Era Of Services Research Articles

Toward the Era of a One-Stop Imaging Service Using an Angiography Suite for Neurovascular Disorders

Transportation of patients requiring multiple diagnostic and imaging-guided therapeutic modalities is unavoidable in current radiological practice. This clinical scenario causes time delays and increased risk in the management of stroke and other neurovascular emergencies. Since the emergence of flat-detector technology in imaging practice in recent decades, studies have proven that flat-detector X-ray angiography in conjunction with contrast medium injection and specialized reconstruction algorithms can provide not only high-quality and high-resolution CT-like images but also functional information. This improvement in imaging technology allows quantitative assessment of intracranial hemodynamics and, subsequently in the same imaging session, provides treatment guidance for patients with neurovascular disorders by using only a flat-detector angiographic suite—a so-called one-stop quantitative imaging service (OSIS). In this paper, we review the recent developments in the field of flat-detector imaging and share our experience of applying this technology in neurovascular disorders such as acute ischemic stroke, cerebral aneurysm, and stenoocclusive carotid diseases.

Risk of Incarceration and Other Characteristics of Iraq and Afghanistan Era Veterans in State and Federal Prisons

The Health Care for Reentry Veterans (HCRV) program provides Veterans Health Administration outreach services to veterans incarcerated in state and federal prisons. This study used HCRV data to compare risk of incarceration of veterans of Operations Enduring Freedom (OEF), Iraqi Freedom (OIF), and New Dawn (OND) and other veterans and to identify sociodemographic and clinical characteristics of incarcerated veterans of OEF/OIF/OND. Administrative national data were analyzed for 30,968 incarcerated veterans, including 1,201 OEF/OIF/OND veterans, contacted from October 2007 to April 2011. Odds ratios were calculated comparing the risk of incarceration among OEF/OIF/OND and other veterans in the HCRV sample and in a weighted sample of nonincarcerated veterans from the 2010 National Survey of Veterans. Stepwise logistic regressions of HCRV data examined characteristics of incarcerated veterans independently associated with OEF/OIF/OND service. Regardless of ethnicity or age, OEF/OIF/OND veterans were less than half as likely as other veterans to be incarcerated and constituted only 3.9% of the incarcerated veterans. Compared with other incarcerated veterans, OEF/OIF/OND veterans were younger, were more likely to be married, were more likely to report combat exposure, expected a shorter incarceration, were 26% less likely to have a diagnosis of drug abuse or dependence, and were three times more likely to have combat-related posttraumatic stress disorder (PTSD). OEF/OIF/OND veterans appeared to be at lower risk of incarceration than veterans of other service eras, but those who were incarcerated had higher rates of PTSD. Efforts to link these veterans to mental health services upon their release are warranted.

Risk of Incarceration and Other Characteristics of Iraq and Afghanistan Era Veterans in State and Federal Prisons

Objective The Health Care for Reentry Veterans (HCRV) program provides Veterans Health Administration outreach services to veterans incarcerated in state and federal prisons. This study used HCRV data to compare risk of incarceration of veterans of Operations Enduring Freedom (OEF), Iraqi Freedom (OIF), and New Dawn (OND) and other veterans and to identify sociodemographic and clinical characteristics of incarcerated veterans of OEF/OIF/OND. Methods Administrative national data were analyzed for 30,968 incarcerated veterans, including 1,201 OEF/OIF/OND veterans, contacted from October 2007 to April 2011. Odds ratios were calculated comparing the risk of incarceration among OEF/OIF/OND and other veterans in the HCRV sample and in a weighted sample of nonincarcerated veterans from the 2010 National Survey of Veterans. Stepwise logistic regressions of HCRV data examined characteristics of incarcerated veterans independently associated with OEF/OIF/OND service. Results Regardless of ethnicity or age, OEF/OIF/OND veterans were less than half as likely as other veterans to be incarcerated and constituted only 3.9% of the incarcerated veterans. Compared with other incarcerated veterans, OEF/OIF/OND veterans were younger, were more likely to be married, were more likely to report combat exposure, expected a shorter incarceration, were 26% less likely to have a diagnosis of drug abuse or dependence, and were three times more likely to have combat-related posttraumatic stress disorder (PTSD). Conclusions OEF/OIF/OND veterans appeared to be at lower risk of incarceration than veterans of other service eras, but those who were incarcerated had higher rates of PTSD. Efforts to link these veterans to mental health services upon their release are warranted.

