Adapting an Alcohol Care Linkage Intervention to US Military Veterans Presenting to Primary Care with Hazardous Drinking and PTSD and/or Depression Symptoms: A Qualitative Study.

There is a critical need to improve linkage to alcohol care for veterans in primary care with hazardous drinking and PTSD and/or depression symptoms (A-MH). We adapted an alcohol care linkage intervention, "Connect to Care" (C2C), for this population. We conducted separate focus groups with veterans with A-MH, providers, and policy leaders.

Non-randomised feasibility study of training workshops for Talking Therapies service high-intensity therapists to optimise depression and anxiety outcomes for individuals with co-morbid personality difficulties: a study protocol.

Background: The NHS Talking Therapies for Anxiety and Depression programme ('TTad'; formerly Improving Access to Psychological Therapies 'IAPT') delivers high-intensity cognitive behavioural therapy (CBT) to over 200,000 individuals each year for common mental health problems like depression and anxiety. More than half of these individuals experience comorbid personality difficulties, who show poorer treatment outcomes. TTad therapists report feeling unskilled to work with clients with personality difficulties, and enhancing the training of TTad therapists may lead to improved treatment outcomes for individuals presenting with secondary personality difficulties alongside depression and anxiety.

Connect To Care (C2C): protocol for two-site randomized controlled pilot trial to improve outcomes for patients with hazardous drinking and PTSD and/or depression symptoms.

Background: In studies of the general population and of military veterans, many primary care patients with hazardous drinking and PTSD and/or depression (abbreviated here as HD +) do not initiate or engage with alcohol-related care. To address this gap in care, we identified and will pilot test a promising evidence-based intervention, Connect To Care (C2C). C2C is a strengths-based approach, delivered by a Care Coach by telephone and/or video, with four components: (1) identifying and leveraging patient strengths to facilitate care initiation, (2) collaborative decision-making around a menu of care options, (3) identifying and resolving barriers to care, and (4) monitoring and facilitating progress toward care initiation by, for example, checking on barriers, identifying solutions, and revisiting care options.

Adapting the Eliminating Medications Through Patient Ownership of End Results Protocol to Promote Benzodiazepine Cessation Among US Military Veterans: Focus Group Study With US Military Veterans and National Veterans Health Administration Leaders.

Background: Long-term dependence on prescribed benzodiazepines is a public health problem. Eliminating Medications Through Patient Ownership of End Results (EMPOWER) is a promising self-management intervention, delivered directly to patients as a printed booklet, that is effective in promoting benzodiazepine reduction and cessation in older adults. EMPOWER has high potential to benefit large health care systems such as the US Veterans Health Administration (VHA), which cares for many veterans who use benzodiazepines for extended periods.

Promoting benzodiazepine cessation through an electronically-delivered patient self-management intervention (EMPOWER-ED): Randomized controlled trial protocol.

Background: Long-term benzodiazepine dependence carries significant health risks which might be reduced with low-cost patient self-management interventions. A booklet version of one such intervention (Eliminating Medications Through Patient Ownership of End Results; EMPOWER) proved effective in a Canadian clinical trial with older adults. Digitizing such an intervention for electronic delivery and tailoring it to different populations could expand its reach.

A laboratory examination of risky sexual behavior among female sexual trauma survivors.

Sexual violence against women is highly prevalent on college campuses. Survivors of sexual violence often engage in coping strategies such as risky sexual behavior. The present study used a behavioral task to measure sexual risk-taking following experiences of positive or negative affect and an emotion suppression experimental manipulation.

The moderating roles of emotion regulation and coping self-efficacy on the association between PTSD symptom severity and drug use among female sexual assault survivors.

Objective: Posttraumatic stress disorder (PTSD) and substance use disorders are a significant comorbid concern among sexual assault survivors. Thus, underlying risk and protective factors are critical to investigate in understanding how to prevent this comorbidity.

Method: The current study assessed potential moderating effects of coping self-efficacy (CSE) and emotion dysregulation on the association between sexual assault-related PTSD symptom severity and drug use severity in a sample of college women.

A randomized controlled trial comparing a manual and computer version of CALM in VA community-based outpatient clinics.

Background: This study compared a computer and manual version of a tailored Coordinated Anxiety Learning and Management (VA CALM) protocol on provider fidelity to CBT and patient outcomes.

Methods: This study was a cluster randomized controlled trial. Providers ( = 32) were randomized to deliver VA CALM by computer or manual.

