Era Of Services Research Articles

Comparing MMPI-2-Restructured Form Scores by Service Era for Veterans Assessed Within the Veteran Affairs Healthcare System.

This study compares profiles of Minnesota Multiphasic Personality Inventory-2-Restructured Form (MMPI-2-RF) scale scores from 1492 VA test-takers who served during the Vietnam or Gulf War service eras. The sample includes all such cases collected at any VA posttraumatic stress disorder Clinical Teams across the United States between January 1, 2008 and May 31, 2015 using the MMPI-2 or MMPI-2-RF (via the VA Mental Health Assistant suite). Associations between gender and score differences were also examined. In contrast to past research using the MMPI-2, results of this study suggest that veterans are generally homogeneous in their MMPI-2-RF profiles across different periods of service. Specifically, the magnitudes of mean differences are small and not clinically significant. Thus, responses on the MMPI-2-RF do not appear influenced by service era. Implications for the clinical use of, and research with, the MMPI-2-RF are discussed within the VA healthcare system.

Peer support in an outpatient program for veterans with posttraumatic stress disorder: Translating participant experiences into a recovery model.

Veterans returning from recent conflicts present with increased rates of posttraumatic stress disorder (PTSD), and veterans from prior service eras continue to seek trauma-based services. Peer support for veterans with PTSD has the potential to resolve ongoing challenges in access and engagement in mental health care. Assessing the value of peer support services requires a thorough understanding of the expected role and the empirical mechanisms of peer support participation in PTSD recovery. To better understand these mechanisms, this study interviewed 29 veteran participants from an established peer support program (PSP), located in the Central Valley of the Veterans Affairs (VA) Palo Alto Health Care System (VAPAHCS) in Northern California. A domain analysis of narrative transcripts generated 34 codes through a grounded theory method. Codes were organized into the following thematic categories: the perceived role of the PSP, supportive experiences of the PSP, global gains from the PSP, and limitations to PSP and further mental health engagement. These results were synthesized into a theoretical model that identifies improved functioning and reduced distress as the expected outcomes of PSP-mediated recovery and illustrates the continuum from in-group experiences to these outcomes. Our results suggest that PSP-mediated recovery is defined as acceptance of PTSD into daily life and identity, rather than resolution of symptoms. This conceptualization has implications for peer support provider training, PSP integration into health care settings, and future outcome analyses on the effectiveness of PSPs. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Functional Cartography – About the quality of maps from the era of artefacts to the era of services and beyond

Abstract. Cartography as a discipline is generally concerned with communicating spatial information to human users (Kraak et al 2017). This is done through applying methods to communicate spatial information by visually perceivable graphical codes. This transfer is needed only because of the restricted human perception system (MacEachren 1995). The subsequently applied cartographic methods are generally sacrificing the quality, accuracy, homogeneity and integrity of the processed spatial data for the sake of human-perceivable aggregated and subsequently abstracted information. Usually this results in representation models, speaking of maps as the most common ones. While the production of maps, including all methods dealing with transforming data into graphics such as generalisation, symbolisation have been heavily looked into in research traditionally, the way maps are used or can be used is recently gaining stronger interest, such as from cognitive and perception perspectives, dealing with questions such as “how maps work”. However, it can be argued, that even if we know a lot about how maps can be produced and modelled, and how they work, we ultimately are not able to say if a map is “good” in terms of satisfying the needs and demands of a particular user in a particular situation and context, thus describing the concept of quality of maps (Gartner 1998). A map can be designed in a way, that it it perceivable, has no graphic conflicts, communicates particular spatial information but might not be leading into the same satisfaction as another map depicting the same spatial information in a different way. We can think of this as similar to other communication forms, e.g. human communication. Although two persons might express something similar, differences in the words which are used, how they are used, how they are pronounced, how quick/slow/loud they are spoken, of whom they are expressed and in which situation are influencing, whether one or the other communication is more effective and successful and seen as the one with “higher quality” (Gartner 1998). Maps have a variety of functions (Morrison 1978). It can be assumed, that only if the map fulfils those particular function, it is assessed and judged as a good map. But what are those functions? Some are related to the data and the information which is depicted in the map (how accurate, how complete), some are related to the way the data is visualised and graphically depicted (how perceivable, how clear) and some are related to the user and his context (how pleasing, how entertaining, how useful, how informative, how “enabling”). In this paper a structured analysis of the functions of maps due to the various context dimensions of the cartographic communication process will be given. It is argued, that cartography as a discipline is going through a major change of paradigms, the cartographic era of artefacts is replaced by the era of services while a cognitive era in the domain of cartography can be envisioned already (Griffin et al 2017). For all of those eras different functions and criterias of qualities need to applied.