The Influence of Depressive Symptoms on Suicidal Ideation Among U.S. Vietnam‐Era and Afghanistan/Iraq‐Era Veterans With Posttraumatic Stress Disorder

Major depressive disorder (MDD) co-occurs frequently with posttraumatic stress disorder (PTSD), and both disorders are linked to suicidal ideation. An emergent literature examines suicidal ideation in U.S. Afghanistan/Iraq-era veterans. Little research, however, has studied the role of PTSD and comorbid MDD on suicidal ideation across service eras. Therefore, this study aimed to examine the impact of depression on suicidal ideation in Afghanistan/Iraq-era and Vietnam-era veterans with PTSD. The sample included 164 Vietnam and 98 Afghanistan/Iraq veterans diagnosed with PTSD at a VA outpatient PTSD Clinic. Using structured interviews, 63% of the Vietnam sample and 45% of the Afghanistan/Iraq sample were diagnosed with comorbid current MDD. Measures included self-report assessments of PTSD and depressive symptoms and the Personality Assessment Inventory. Results of analyses suggested that in veterans of both eras, PTSD, MDD, and their interaction were significantly related to suicidal ideation (PTSD: η(2) = .01; MDD: η(2) = .10; PTSD × MDD: η(2) = .02). For veterans reporting greater depressive symptoms, there was a stronger relationship between PTSD symptoms and suicidal ideation. These results suggest that veterans from both eras display a similar clinical presentation and highlight the need to consider depressive symptoms when assessing veterans with PTSD. Future research should examine suicidal ideation and behaviors as they change over time in these two cohorts.

Psychiatric Diagnoses, Mental Health Utilization, High-Risk Behaviors, and Self-Directed Violence Among Veterans With Comorbid History of Traumatic Brain Injury and Substance Use Disorders

To describe various characteristics of veterans with co-occurring histories of traumatic brain injury (TBI) and substance use disorder (SUD) for purposes of hypothesis generation. Archival data collected over a period of 4 years. Sixty-five veterans across eras of service with confirmed histories of TBI and SUD. : Demographic and TBI information were obtained from an archival clinical database. Electronic medical records were reviewed for mental health utilization, psychiatric diagnoses, self-directed violence, and risk-taking behaviors. In addition to a SUD, veterans were reported to have an average of 3 additional psychiatric diagnoses and a median of 3 TBIs per person. All utilized various mental health services in addition to substance use treatment. Individuals were found to have engaged in a variety of risky behaviors. There were significant associations between suicidal ideation and assaultive behaviors, as well as between suicide attempt and impulsivity. This study describes a sample of veterans with co-occurring histories of TBI, SUD, risk-taking behaviors, and self-directed violence. More research is needed to examine these complex interrelationships and to identify specific risk factors for intervention/prevention strategies.

Personal Characteristics Affecting Veterans' Use of Services for Posttraumatic Stress Disorder

Posttraumatic stress disorder (PTSD) is widespread among veterans, but many veterans with PTSD use few health services. This study examined how individual characteristics influenced use of outpatient visits by veterans with PTSD. The study assessed number of annual visits by 414,748 veterans with PTSD who sought care from October 2007 through September 2008 at U.S. Department of Veteran Affairs (VA) facilities. Negative binomial regression and adjusted risk ratios assessed the relationship of number of visits and demographic characteristics as well as place of residence, era of service, extent to which disability was connected to service history, and having comorbid illnesses. Veterans from rural or highly rural areas had 19% (confidence interval [CI]=.80-.82) and 25% (CI=.72-.79), respectively, fewer visits than urban-dwelling veterans. Iraq and Afghanistan veterans had 21% fewer visits than veterans of prior eras (CI=.78-.81). Veterans with comorbid conditions had 64% more visits than veterans with only PTSD (CI=1.62-1.66). Veterans from rural or highly rural areas had 22% (CI=.87-.89) and 33% (CI=.64-.71), respectively, fewer visits to PTSD specialty clinics than veterans from urban areas. Service use by veterans is lower in rural areas. The VA should build on existing efforts to provide more outreach and care opportunities, including telemental health and specialized PTSD services, in rural areas and for veterans of the current service era. Future research should investigate the impact of fewer visits on aspects of functioning, such as interpersonal factors, and the impact of system-level variables on service utilization.

Neil Lessels Dallas

Neil Lessels Dallas was born in Bradford and educated at Uppingham. He graduated from Trinity Hall, Cambridge, and completed his medical training at St Thomas’ Hospital in London. In the...

