Risk-Adjusting Mortality in the Nationwide Veterans Affairs Healthcare System.

Background: The US Veterans Affairs (VA) healthcare system began reporting risk-adjusted mortality for intensive care (ICU) admissions in 2005. However, while the VA's mortality model has been updated and adapted for risk-adjustment of all inpatient hospitalizations, recent model performance has not been published. We sought to assess the current performance of VA's 4 standardized mortality models: acute care 30-day mortality (acute care SMR-30); ICU 30-day mortality (ICU SMR-30); acute care in-hospital mortality (acute care SMR); and ICU in-hospital mortality (ICU SMR).

The SOLAR group program to promote recovery after disaster and trauma-A randomized controlled feasibility trial among German trauma survivors.

Introduction: Many disaster and trauma survivors experience persistent subclinical distress that places them at risk of developing a mental health disorder. This study describes the first European feasibility study of a brief and scalable skills-based intervention targeting persistent subclinical distress following disasters and trauma.

Method: Randomized controlled feasibility study of the Skills fOr Life Adjustment and Resilience (SOLAR) group program.

[Skills fOr Life Adjustment and Resilience Program].

Background: After catastrophes, trauma and other highly stressful experiences, a proportion of individuals develop mental illness, while another proportion exhibit persisting subclinical distress that limits psychosocial functioning. Individuals with persisting subclinical distress rarely receive psychosocial support services.

Aim Of The Study: This paper presents the Skills fOr Life Adjustment and Resilience (SOLAR) program, a brief intervention developed for people with persistent subclinical distress following catastrophes and other severe stressors.

Ribosome-associated vesicles: A dynamic subcompartment of the endoplasmic reticulum in secretory cells.

The endoplasmic reticulum (ER) is a highly dynamic network of membranes. Here, we combine live-cell microscopy with in situ cryo-electron tomography to directly visualize ER dynamics in several secretory cell types including pancreatic β-cells and neurons under near-native conditions. Using these imaging approaches, we identify a novel, mobile form of ER, ribosome-associated vesicles (RAVs), found primarily in the cell periphery, which is conserved across different cell types and species.

New roles for dopamine D and D receptors in pancreatic beta cell insulin secretion.

Although long-studied in the central nervous system, there is increasing evidence that dopamine (DA) has important roles in the periphery including in metabolic regulation. Insulin-secreting pancreatic β-cells express the machinery for DA synthesis and catabolism, as well as all five DA receptors. In these cells, DA functions as a negative regulator of glucose-stimulated insulin secretion (GSIS), which is mediated by DA D-like receptors including D (D2R) and D (D3R) receptors.

Pathophysiology of drug induced weight and metabolic effects: findings from an RCT in healthy volunteers treated with olanzapine, iloperidone, or placebo.

Second generation antipsychotics are prescribed for an increasing number of psychiatric conditions, despite variable associations with weight gain, dyslipidemia, and impaired glucose tolerance. The mechanism(s) of the apparent causal relationships between these medications and metabolic effects have been inadequately defined and are potentially confounded by genetic risk of mental illness, attendant lifestyle, and concomitant medications. Therefore, we conducted a study in which 24 healthy volunteers were randomized to olanzapine (highly weight-gain liability), iloperidone (less weight-gain liability), or placebo treatment for 28 days under double-blind conditions.

Neuronal Depolarization Drives Increased Dopamine Synaptic Vesicle Loading via VGLUT.

The ability of presynaptic dopamine terminals to tune neurotransmitter release to meet the demands of neuronal activity is critical to neurotransmission. Although vesicle content has been assumed to be static, in vitro data increasingly suggest that cell activity modulates vesicle content. Here, we use a coordinated genetic, pharmacological, and imaging approach in Drosophila to study the presynaptic machinery responsible for these vesicular processes in vivo.

Mechanisms of amphetamine action illuminated through optical monitoring of dopamine synaptic vesicles in Drosophila brain.

Amphetamines elevate extracellular dopamine, but the underlying mechanisms remain uncertain. Here we show in rodents that acute pharmacological inhibition of the vesicular monoamine transporter (VMAT) blocks amphetamine-induced locomotion and self-administration without impacting cocaine-induced behaviours. To study VMAT's role in mediating amphetamine action in dopamine neurons, we have used novel genetic, pharmacological and optical approaches in Drosophila melanogaster.

