Medicare Part D only, and 5% were “dual users,” receiving opioids through both VA and Part D. Compared to veterans who received opioids from the VA or Part D only, dual users had a greater likelihood of potentially unsafe opioid use outcomes, including greater number of days on opioids, higher daily doses, and higher odds of chronic use. Conclusions Chronic GI patients in the VA may be frequent users of opioids and may have a unique set of risk factors for unsafe opioid use. Careful monitoring of opioid use among chronic GI patients may help to begin risk stratifying this group. and develop tailored approaches to minimize chronic use. The findings underscore potential nuances within the opioid epidemic and suggest that components of the VA’s Opioid Safety Initiative may need to be adapted around veterans at a higher risk of opioid-related adverse events.
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Mekarisce, Arnild Augina, e Rumita Ena Sari. "Analisis Rencana Strategis Puskesmas sebagai Upaya Persiapan Penyusunan Rencana Strategis Badan Layanan Umum Daerah Puskesmas Pakuan Baru". Syntax Literate ; Jurnal Ilmiah Indonesia 8, n.º 3 (29 de março de 2023): 2269–75. http://dx.doi.org/10.36418/syntax-literate.v8i3.11495.
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Pakuan Baru Public Health Center has been a regional public service agency since 2017 so that it has the mandate of the Minister of Home Affairs Regulation to make a strategic plan based on regional public service agencies, but it has not been implied in the strategic plan in 2019-2023, besides that most health workers did not understand in depth how to make a strategic plan. The objectives of this study include analyzing the strategic plan of the Pakuan Baru community health center for 2019-2023 as an effort to prepare the strategic plan for the regional public service agency of the Pakuan Baru public health center for 2024-2028. This research method descriptive research with a qualitative approach. The subject of this research is the Pakuan Baru public health center. Data collection was taken from secondary data by reviewing documentation in August-November 2021. Data validity checking techniques by increasing diligence, using reference materials and triangulation techniques. The results of data analysis show that the strategic plan of the Pakuan Baru public health center is partly in accordance with the standards, but has not included a complete overview and organization, has not included revenue realization and expenditure realization, vision, mission, and policy direction, and the inclusion of repeated performance. It is expected that the public health center can carry out guidance and technical activities on public health center officers in the preparation of the strategic plan of the public health center of the regional public service agency.
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Barratt, Caroline Cason, e Elizabeth White. "Case Study for a Large Research Institution Library: The University of Georgia's Miller Learning Center". Journal of Library Administration 50, n.º 2 (20 de janeiro de 2010): 135–44. http://dx.doi.org/10.1080/01930820903454977.
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Amin, Muhammad As’ad, Rasyid Thaha e Andi Lukman Irwan. "Quality of Government Innovation Public Safety Center (PSC) 199 in Soppeng Regency". Journal La Bisecoman 4, n.º 4 (30 de novembro de 2023): 148–55. http://dx.doi.org/10.37899/journallabisecoman.v4i4.998.
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Government innovation in health services is one of the autonomy affairs that has a lot of room for innovation because the challenges of health services are very complex, that complexity produces various ideas in addition to producing novelty in a government innovation update, among others, in improving services to the community both in the central government and local governments. At the local level, for example, there are currently several city districts that have succeeded in holding administrative innovations, to improve government administration, and can serve the community well. But the performance of local governments in implementing public services in improving the achievement of local government development. This research uses qualitative methods. Data collected through observation and documentation and developed through interviews. The results of this study indicate that the quality of Soppeng Regency local government innovation in health services for 24 hours can be categorized as good and maximum service, because it is based on the rules of the government itself and perceived service to community leaders and service users (Patients).
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Williamson, Alicia K., Rachel P. Riendeau, Kelly Stolzmann, Allie F. Silverman, Bo Kim, Christopher J. Miller, Samantha L. Connolly, Jeffery Pitcock e Mark S. Bauer. "An Exploratory Analysis of Self-Reported Protective Factors against Self-Harm in an Enrolled Veteran General Mental Health Population". Military Medicine 184, n.º 11-12 (15 de maio de 2019): e738-e744. http://dx.doi.org/10.1093/milmed/usz111.
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Abstract Introduction The purpose of this study is to characterize self-reported protective factors against suicide or self-harm within free-response comments from a harm-risk screening. Materials and Methods Veterans enrolled in Department of Veterans Affairs mental health care were administered a self-harm and suicide screening as part of the baseline assessment in an ongoing implementation trial. Veterans indicated if they had thoughts of harming themselves and if so, what kept them from acting on them. Responses were coded based on established Centers for Disease Control protective factor categories. Descriptive analyses of demographic factors (such as age, gender, and race), clinical factors, and quality of life measures were conducted across groups depending on levels of self-harm risk. Results Of 593 Veterans, 57 (10%) screened positive for active thoughts of self-harm or suicide. Those with thoughts of self-harm had lower quality of life scores and higher rates of depression diagnoses. Of those individuals, 41 (72%) reported protective factors including Personal Resources (17%), Community Resources or Relationships (68%), and Other including pets and hobbies (15%). Those with stated protective factors had higher rates of employment and lower rates of PTSD diagnoses. Conclusion This is one of the first open-response studies of harm-risk protective factors, allowing for a patient-centered approach that prioritizes the individual’s voice and values. New protective factors emerged through the open-response format, indicating important factors that kept Veterans safe from self-harm or suicide such as pets and hobbies. Increasing focus on strengths and positive aspects of Veterans’ lives that serve as protective factors may ultimately improve mental health treatment and prevention of suicide and self-harm.