Centralization of HIV services in HIV-positive African-American and Hispanic youth improves retention in care

African-American and Hispanic HIV-infected youth are a high risk group for not remaining in HIV care. We examined differences in retention in care among 174 HIV-infected African-American and Hispanic youth between 13 and 23 years old who presented for HIV primary care between 1 January 2002 and 31 August 2008. Patients were included in three service eras, based on when they entered the clinic: when no youth-specific services were available (the decentralized era), after formation of a youth clinic staffed by adolescent providers and a case-manager (the centralized era), and after educational activities and support groups were added and the social services staff were trained in the use of motivational interviewing (the centralized with supportive services era). Patient and attendance data for the 12-months following entry into care were captured. Retention in HIV care was examined using two different measures: adequate visit constancy (at least three quarters with at least one visit in each quarter) and having a gap in care (two consecutive medical visits ≥180 days apart). Adequate visit constancy improved by service era from 31% in the decentralized era to 57% in the centralized era and 65% in the centralized with supportive services era (p=0.01). The percent of patients with no gap in care remained stable at about 80% in the decentralized and centralized eras, but then increased to 96% in the centralized with supportive services era (p=0.04). Results suggest that centralizing youth-specific care and expanding youth services can improve retention in HIV care. These system changes should be considered when resources allow.

Government Programs Helping to Identify More PTSD Sufferers

Government Programs Helping to Identify More PTSD Sufferers

Recent Trends in the Treatment of Posttraumatic Stress Disorder and Other Mental Disorders in the VHA

This study proposed to evaluate Veterans Health Administration (VHA) specialty mental health care workload for treating posttraumatic stress disorder (PTSD) and other mental disorders between 2005 and 2010 in comparison with results from 1997 to 2005. The 2005-2010 time frame represents a period of increased utilization of services by recently returning veterans and of program expansion within VHA. VHA administrative databases were queried for all veterans receiving specialty mental health treatment annually between 2005 and 2010. Veterans were categorized by military service era (WWII or Korea, Vietnam, post-Vietnam, Persian Gulf War [including operations in Iraq and Afghanistan], and peacetime or other), diagnosis (PTSD or a non-PTSD mental disorder), and deployment to Iraq or Afghanistan. The total number of veterans served per year increased by 623,326 (117.6%) between 1997 and 2010. Veterans with PTSD increased at a greater rate since 2005 compared with veterans with other mental disorders. Vietnam veterans constituted a majority of all veterans treated for PTSD or for other mental disorders, and the number of Vietnam veterans treated for PTSD continues to grow. The number of visits per veteran with PTSD increased between 2006 and 2010, reversing previous trends. The rate of increase has been highest for Iraq and Afghanistan veterans. Both the number treated and treatment intensity have increased for veterans with PTSD who served in current conflicts, which might be expected, and in the Vietnam era, now 30 years past. A reversal of past declines in treatment intensity coincides with an increase in PTSD treatment funding and program expansion since 2005.

Tony Mason and Eliza Riedi . Sport and the Military: The British Armed Forces, 1880–1960 . New York: Cambridge University Press. 2010. Pp. ix, 288. Cloth $90.00, paper $32.99.

This deeply researched book provides the first close look at the role of sport in the British military. Tony Mason and Eliza Riedi offer a fascinating account that highlights the importance of military sport, not just at home but on battleships, behind the trenches in World War I, and in the midst of the Desert War. Sport was played by servicemen and women, both officers and those in the ranks. Sport remained strictly sex segregated, but it increasingly brought together people from all ranks. It functioned both as a marker reinforcing military and social hierarchies and as a means to blur these distinctions, at least on the playing field. This book charts the rise of military sport from informal beginnings in the late Victorian period to the foundation of the Army Sport Control Board in 1918 and the creation of corresponding bodies in the Royal Navy and Royal Air Force, concluding with the era of national service. While equestrian sport and particularly hunting and polo dominated officer sport until the 1930s, football was most popular among the ranks, followed by rugby, boxing, cricket, and track and field. Mason and Riedi also explore the relationship between military and civilian sport; for example, they point to the pioneering role of the Royal Engineers in promoting the new game of football in the 1870s and 1880s.

E Government: Bringing Government Closer to the Citizens

The challenging era of online services has moved its forces towards government sector just the way it has forced commercial and business sectors to move into online businesses. In this piece of work I have tried to explain whether the advent of e-government helps the governments to get closer to the citizens. This article is based on literature review that highlights the impacts and factors of egovernment which affects efficiency, citizen participation, trust and transparency in services the government takes online.