Impact of pharmacy services on cystic fibrosis transmembrane conductance regulator modulator prescribing at a pediatric cystic fibrosis center.

This study was undertaken to determine if the presence of a clinical pharmacy team impacted patients' access to cystic fibrosis transmembrane conductance regulator (CFTR) modulators. A retrospective chart review of electronic medical records from the University of Iowa Hospitals and Clinics (UIHC) was conducted. Data were collected regarding the timing of prior authorization (PA) submissions and approvals from 2012 to 2018. The Wilcoxon rank-sum test was used to compare the meantime (days) between prescription and PA submission dates, and PA submission and approval date for all patients included in the analysis. Comparisons were made for pre- and postpharmacy services eras as well as the UIHC Specialty Pharmacy versus a non-UIHC Specialty Pharmacy. Sixty-three patients were included in the final analysis. The average time between prescription date and PA submission was 12.5 days (standard deviation [SD] = 17.4 days) in the preclinical pharmacy services era and 3.5 days (SD = 5.8 days; P = .028) in the postclinical pharmacy services era. The average time to PA submission significantly decreased from 9.8 days (SD = 13.1 days) to 1.3 days (SD = 4.2 days; P < .0001) when prescriptions were filled by the UIHC Specialty Pharmacy vs a non-UIHC Specialty Pharmacy. There was a significant benefit to CFTR modulator prescribing when clinical pharmacy services were incorporated in our cystic fibrosis (CF) care team, which will become increasingly important with the anticipation of new CF medications in the near future.

P049 Changing population and treatment of children and young people with cystic fibrosis in post newborn screening era in a local shared care service

P049 Changing population and treatment of children and young people with cystic fibrosis in post newborn screening era in a local shared care service

Accelerating the Growth of Evidence-Based Care for Women and Men Veterans.

Accelerating the Growth of Evidence-Based Care for Women and Men Veterans.

The new era of service: new roles, new places and new partnerships

Healthcare is in an unprecedented time of change. Our aging population experiences more chronic disease. The rapid expansion of technology and AI learning in diagnostics and care offer opportunities to think and care in new ways. We are learning from an unprecedented amount and speed of research production. Spreading new models of care quickly and reliably is on the agenda for all senior leaders. We have more diversity in the workforce, with five distinct generations for the first time in history. And increasingly, patients will be co-designers in the health and care. Our work today clearly needs innovations and new ways to think about health and care.

Comorbid mood and anxiety disorders and severity of posttraumatic stress disorder symptoms in treatment-seeking veterans.

Comorbidity is the rule and not the exception among veterans with posttraumatic stress disorder (PTSD). Examining comorbidities in a veteran population allows us to better understand veterans' symptoms and recognize when mental health treatment may need to be tailored to other co-occurring issues. This article evaluates comorbid mood and anxiety disorders and PTSD symptom severity in a large sample of veterans from multiple eras of service, including the recent wars in Iraq and Afghanistan. The current study used data from veterans who sought treatment for PTSD at a VA PTSD Clinical Team from 2005 to 2013. Veterans were assessed for PTSD, mood, and anxiety disorders using a structured clinical interview and completed self-report symptom measures as part of the PTSD clinic intake procedure. A total of 2,460 veterans were evaluated, and 867 met diagnostic criteria for PTSD. Veterans with PTSD were significantly more likely than those without PTSD to be diagnosed with social anxiety disorder and obsessive-compulsive disorder, but significantly less likely to be diagnosed with depression. In addition, veterans who had at least one comorbid diagnosis in addition to PTSD reported significantly higher PTSD symptom severity than veterans with PTSD alone. PTSD symptom severity also varied by era of service. These results suggest that among veterans seeking treatment for PTSD, comorbid mood and anxiety disorders may be associated with greater severity of PTSD symptoms. Future work is needed to determine the impact of specific comorbidities on trauma-focused treatment outcomes. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Predictors of dropout from a randomized clinical trial of cognitive processing therapy for female veterans with military sexual trauma-related PTSD