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Gordon, M. "PGS9 OUTCOMES ANALYSIS OF RABEPRAZOLE (ACIPHEX) USE AT A VETERAN AFFAIRS MEDICAL CENTER". Value in Health 5, n.º 6 (novembro de 2002): 503–4. http://dx.doi.org/10.1016/s1098-3015(10)61338-1.
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Raad, Jason H., Elizabeth Tarlov, Abel N. Kho e Dustin D. French. "Health Care Utilization Among Homeless Veterans in Chicago". Military Medicine 185, n.º 3-4 (12 de novembro de 2019): e335-e339. http://dx.doi.org/10.1093/milmed/usz264.
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Abstract Introduction The U.S. Department of Veterans Affairs (VA), the single largest health care system in the United States, provides comprehensive medical and behavioral health services to more than 9 million Veterans. The size and scope of the VA’s system of care allow health care providers, policymakers, and community stakeholders to conduct detailed analyses of health care utilization among Veterans; however, these analyses do not include health care encounters that occur outside VA. Although many Veterans obtain care in non-VA settings, understanding health care utilization among vulnerable populations of Veterans, including those who are homeless or at risk of becoming homeless, is needed to identify potential opportunities to enhance access and reduce fragmentation of care. Materials and Methods VA administrative data were merged with data from the Chicago HealthLNK Data Repository to identify Veterans eligible for VA services who were homeless, or at risk of becoming homeless, in the greater Chicago metropolitan area for the years 2010–2012. Results During the 3-year study period, about 208,554 Veterans were registered for care at two VA medical centers located in the City of Chicago and an adjacent suburb. Of those, 13,948 were identified as homeless or at risk of becoming homeless. Results suggest that 17% (n = 2,309) of Veterans in this sample received some or all of their care in the community. Much of the care these Veterans received was for chronic health conditions, substance use, and mental health disorders. Conclusions Veterans eligible for VA servicers who are homeless, or at risk of becoming homeless, frequently sought care in the community for a variety of chronic health conditions. Health information exchanges and partner-based registries may represent an important tool for identifying vulnerable Veteran populations while reducing duplication of care.
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Quaye, Stephen John, Erin M. Satterwhite e Jasmine Abukar. "Black Women’s Narratives Navigating Gendered Racism in Student Affairs". Education Sciences 13, n.º 9 (28 de agosto de 2023): 874. http://dx.doi.org/10.3390/educsci13090874.
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White people, Black men, and non-Black People of Color often expect Black women to care for others, often to the detriment of Black women being able to prioritize their own needs. This feeling is even more pronounced in helping professions, such as student affairs, and is consistent with a history of expectations that Black women care for others’ needs. In this manuscript, we use Black Feminist Thought to explore racial battle fatigue and how Black women student affairs educators worked to center themselves and focus on their healing from gendered racism. We employed a narrative inquiry methodology to center participants’ stories. Findings illustrate differences between self-care and healing, the importance of community, and efforts to support future generations of Black women. Our work builds on Black Feminist Thought as a theoretical framework and contributes to the literature on the particular ways racial battle fatigue manifests and strategies for healing in the midst of navigating gendered racism.
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Yushan, Xu. "Social Governance Innovations in Shenzhen: An Interview with Liu Runhua (刘润华)". China Nonprofit Review 4, n.º 2 (2012): 219–36. http://dx.doi.org/10.1163/18765149-12341246.
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Editor’s Note Over the past thirty years, as a special economic administrative region, Shenzhen has blazed many new paths of reform. Now, after thirty years, Shenzhen is once again leading the way with innovations and trials in the area of social reforms. From the Yantian Model (盐田模式) to “three half-steps”, the reformed method of social organization registration; from non-governmentally run social work units to establishment of community service centers; from encouraging the growth of the One Foundation’s operations in Shenzhen to inviting national philanthropic figures to participate in Shenzhen’s public-interest work, Shenzhen’s reforms have been inseparable from the encouragement of its Civil Affairs departments, inseparable from the innovative reform mindedness of the “Former Civil Affairs Bureau Chief”, Liu Runhua. In 2011, a team led by Professor Wang Ming (王名), Director of the NGO Research Center at the Tsinghua School of Public Policy and Management, conducted in-person interviews with this “social reformer”. Liu Runhua, then still Director of the Civil Affairs Bureau, stood both atop history and outside of his departmental context, to offer us far-reaching reflections on Shenzhen’s social management innovations. At the time of writing, Mr. Liu had been promoted up to Guangdong, where, as Managing Deputy Director of the Guangdong Provincial Social Work Committee, he is now able promulgate his ideas on public-interest activities in practice from a higher platform.
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Tsai, Jack, Natalie Jones, Anne Klee e Debbie Deegan. "Job Burnout Among Mental Health Staff at a Veterans Affairs Psychosocial Rehabilitation Center". Community Mental Health Journal 56, n.º 2 (5 de outubro de 2019): 294–97. http://dx.doi.org/10.1007/s10597-019-00487-5.
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