Development of a Rapid Insulin Assay by Homogenous Time-Resolved Fluorescence.

Direct measurement of insulin is critical for basic and clinical studies of insulin secretion. However, current methods are expensive and time-consuming. We developed an insulin assay based on homogenous time-resolved fluorescence that is significantly more rapid and cost-effective than current commonly used approaches.

β-Blockade and Operative Mortality in Noncardiac Surgery: Harmful or Helpful?

Importance: The use of perioperative pharmacologic β-blockade in patients at low risk of myocardial ischemic events undergoing noncardiac surgery (NCS) is controversial because of the risk of stroke and hypotension. Published studies have not found a consistent benefit in this cohort.

Objective: To determine the effect of perioperative β-blockade on patients undergoing NCS, particularly those with no risk factors.

Denominator doesn't matter: standardizing healthcare-associated infection rates by bed days or device days.

Objective: To examine the impact on infection rates and hospital rank for catheter-associated urinary tract infection (CAUTI), central line-associated bloodstream infection (CLABSI), and ventilator-associated pneumonia (VAP) using device days and bed days as the denominator

Design: Retrospective survey from October 2010 to July 2013 SETTING: Veterans Health Administration medical centers providing acute medical and surgical care

Patients: Patients admitted to 120 Veterans Health Administration medical centers reporting healthcare-associated infections

Methods: We examined the importance of using device days and bed days as the denominator between infection rates and hospital rank for CAUTI, CLABSI, and VAP for each medical center. The relationship between device days and bed days as the denominator was assessed using a Pearson correlation, and changes in infection rates and device utilization were evaluated by an analysis of variance.

Results: A total of 7.

Nationwide reduction of health care-associated methicillin-resistant Staphylococcus aureus infections in Veterans Affairs long-term care facilities.

The Veterans Affairs methicillin-resistant Staphylococcus aureus (MRSA) Prevention Initiative was implemented in its 133 long-term care facilities in January 2009. Between July 2009 and December 2012, there were ~12.9 million resident-days in these facilities nationwide.

Veterans Affairs methicillin-resistant Staphylococcus aureus prevention initiative associated with a sustained reduction in transmissions and health care-associated infections.

Implementation of a methicillin-resistant Staphylococcus aureus (MRSA) Prevention Initiative was associated with significant declines in MRSA transmission and MRSA health care-associated infection rates in Veterans Affairs acute care facilities nationwide in the 33-month period from October 2007 through June 2010. Here, we show continuing declines in MRSA transmissions (P = .004 for trend, Poisson regression) and MRSA health care-associated infections (P < .

Degree of Acute Kidney Injury before Dialysis Initiation and Hospital Mortality in Critically Ill Patients.

In a multicenter observational cohort of patients-admitted to intensive care units (ICU), we assessed whether creatinine elevation prior to dialysis initiation in acute kidney injury (AKI-D) further discriminates risk-adjusted mortality. AKI-D was categorized into four groups (Grp) based on creatinine elevation after ICU admission but before dialysis initiation: Grp I  > 0.3 mg/dL to <2-fold increase, Grp II ≥2 times but <3 times increase, Grp III ≥3-fold increase in creatinine, and Grp IV none or <0.

The membrane raft protein Flotillin-1 is essential in dopamine neurons for amphetamine-induced behavior in Drosophila.

The dopamine transporter (DAT) is the primary molecular target responsible for the rewarding properties of the psychostimulants amphetamine (AMPH) and cocaine. AMPH increases extracellular dopamine (DA) by promoting its nonexocytotic release via DAT-mediated efflux. Previous studies in heterologous cells have shown that phosphorylation of the amino terminus of DAT is required for AMPH-induced DA efflux but not for DA uptake.

A hybrid Centers for Medicaid and Medicare service mortality model in 3 diagnoses.

Introduction: Reliance on administrative data sources and a cohort with restricted age range (Medicare 65 y and above) may limit conclusions drawn from public reporting of 30-day mortality rates in 3 diagnoses [acute myocardial infarction (AMI), congestive heart failure (CHF), pneumonia (PNA)] from Center for Medicaid and Medicare Services.