Many veterans do not complete evidence-based treatments (EBTs) for posttraumatic stress disorder (PTSD). Veterans with military sexual trauma (MST)-related PTSD were shown to have higher than average rates of dropout from PTSD treatment in a national study of EBT implementation. Although predictors of dropout from EBTs have been identified, these factors are largely unmodifiable (e.g., age, service era). The purpose of the present study was to identify dynamic psychosocial predictors of dropout among female veterans from cognitive processing therapy (CPT). Data were utilized from 56 female veterans who participated in a randomized clinical trial investigating the effectiveness of CPT for MST-related PTSD. Dropout was defined continuously (i.e., number of sessions attended) and dichotomously (i.e., attending six or more sessions). Potential predictors included sociodemographic factors, psychotherapist fidelity, PTSD-related service connection, psychiatric symptom severity (i.e., PTSD, depression), trauma-related negative cognitions (about self, self-blame, world), and treatment expectations. Higher trauma-related negative cognitions about self-blame and lower trauma-related negative cognitions about self were protective against dropout. The current study generated testable hypotheses for further research on dynamic predictors of dropout from CPT in female veterans with MST-related PTSD. With replication, results may assist with identifying pre-treatment strategies to reduce dropout in this clinical population.

Protection Of Customers for Management of Digital Banking Services (Study at PT. BRI Unit Boyolali)

Increasing competition in the Indonesian banking industry has encouraged many banks to improve the quality of services to customers by utilizing information technology developments. Service innovation in the use of information technology encourages banks to enter the era of digital banking services. However, the development of digital banking services also increases the risks faced by banks. The purpose of this study is to provide an overview of the implementation of digital banking services and customer protection for risks from digital banking services. The method used in this study is an empirical legal research method. The results of this study indicate that the implementation of digital banking services is regulated by OJK Regulation No.12/POJK.03/2018. The existence of this OJK Regulation is expected by banks as providers of digital banking services to always prioritize risk management in the use of information technology. In addition, this study also shows the existence of 2 types of customer protection for the use of digital banking services, namely preventive protection in the form of legislation related to customer protection in the financial services sector and repressive protection in the form of bank accountability for complaints from customers using digital banking services.

Changes in Post-traumatic Stress Disorder Service Connection Among Veterans Under Age 55: An 18-Year Ecological Cohort Study.

Mandatory, age-based re-evaluations for post-traumatic stress disorder (PTSD) service connection contribute substantially to the Veterans Benefits Administration's work load, accounting for almost 43% of the 168,013 assessments for PTSD disability done in Fiscal Year 2017 alone. The impact of these re-evaluations on Veterans' disability benefits has not been described. The study is an 18-year, ecological, ambispective cohort of 620 men and 970 women receiving Department of Veterans Affairs PTSD disability benefits. Veterans were representatively sampled within gender; all were eligible for PTSD disability re-evaluations at least once because of age. Outcomes included the percentage whose PTSD service connection was discontinued, reduced, re-instated, or restored. We also examined total disability ratings among those with discontinued or reduced PTSD service connection. Subgroup analyses examined potential predictors of discontinued PTSD service connection, including service era, race/ethnicity, trauma exposure type, and chart diagnoses of PTSD or serious mental illness. Our institution's Internal Review Board reviewed and approved the study. Over the 18 years, 32 (5.2%) men and 180 (18.6%) women had their PTSD service connection discontinued; among them, the reinstatement rate was 50% for men and 34.3% for women. Six men (1%) and 23 (2.4%) women had their PTSD disability ratings reduced; ratings were restored for 50.0% of men and 57.1% of women. Overall, Veterans who lost their PTSD service connection tended to maintain or increase their total disability rating. Predictors of discontinued PTSD service connection for men were service after the Vietnam Conflict and not having a Veterans Health Administration chart diagnosis of PTSD; for women, predictors were African American or black race, Hispanic ethnicity, no combat or military sexual assault history, no chart diagnosis of PTSD, and persistent serious mental illness. However, compared to other women who lost their PTSD service connection, African American and Hispanic women, women with no combat or military sexual assault history, and women with persistent serious illness had higher mean total disability ratings. For both men and women who lost their PTSD service connection, those without a PTSD chart diagnosis had lower mean total disability ratings than did their counterparts. Particularly for men, discontinuing or reducing PTSD service connection in this cohort was rare and often reversed. Regardless of gender, most Veterans with discontinued PTSD service connection did not experience reductions in their overall, total disability rating. Cost-benefit analyses could help determine if mandated, age-based re-evaluations of PTSD service connection are cost-effective.