A qualitative study of U.S. veterans' reasons for seeking Department of Veterans Affairs disability benefits for posttraumatic stress disorder

Posttraumatic stress disorder (PTSD) is the most prevalent compensable mental disorder within the U.S. Department of Veterans Affairs disability system and the number of veterans with PTSD service-connected disability has increased steadily over the past decade. An understanding of the reasons veterans apply for PTSD disability status may inform interpretation of this increase and policies and interventions to assist veterans with military-related PTSD. The authors conducted an exploratory qualitative study to describe the reasons veterans seek PTSD disability benefits and explored differences between those who served in different military service eras. They gathered data through in-depth interviews with 44 purposefully selected U.S. veterans, and conducted content analysis of transcribed interviews using inductive and deductive analysis with constant comparison. Participants described 5 interrelated categories of reasons for seeking PTSD disability benefits, including 3 internal factors (tangible need, need for problem identification or clarification, beliefs that justify/legitimize PTSD disability status) and 2 external factors (encouragement from trusted others and professional assistance). There were no major differences by service era. Findings may help policy makers, providers, and researchers understand what veterans hope to achieve through PTSD disability and the instrumental role of social networks and government systems in promoting the pursuit of PTSD disability status.

From War to Prison: Examining the Relationship Between Military Service and Criminal Activity

In February of 2008 the New York Times ran a series—War Torn—on Iraq and Afghanistan war veterans and their adjustment to civilian life upon return from the war zone. The authors assessed the criminal involvement of veterans by using newspaper accounts and other open source data to identify homicides in which the offender was an Afghanistan or Iraq war veteran. This particular aspect of the series drew a great deal of criticism, in part because of disagreements about the wisdom of the wars, but also because the sources of data used were perceived as less than systematic and accurate. This series and the debate that it engendered raised once again to prominence the issue of whether veterans are disproportionately involved in crime upon their return from service and specifically from combat assignments. The series also raised the question of whether media accounts of violent behavior by returning combat veterans are simply anecdotal or if they portend a more system-wide problem. This paper uses data from the Surveys of Inmates of State and Federal Correctional Facilities and the Current Population Surveys from 1985 to 2004 to estimate more systematically the prevalence and nature of the offending by military veterans in civilian society. The study seeks to avoid some of the methodological weaknesses of earlier studies that examined the criminal behavior of returning veterans. Specifically, the research considers whether criminal behavior, as reflected in the likelihood of imprisonment, is affected by military service, era of service, or service during wartime after controlling for social and demographic characteristics associated with offending. The findings indicate that military service in general is not predictive of incarceration when key demographic and social integration variables are taken into account. Service during wartime was found to be inversely related to subsequent incarceration, while veterans of the post-1973 All Volunteer Force were more likely to be incarcerated than were civilians and veterans who served during the draft era.

New era of simulation services for SMEs

Over the last 20 years, personal computer has made big footprints to make this world better. Today, nobody can get any information without computer and network. At working places, at home and even at a resort, everyone is enjoying life with computers, with the Internet and the cyberspace to improve the working efficiencies. That is, a new generation of computing environment is just starting for all mankind to provide better services over the network, and it bears the ‘cloud computing’ concept. Computer aided engineering (CAE) was born ∼30 years ago, and today, so many fields are introducing CAE technologies to get better information, to produce objects with high efficiencies at low price. In foundries, so many CAE software packages are on sale in the world. Almost all of them include heat transfer analysis, fluid dynamics, structural analysis and microstructure morphology predictions, and more modelling methods are being developed by many researchers in the world. In respect that more foundries should introduce CAE technologies to their manufacturing field to jump up to the next technology level, e-business should be introduced into technology providing and supporting markets. Because of the expensive price of CAE tools, many small/medium sized enterprises are hesitating to try or introduce these technologies into their manufacturing field. To provide more helpful technologies based on CAEs, the authors developed and started new CAE services over the Internet. Everyone can enjoy CAE services through the Internet by a simple click. The user can download pre- and post-processors through the Internet, and then they can manipulate any operation using the downloaded application. All the solvers run at cluster computers behind the clouds. Therefore, users do not need to know how their jobs run, but they can carry out CAE jobs anywhere through the Internet.

A Five-Step Guide for Moving from Observational Studies to Interventional Research for Women Veterans

A Five-Step Guide for Moving from Observational Studies to Interventional Research for Women Veterans

Future directions for digital television [Industry Perspectives

With the transition to digital television (DTV) receding quickly in the rear view mirror, the various industries encompassed by "broadcasting" are looking toward what's next. Not just looking, actually; they are doing something about it. The Advanced Television Systems Committee (ATSC) has launched a number of initiatives intended to move the broadcast industry into a new era of service to consumers.

