Small VA Research Articles

THE GEOTOURIST ATTRACTIVENESS OF ŁAGOWICA RIVER VALLEY (HOLY CROSS MOUNTAINS, POLAND) – A PROJECT OF A GEOTOURIST TRAIL

Geotourist evaluation of thirteen small geological, geomorphological and mining heritage objects was carried out in a small v alley of the Upper Łagowica River and in its surroundings (Holy Cross Mountains, Poland). The point grading method was used, which is functional in the case of evaluation of small geotourist objects. It was shown that the analysed objects are characterized by high and medi um geotourist attractiveness. When analysed together, they strengthen their own individual values. They are suited to mark out geotourist trails ( geotrail), and additionally become a source of information about spatial changes of geodiversity. They also determine the uniqueness of this type of small river valleys of the Holy Cross Mountains on a regional and supra-regional scale. The evaluation of these objects and the proposal of a geotourist trail in the Upper Łagowica River valley may contribute to the activation of local communities and government authorities in the promotion of geoeducation and geotourism, draw their attention to the need for preservation and protection of the geodiversity of small va lleys of the Holy Cross Mountains, and, what is especially important, may give information about the investment attractiveness of the area.

Blackwelder and Cross collaborate in family medicine clinic

When Brian Cross, PharmD, first went to work for the Indian Health Service (IHS) on the San Carlos Apache Reservation in eastern Arizona in 1991, he believed that the physician-pharmacist collaboration that he encountered there—a model pioneered by the IHS and a handful of other federal agencies and private health care systems—as common across the country.

Abstract W P334: VA Healthcare System Responses to National Stroke Care Reorganization

Aims: In 2011, the VA released the Acute Ischemic Stroke (AIS) Directive which mandated reorganization of acute stroke care, including self-designation as Primary (P), Limited Hours (LH), or Supporting (S) stroke center. We conducted interviews across stroke centers to understand barriers and facilitators faced in response. Methods: The final sample included 38 (84% invited) facilities: 9 P, 24 LH, and 5 S facilities. In total, 107 persons were interviewed including ED Chiefs, Chiefs of Neurology, ED Nurse Managers/Nurses and other staff. Semi-structured interviews were based on the AIS Directive. Completed interviews were transcribed and analyzed using Nvivo 10. Results: Barriers reported were a lack of personnel assigned to coordinate the facility response to the directive. Data collection and lack of staff were likewise commonly reported as barriers. For thrombolysis measures, the low number of eligible Veterans was another major barrier. LH and S facilities reported some unique barriers: access to radiology and neurology services; EMS diverting stroke patients to nearby stroke centers, maintaining staff competency, and a lack of stroke clinical champions. Some solutions applied included cross training X-ray technicians to provide head CT coverage, developing stroke order sets and templates, and staff training. Larger facilities added a stroke code pager system and improved upon its use, and established ED nurses to become first alerts for an acute stroke patient. LH and S facilities also responded by attempting to secure additional services and by establishing formal transfer agreements to improve Veteran tPA access. Conclusions: The AIS Directive brought focused attention to reorganizing and improving stroke care across a range of facility types. Larger VA facilities tended to follow established practices for organizing stroke care, but the unique LH designation presented challenges to consistently organize systems. Since Veterans have financial interest in presenting to a VA facility, ongoing work to organize VA care and to improve access to thrombolysis at smaller VA facilities is needed. This protocol was supported by Genentech Inc. Protocol ML 28238, VA HSRD QUERI Rapid Response Project 11-374, and the VA Stroke QUERI Center.

Visual Acuity Level, Ocular Morbidity, and the Better Seeing Eye Affect Sensitivity and Responsiveness of the Visual Function Index

To examine the relation between Visual Function Index-14 (VF-14) scores and VA by accounting for concurrent ocular comorbidities, effect of the better seeing eye (BSE), and VA before and after cataract surgery. Prospective cohort study. A total of 4335 patients with cataract who completed the VF-14 before and after cataract surgery. Collaborating clinicians provided demographic and clinical data before and after cataract surgery. Lowess curves, general linear models, and Spearman correlation coefficients were used to study the relation between the VF-14 and the VA. Scores in the VF-14 preintervention, change in VF-14 after surgery, VA before surgery, and VA change after surgery. General linear models and Spearman correlation coefficients showed a significant (P < 0.0001) association between VF-14 score and VA (measured in decimal fraction) when the preoperative VA was ≤0.5 (20/40) and no association (P > 0.4020) when the VA was >0.5 (20/40). Small VA gains (≤0.5) after surgery only led to significant gains (P < 0.0001) in functionality in patients with other ocular pathologies and whose BSE was the surgical eye. Gains in VA >0.5 had a significant (P < 0.02) effect on VF-14 change scores in most patients. The VF-14 seems to be more sensitive when the preoperative VA is <0.5 (20/40), especially in patients whose BSE is the surgical eye. The VF-14 seems responsive to increases in VA if the gains exceed 0.5. For gains <0.5, the VF-14 seems unresponsive, except for patients with other ocular pathologies in whom the BSE before and after surgery is the surgical eye.