Opportunities and Challenges of mmWave NR

The realization of a seamless, fully connected world requires enhancements to our current communications technology, from both a network infrastructure perspective and a user equipment (UE) perspective. These demands are directly driven by the consumer’s expectations, application requirements, and saturation of frequency bands used in current spectrum. The fifth generation (5G) of mobile communication networks, and specifically millimeter-wave (mmWave) New Radio (NR), aims to enable this future with ultra-low-latency, ultra-wideband services, opening up a whole new era of applications and services, much like 4G Long Term Evolution (LTE) did a decade ago. To enable 5G, the Third Generation Partnership Project (3GPP) is focusing on defining the technical specifications for NR technology, as well as enhancements to the current LTE. However, enabling and launching 5G NR presents both technological opportunities and challenges. In this column, we explore how 5G mmWave challenges are being approached in 3GPP standardization and how solutions can enable the technology to help achieve broader bandwidths and harness some of the inherent benefits of higher-frequency communications.

Mental Health Treatment Delay: A Comparison Among Civilians and Veterans of Different Service Eras

The study compared delay of treatment for posttraumatic stress disorder (PTSD), major depressive disorder, and alcohol use disorder among post-9/11 veterans versus pre-9/11 veterans and civilians. The 2012-2013 National Epidemiologic Survey on Alcohol and Related Conditions-III (NESARC-III), a nationally representative survey of U.S. noninstitutionalized adults, was used. Participants included 13,528 civilians, 1,130 pre-9/11 veterans, and 258 post-9/11 veterans with lifetime diagnoses of PTSD, major depression, or alcohol use disorder. Cox proportional hazard models, controlling for relevant demographic characteristics, were used to estimate differences in treatment delay (i.e., time between diagnosis and treatment). Post-9/11 veterans were less likely to delay treatment for PTSD and depression than pre-9/11 veterans (adjusted hazard ratios [AHRs]=0.69 and 0.74, respectively) and civilians (AHRs=0.60 and 0.67, respectively). No differences in treatment delay were observed between post-9/11 veterans and pre-9/11 veterans or civilians for alcohol use disorder. In an exploratory analysis, post-9/11 veterans with past-year military health care coverage (e.g., Veterans Health Administration) had shorter delays for depression treatment compared with post-9/11 veterans without military coverage, pre-9/11 veterans regardless of health care coverage, and civilians, although past-year coverage did not predict treatment delay for PTSD or alcohol use disorder. Post-9/11 veterans were less likely to delay treatment for some common psychiatric conditions compared with pre-9/11 veterans or civilians, which may reflect efforts to engage recent veterans in mental health care. All groups exhibited low initiation of treatment for alcohol use disorder, highlighting the need for further engagement efforts.