Substance Use Comorbidity among Veterans with Posttraumatic Stress Disorder and Other Psychiatric Illness

There is considerable concern about the emergence of significant substance abuse among younger veterans of war in the Middle East, especially among those with Posttraumatic Stress Disorder (PTSD), but little information exists on the magnitude of this problem. Using national administrative data from the Department of Veterans Affairs (VA) (n = 1,001,996), we examined rates of diagnosed substance use disorders in Veterans who served in Iraq and Afghanistan diagnosed with PTSD compared to other psychiatric disorders; and compared rates among veterans of other service eras. Of VA patients with a selected mental disorder, 21.0% had a comorbid substance diagnosis. Veterans who served in the post-Vietnam era (VET) (1973-1991) had the highest rates of comorbidity. Logistic regression models indicated that veterans with each selected psychiatric diagnosis were significantly more likely to be dually diagnosed in comparison to veterans with PTSD; post-Vietnam veterans were significantly more likely to be dually diagnosed than veterans from other eras. Bipolar disorder and schizophrenia are most strongly associated with dual diagnosis in OEF/OIF (Operation Enduring Freedom/Operation Iraqi Freedom) veterans. There are high rates of substance use disorders among veterans with mental illness. The highest rates of comorbidity occur among those with bipolar disorder and schizophrenia; and in post-VET veterans.

Gifting, service, and performance: three eras in minority‐language media policy and practice

Adapting Tom Ricento's (2006) three‐era framework in language policy to the case of the Sámi in Finland and Irish in the Republic of Ireland, we identify three key eras in the development of minority‐language media: the gifting era, the service era, and the performance era. Each era has its own particular logic and normativities in relation to the value and functions allocated to minority‐language media, the key actors involved in these media, and concepts of languages and speakers. Although we observe a chronology in the evolution of these eras, previous eras do not simply disappear with this evolution. We argue instead that they are embedded in any single moment of media engagement in relation to minority languages and with implications for speakers.Soveltaen Tom Ricenton (2006) kolmen aikakauden viitekehystä, tarkastelemme tässä artikkelissa vähemmistökielisen median kehittymisen kolmea keskeistä aikakautta: lahjan aikakautta, palvelun aikakautta ja performanssin aikakautta. Tapaustutkimuksemme liittyvät saamenkieliseen mediaan Suomessa ja iirinkieliseen mediaan Irlannissa. Tuomme artikkelissamme esille, kuinka jokaisella aikakaudella on oma logiikkansa ja normatiivisuutensa, jotka organisoivat vähemmistökieliin liittyviä arvostuksia ja toiminnallisuutta, keskeisiä mediatoimijoita sekä käsityksiä kielistä ja niiden puhujista. Vaikka näiden aikakausien kehittymisessä voidaan huomata tiettyä kronologisuutta, aikaisemmat aikakaudet eivät yksinkertaisesti häviä tässä kehitysprosessissa. Jokainen aikakausi on mukana puhuttaessa median suhteesta vähemmistökieliin ja tällä puolestaan on vaikutuksia kielten puhujiin.

Serving Those Who Served: Retention of Newly Returning Veterans From Iraq and Afghanistan in Mental Health Treatment

There are growing concerns about the mental health status of returning veterans from the recent conflicts in Iraq (Operation Iraq Freedom [OIF]) and Afghanistan (Operation Enduring Freedom [OEF]) and about retention in mental health treatment of veterans with posttraumatic stress disorder (PTSD). This study obtained data from veterans who had a new diagnosis of PTSD from fiscal year (FY) 2004 to FY 2007 and determined whether retention in PTSD treatment and the number of mental health visits were comparable among OIF-OEF veterans and veterans from other service eras. Data from the Department of Veterans Affairs and the Department of Defense were combined to identify veterans who were newly diagnosed as having PTSD (N=204,184) and their service era. Survival analysis assessed dropout from mental health treatment within one year from initial diagnosis, and Poisson regression assessed the association between war era and number of mental health visits. Although a smaller proportion of OIF-OEF veterans than Vietnam-era veterans remained in treatment for more than one year (37.6% versus 46.0%), when the analyses adjusted for demographic characteristics and comorbid diagnoses, OIF-OEF veterans were less likely than Vietnam-era veterans to discontinue psychiatric treatment for PTSD within one year. OIF-OEF veterans attended fewer mental health visits than Vietnam-era veterans did (8.15 versus 13.37). However, multivariate analysis indicated that, after the analyses adjusted for confounding factors, OIF-OEF veterans had significantly more visits than Vietnam-era veterans associated with PTSD treatment. Retention and numbers of visits were found to be lower among OIF-OEF veterans primarily as a function of age and comorbid conditions and not as a function of the particular war era. Interventions should be designed to target specific barriers to care that may interfere with continued engagement in mental health services.