An Evidence-Based Model for Disseminating-Implementing Coordinated Anxiety Learning and Management in Department of Veterans Affairs' Community-Based Outpatient Clinics.

Purpose: To explore the feasibility and utility of using a workshop, and supervision-consultation plus external facilitation to disseminate and implement cognitive-behavioral therapy in Veterans Affairs (VA) community-based outpatient clinics (CBOCs).

Methods: This study occurred in the context of a randomized controlled trial aimed at comparing 2 methods for implementing Coordinated Anxiety Learning Management (CALM) in VA CBOCs. A 3-phase (workshop, supervision-consultation, external facilitation) model was used to support 32 VA CBOC mental health providers in learning and adopting CALM in their clinical practice.

Stockpiled "Tifton 85" bermudagrass for cow-calf production as influenced by nitrogen fertilization.

A 2-yr study was conducted to determine the effects of rate of N fertilization on productivity and nutritive value of stockpiled "Tifton 85" bermudagrass for lactating-cow and calf performance. On 31 October 2012 (year 1) and 11 November 2013 (year 2), 16 Angus × Simmental cows (mean initial BW for both years, 647 ± 23 kg) and their calves (mean age for both years, 16 ± 3 d) were assigned randomly to 0.76-ha paddocks (2 cow-calf pairs/paddock) of stockpiled "Tifton 85" bermudagrass pasture that had been cut to a 10-cm stubble height in early August and fertilized with either 56 (56N), 112 (112N), or 168 (168N) kg N/ha (2 paddocks/treatment), or to replicate 0.

Clinical element models in the SHARPn consortium.

Objective: The objective of the Strategic Health IT Advanced Research Project area four (SHARPn) was to develop open-source tools that could be used for the normalization of electronic health record (EHR) data for secondary use--specifically, for high throughput phenotyping. We describe the role of Intermountain Healthcare's Clinical Element Models ([CEMs] Intermountain Healthcare Health Services, Inc, Salt Lake City, Utah) as normalization "targets" within the project.

Materials And Methods: Intermountain's CEMs were either repurposed or created for the SHARPn project.

Direct measurement of electron beam quality conversion factors using water calorimetry.

Purpose: In this work, the authors describe an electron sealed water calorimeter (ESWcal) designed to directly measure absorbed dose to water in clinical electron beams and its use to derive electron beam quality conversion factors for two ionization chamber types.

Methods: A functioning calorimeter prototype was constructed in-house and used to obtain reproducible measurements in clinical accelerator-based 6, 9, 12, 16, and 20 MeV electron beams. Corrections for the radiation field perturbation due to the presence of the glass calorimeter vessel were calculated using Monte Carlo (MC) simulations.

Normalization and standardization of electronic health records for high-throughput phenotyping: the SHARPn consortium.

Research Objective: To develop scalable informatics infrastructure for normalization of both structured and unstructured electronic health record (EHR) data into a unified, concept-based model for high-throughput phenotype extraction.

Materials And Methods: Software tools and applications were developed to extract information from EHRs. Representative and convenience samples of both structured and unstructured data from two EHR systems-Mayo Clinic and Intermountain Healthcare-were used for development and validation.

Monitoring and managing metabolic effects of antipsychotics: a cluster randomized trial of an intervention combining evidence-based quality improvement and external facilitation.

Background: Treatment of psychotic disorders consists primarily of second generation antipsychotics, which are associated with metabolic side effects such as overweight/obesity, diabetes, and dyslipidemia. Evidence-based clinical practice guidelines recommend timely assessment and management of these conditions; however, research studies show deficits and delays in metabolic monitoring and management for these patients. This protocol article describes the project 'Monitoring and Management for Metabolic Side Effects of Antipsychotics,' which is testing an approach to implement recommendations for these practices.

The evolving practice of intrauterine cervix brachytherapy in Canada: a medical physics perspective.

Purpose: To determine the current equipment, technology, and treatment planning methods used in Canadian cancer centers for intrauterine cervix brachytherapy.

Methods And Materials: A questionnaire was developed to survey medical physicists in Canada regarding technical aspects of intrauterine cervix brachytherapy. A response was obtained from one physicist at each radiotherapy facility in Canada.

A collaborative approach to lean laboratory workstation design reduces wasted technologist travel.

Lean methodologies have been applied in many industries to reduce waste. We applied Lean techniques to redesign laboratory workstations with the aim of reducing the number of times employees must leave their workstations to complete their tasks. At baseline in 68 workflows (aggregates or sequence of process steps) studied, 251 (38%) of 664 tasks required workers to walk away from their workstations.