Factors Affecting Service Innovation, Customer Value toward Customer Satisfaction: Case on Health Care Industry

The fierce competition among industries and the rapid environment changes have health care companies not only face the competitive prices of products but also bear the pressure of shortening product life cycle. Looking back the barter time before, there was not customer service. With the time and space changes, customer service is constantly enhanced along with the economic development. In the service era, a business should complete the service value from the aspect of customer to achieve the goal of customer satisfaction, actively understand customers’ real needs, and provide products and services required for customers in order to create higher service value for customers. Taking the employees of health care industry in Shanghai City as the research object, questionnaire survey is used for collecting relevant data. With statistical analyses, the following research conclusions are summarized: (1) Service innovation shows significantly positive correlations with customer value; (2) Customer value reveals remarkably positive correlations with customer satisfaction; (3) Service innovation reveals notably positive correlations with customer satisfaction. Reference for health care industry making operation policies is provided in this study. By strengthening customer value and customer satisfaction, it is expected to enhance customer loyalty and create the niche for the sustainable management of health care industry.

MENTAL HEALTH DIAGNOSES IN VETERANS REFERRED FOR OUTPATIENT GERIATRIC PSYCHIATRIC CARE AT A VETERANS AFFAIRS MEDICAL CENTER

Introduction In 2015, 47% of the U.S. Veteran population consisted of individuals 65 years of age and older. This percentage is projected to remain stable for at least the next 15 years. Relative to non-veterans of similar age, older Veterans are at higher risk for mental health disorders. The negative impacts of these conditions are substantial. Later-life depression and neurocognitive disorders are associated with impaired function, increased mortality, diminished health and functioning of caregivers, and significant health care costs to society. There is a relative shortage of geriatric specialty-trained providers, and a lack of necessary knowledge and skills to meet the mental health needs of the aging population, particularly among Veterans. With recognition that the supply of geriatric specialty-trained providers is unable to keep pace with the number of Veterans seeking their services, we are conducting a Quality Improvement initiative to advance the efficiency and delivery of mental health interventions for older Veterans served at the Minneapolis Veterans Affairs Health Care System (MVAHCS). This presentation reports the initial efforts to understand the demographic and diagnostic characteristics of Veterans seen for outpatient geriatric subspecialty mental health care at MVAHCS. Methods Retrospective chart review of demographics and psychiatric diagnoses in Veterans seen for outpatient geriatric mental health intake between May 1, 2011 and April 30, 2016, at the MVAHCS. Descriptive statistics were performed using Microsoft Excel. Chi-square analysis of diagnosis by military service era were conducted using SPSS version 19. Results A total of 1059 Veterans were evaluated. Descriptive statistics on age, sex, race, marital status, military service era and mental disorder prevalence are reported in the Table. 1732 mental health diagnoses were coded among the Veteran sample. The top ten mental health diagnostic categories, in descending order of prevalence, included: depression, neurocognitive, anxiety, posttraumatic stress, alcohol use, adjustment, sleep, mood/bipolar, personality, psychosis. Prevalence of depressive, neurocognitive, anxiety, posttraumatic stress, and alcohol use disorders showed a statistically significant association with service era. Depressive disorders were most prevalent in Vietnam Veterans (56%), whereas neurocognitive disorders were most prevalent in World War II Veterans (71%) (see Figure). Conclusions The prevalence of major mental health conditions is high in Veterans seen in geriatric psychiatry. When examining diagnoses within service era subgroups, these subgroups differ in the prevalence of several major diagnostic categories. Vietnam Veterans show a relatively higher prevalence of depressive, posttraumatic stress, and alcohol use diagnoses. This finding is consistent with other studies supporting elevated rates of psychiatric problems in Vietnam Veterans relative to other service eras, potentially due to differing military experiences and relatively less homecoming support. As the relatively younger group, they represent the cohort that geriatric specialists will see in larger proportion over the coming years. Also, as age is the primary risk factor in later-life neurodegenerative diseases, we anticipate greater incidence of neurocognitive disorders among Vietnam Veterans in the future. In the present study, post-hoc analysis of the association of age with neurocognitive disorder prevalence showed a significant positive correlation (Spearman's rho = 0.38, p This research was funded by None.