Methods: We categorized patients with diagnostic codes for AMI, CHF, and PNA admitted to 138 Veterans Administration hospitals (2006-2009) into 2 groups (less than 65 y or ALL), then applied 3 different models that predicted 30-day mortality [Center for Medicaid and Medicare Services administrative (ADM), ADM+laboratory data (PLUS), and clinical (CLIN)] to each age/diagnosis group. C statistic (CSTAT) and Hosmer Lemeshow Goodness of Fit measured discrimination and calibration.

Veterans Affairs initiative to prevent methicillin-resistant Staphylococcus aureus infections.

Background: Health care-associated infections with methicillin-resistant Staphylococcus aureus (MRSA) have been an increasing concern in Veterans Affairs (VA) hospitals.

Methods: A "MRSA bundle" was implemented in 2007 in acute care VA hospitals nationwide in an effort to decrease health care-associated infections with MRSA. The bundle consisted of universal nasal surveillance for MRSA, contact precautions for patients colonized or infected with MRSA, hand hygiene, and a change in the institutional culture whereby infection control would become the responsibility of everyone who had contact with patients.

Occupational exposure to trichloroethylene and cancer risk for workers at the Paducah Gaseous Diffusion Plant.

Objective: The Paducah Gaseous Diffusion Plant (PGDP) became operational in 1952; it is located in the western part of Kentucky. We conducted a mortality study for adverse health effects that workers may have suffered while working at the plant, including exposures to chemicals.

Materials And Methods: We studied a cohort of 6820 workers at the PGDP for the period 1953 to 2003; there were a total of 1672 deaths to cohort members.

Reduction of central line infections in Veterans Administration intensive care units: an observational cohort using a central infrastructure to support learning and improvement.

Background: Elimination of hospital-acquired infections is an important patient safety goal.

Setting: All 174 medical, cardiac, surgical and mixed Veterans Administration (VA) intensive care units (ICUs).

Intervention: A centralised infrastructure (Inpatient Evaluation Center (IPEC)) supported the practice bundle implementation (handwashing, maximal barriers, chlorhexidinegluconate site disinfection, avoidance of femoral catheterisation and timely removal) to reduce central line-associated bloodstream infections (CLABSI).

Infrastructure for quality transformation: measurement and reporting in veterans administration intensive care units.

BACKGROUND Veterans Health Administration (VA) intensive care units (ICUs) develop an infrastructure for quality improvement using information technology and recruiting leadership. METHODS Setting Participation by the 183 ICUs in the quality improvement program is required. Infrastructure includes measurement (electronic data extraction, analysis), quarterly web-based reporting and implementation support of evidence-based practices.

Medical monitoring: a beneficial remedy for residents living near an environmental hazard site.

Objective: People living close to an environmental hazard site may suffer health harms from real or perceived contaminant exposures. In class-action litigation, medical monitoring is a potential remedy that has been allowed in some jurisdictions but not others. From 1952 to 1989, a US Department of Energy uranium metal plant near Fernald, Ohio, released ionizing radiation and uranium particulates into the surrounding community.

Hyperglycemia-related mortality in critically ill patients varies with admission diagnosis.

Objectives: Hyperglycemia during critical illness is common and is associated with increased mortality. Intensive insulin therapy has improved outcomes in some, but not all, intervention trials. It is unclear whether the benefits of treatment differ among specific patient populations.

Incidence and outcomes of acute kidney injury in intensive care units: a Veterans Administration study.

Objectives: : To examine the effect of severity of acute kidney injury or renal recovery on risk-adjusted mortality across different intensive care unit settings. Acute kidney injury in intensive care unit patients is associated with significant mortality.

Design: : Retrospective observational study.

Quantitative and qualitative measures of behavior in adolescent girls.

Social experiences are central to the adolescent experience (Hartup & Stevens, 1997). The current study examined how this emphasis on social behavior would be reflected in both quantitative and qualitative measures. To do this, 57 adolescent girls (aged 11-19 years) completed questionnaires about their achievements and social and relaxation activities.