Exploring the process of adjusting to diabetic kidney disease.

The psychological process of adjusting to diabetic kidney disease (DKD) has been afforded little attention within previous literature. This study aimed to explore the process of adjusting to DKD as a secondary condition to type 1 diabetes. A qualitative method was used in the study design.

Platelet CD36 surface expression levels affect functional responses to oxidized LDL and are associated with inheritance of specific genetic polymorphisms.

CD36 modulates platelet function via binding to oxidized LDL (oxLDL), cell-derived microparticles, and thrombospondin-1. We hypothesized that the level of platelet CD36 expression may be associated with inheritance of specific genetic polymorphisms and that this would determine platelet reactivity to oxLDL. Analysis of more than 500 subjects revealed that CD36 expression levels were consistent in individual donors over time but varied widely among donors (200-14,000 molecules per platelet).

Deficiency in core circadian protein Bmal1 is associated with a prothrombotic and vascular phenotype.

Aging is associated with both the disturbances of circadian rhythms and a prothrombotic phenotype. It remains poorly understood how the circadian system regulates thrombosis, a critical outcome of aging-related cardiovascular disease. Using multiple in vivo models, we now show that mice with genetic ablation of the core clock gene Bmal1, which display pre-mature aging, have a dramatic prothrombotic phenotype.

Pre-dialysis insulin: a new concept to treat an old problem.

Diabetes and chronic kidney disease are two disease processes that remain with the patient from diagnosis to the end of their lives. The field of diabetes and renal failure is a complex area, merging together these two chronic diseases, each a speciality in its own right. Patients with diabetes need to start dialysis much earlier than those without diabetes due to the cumulative effect of proteinuria and its associated symptoms.

Diabetes and chronic kidney disease: a complex combination.

Diabetes and chronic kidney disease (CKD) are two disease processes that remain with patients from diagnosis to the end of their lives. Both are destructive conditions that must be diagnosed early to prevent longer-term complications, such as retinopathy and neuropathy. Diabetes remains the single most important cause of kidney failure.

Genotype-phenotype correlation in combined deficiency of factor V and factor VIII.

Combined deficiency of factor V and factor VIII (F5F8D) is caused by mutations in one of 2 genes, either LMAN1 or MCFD2. Here we report the identification of mutations for 11 additional F5F8D families, including 4 novel mutations, 2 in MCFD2 and 2 in LMAN1. We show that a novel MCFD2 missense mutation identified here (D81Y) and 2 previously reported mutations (D89A and D122V) abolish MCFD2 binding to LMAN1.

An LRP8 variant is associated with familial and premature coronary artery disease and myocardial infarction.

Our previous genomewide linkage scan of 428 nuclear families (GeneQuest) identified a significant genetic susceptibility locus for premature myocardial infarction (MI) on chromosome 1p34-36. We analyzed candidate genes in the locus with a population-based association study involving probands with premature coronary artery disease (CAD) and/or MI from the GeneQuest families (381 cases) and 560 controls without stenosis detectable by coronary angiography. A nonconservative substitution, R952Q, in LRP8 was significantly associated with susceptibility to premature CAD and/or MI by use of both population-based and family-based designs.

Creation of a large-scale genetic data bank for cardiovascular association studies.

Background: A prerequisite for undertaking genetic association studies is the need for a genetic data bank with adequate DNA samples and a well-described clinical cohort.

Methods: We initiated a prospective single-center study enrolling 6,273 patients referred for cardiac catheterization in a genetic data bank (with eventual goal of 10,000 enrollees). Using a prescreening tool, the patients had comprehensive clinical phenotyping, including angiogram, electrocardiogram, echocardiogram, clinical history, and medication profile (Appendix A).

Lichtenstein vs anterior preperitoneal prosthetic mesh placement in open inguinal hernia repair: a prospective, randomized trial.

Male veterans with unilateral primary inguinal hernia, classified intraoperatively as Gilbert Type III or IV, were randomized to subaponeurotic (Lichtenstein, n=126) or preperitoneal (Read-Rives, n=121) repair under general or spinal anesthesia. The two groups of patients were comparable in age, body weight index, comorbidities, and size and type of hernia. Of the 247 patients enrolled, 224 were followed for at least 2 years (median 82 months, range 24-110 months), 16 were lost to follow-up, and seven died from causes unrelated to the surgery.