Assessment of Node- and Link- Level Blocking and Creating Cost-Effective Networks in the Era of Large Bandwidth Services

Assessment of Node- and Link- Level Blocking and Creating Cost-Effective Networks in the Era of Large Bandwidth Services

Comparing post-Gulf War and post-9/11 era of service among veterans: Intimate partner violence and substance use by race and ethnicity

Using structural equation modeling to examine intimate partner violence (IPV) among post-Gulf War and post-9/11 military families, this study considers variations of IPV from the point of the perpetrator to test the impact of demographic factors on the type of IPV most prevalent among military perpetrators. The study sample contains information about 449 male veterans from the National Longitudinal Study of Adolescent to Adult Health (1994–2008): Waves I and IV in-home interviews. Study findings indicate that the perpetration of physical and sexual IPV depends on the context of veteran cohort and race/ethnicity.

Paratransit as a connective mode for mass transit systems in Asian developing cities: Case of Bangkok in the era of ride-hailing services

Paratransit services have been established to mitigate poor accessibility in Asian developing cities. However, their potential role as a connective mode for mass transit systems is often overlooked. This study verifies the hypothesis that, due to the lack of guidance or planning by the government, paratransit services have been driven by market mechanisms to concentrate in areas closer to mass transit stations and other centers of economic activity, including markets. We tested this hypothesis with a negative binomial regression using data on motorcycle taxi services in Bangkok, as a case study. Motorcycle taxis mostly operate as a group, known as a win in Thai, waiting for passengers at certain places, including mass transit stations. Location data on 821 wins were randomly collected from 144 grid zones (= 144 km2) through Google Maps between July 24 and August 24, 2017. Win density was defined as the number of wins in each one-square-kilometer zone. The results showed that win density increased by 4.4% and 25.1% in zones that were 1 km closer to transit stations and markets, respectively, all else being held constant; this confirmed the hypothesis. Policy implications are discussed along with the recent penetration of ride-hailing services in the paratransit market.

A survey on content awareness challenges in IPTV delivery networks

Nowadays, with the evolution of digital video broadcasting, as well as, the advent of high speed broadband networks, a new era of TV services has emerged known as IPTV. IPTV is a system that exploits the high speed broadband networks to deliver TV services to the subscribers. From the service provider viewpoint, the challenge in IPTV systems is how to build delivery networks that exploits the resources efficiently and reduces the service cost, as well. However, designing such delivery networks are affected by many factors including choosing the suitable network architecture, load balancing, resources waste, and cost reduction. Furthermore, IPTV contents characteristics; particularly size, popularity, and interactivity play an important role in balancing the load and avoiding the resources waste for delivery networks. Ignoring the content status in solving delivery networks issues particularly replica placement, request distribution, and resource allocation problems leads to load imbalance, which in turn, leads to performance degradation in IPTV system. In this survey paper, we introduce IPTV delivery networks terminology and taxonomy. Upon that, we investigate the challenges related to the contents’ awareness in those delivery networks. At the end of the paper, we propose a content-awareness in ITV delivery networks and CDN as the future direction and discuss its importance in different aspects as request redirection, resource allocation, and replica placement.

A field survey on provision of health care service in a community clinic of Bangladesh: a case study of Raicho community clinic

Background: Community clinics have been restarted in 2009 by government of Bangladesh through a project called “Revitalization of Community Health Care Initiatives in Bangladesh” (RCHCIB) to enhance provision of healthcare services at community level. We have conducted a survey on provision of health care service to recognize the availability and extent of health services provided in a community clinic of Bangladesh.Methods: 25 respondents who usually receive primary health care service from Raicho community clinic situated in Comilla district of Bangladesh were included in the survey.Results: The highest number of respondents was male (52%) and the majority of them were literate (96%).36% of study population were included in no income group, whereas 20% belong to rich population group. 32% people presented with fever (32%) followed by weakness (24%) in the community clinic. 32% respondents went to community clinic for him/her and that was the highest. The highest number of people were referred to private clinic (32%). 70% respondents think that women are receiving maternal service in the clinic. 88% respondents have participated in EPI vaccination program. 80% respondents use contraceptive method and majority used contraceptive pill. 68% people received sufficient medicine, whereas 32% respondents did not receive medication from the clinic. 75% respondents think that during working hours CHCP and HA are available in the clinic. 48% population mentioned corruption is the most possible responsible factor for heath service inequalities at grass-root level.Conclusions: Although standards are lacking in providing services, community clinics have opened a new era in health service of Bangladesh.