Prenatal MR imaging of Dandy-Walker complex: Midline sagittal area analysis

To measure the mid-sagittal areas of vermis (VA) and of posterior fossa (PFA) and determine their differences among fetuses with various Dandy-Walker (DW) entities and control subjects. We reviewed data in 25 fetal patients with a MR diagnosis of DW complex including hypoplastic vermis (HV), HV with rotation (HVR), and mega cistern magna (MCM), and in 85 fetal controls with normal CNS. PFA and VA of each subject were manually traced on mid-sagittal MR images. Regarding each of VA and PFA, after age correction, we determined statistically significant differences among HVR, HV, MCM, and control groups. The mean VA residue of MCM was greater than that of the control, which was in turn greater than those of HVR and HV. The mean PF residue of the control was smaller than all other groups. Fetuses with HVR or HV had smaller VA than fetuses with MCM or control subjects. Fetuses with MCM, HVR, or HV had larger PFA than control subjects. These results may be an early step leading to better understanding of the confusion about the PF anomalies in future.

A randomized trial of telemedicine-based collaborative care for depression.

Evidence-based practices designed for large urban clinics are not necessarily portable into smaller isolated clinics. Implementing practice-based collaborative care for depression in smaller primary care clinics presents unique challenges because it is often not feasible to employ on-site psychiatrists. The purpose of the Telemedicine Enhanced Antidepressant Management (TEAM) study was to evaluate a telemedicine-based collaborative care model adapted for small clinics without on-site psychiatrists. Matched sites were randomized to the intervention or usual care. Small VA Community-based outpatient clinics with no on-site psychiatrists, but access to telepsychiatrists. In 2003-2004, 395 primary care patients with PHQ9 depression severity scores > or = 12 were enrolled, and followed for 12 months. Patients with serious mental illness and current substance dependence were excluded. Medication adherence, treatment response, remission, health status, health-related quality of life, and treatment satisfaction. The sample comprised mostly elderly, white, males with substantial physical and behavioral health comorbidity. At baseline, subjects had moderate depression severity (Hopkins Symptom Checklist, SCL-20 = 1.8), 3.7 prior depression episodes, and 67% had received prior depression treatment. Multivariate analyses indicated that intervention patients were more likely to be adherent at both 6 (odds ratio [OR] = 2.1, p = .04) and 12 months (OR = 2.7, p = .01). Intervention patients were more likely to respond by 6 months (OR = 2.0, p = .02), and remit by 12 months (OR = 2.4, p = .02). Intervention patients reported larger gains in mental health status and health-related quality of life, and reported higher satisfaction. Collaborative care can be successfully adapted for primary care clinics without on-site psychiatrists using telemedicine technologies.

ナノ結昌Ｆｅ−Ｎｂ−Ｂ（−Ｐ−Ｃｕ）合金の微細構造と軟磁気特性

The effects of the structural inhomogeneity, volume fraction (va), and Curie temperature (Tcam) of an inter-granular amorphous phase on the soft magnetic properties of nanocrystalline Fe-Nb-B(-P-Cu) alloys were investigated. The Fe85Nb6B9 alloy has a mixed as-quenched structure composed of an amorphous phase and α-Fe grains, and an inhomogeneous nanostructure including coarse α-Fe grains with a diameter of about 40 nm after crystallization. The simultaneous replacement of B by 1 at% P and Fe by 0.1 at% Cu in the alloy decreases the α-Fe grain size to the nano-scale in an as-quenched state and leads to a homogeneous nanostructure, small va, and high Tcam after crystallization. Analysis based on the random anisotropy model shows that a homogeneous nanostructure with small va and high Tcam provides good soft magnetic properties.

Temperature dependence of the water‐sorption isotherms of wool

Against the background of various other theories, the well-established D'Arcy/Watt model is applied to sorption data of wool between 20 and 100°C to determine its suitability to describe the isotherms and to systematize their temperature dependence. The model contains three components that represent two types of primary adsorption processes (Langmuir- and Henry-type adsorption) and a third one, describing multilayer formation of water molecules. Sorption isotherm data, as taken from the literature, could, in all cases, be fitted extremely well by the model. The temperature dependence of the five parameters of the model, related to the continuous decrease of water regain with increasing temperature for all humidities, reveals a number of inconsistencies. Probably the most important of these is that the Langmuir capacity constant apparently becomes zero at the glass transition temperature of dry wool. This is at variance with the idea of specific molecular sites of water sorption, which is inherent to the model. Other inconsistencies relate to the small van't Hoff enthalpies and possible compensation effects for various parameters. These observations indicate that the D'Arcy/Watt theory, despite its physicochemical plausibility and empirical success, overinterprets the complexity of the mechanisms underlying the sorption behavior of wool and other α-keratin fibers. © 2000 John Wiley & Sons, Inc. J Appl Polym Sci 79: 1054–1061, 2001

Temperature dependence of the water-sorption isotherms of wool

Against the background of various other theories, the well-established D'Arcy/Watt model is applied to sorption data of wool between 20 and 100°C to determine its suitability to describe the isotherms and to systematize their temperature dependence. The model contains three components that represent two types of primary adsorption processes (Langmuir- and Henry-type adsorption) and a third one, describing multilayer formation of water molecules. Sorption isotherm data, as taken from the literature, could, in all cases, be fitted extremely well by the model. The temperature dependence of the five parameters of the model, related to the continuous decrease of water regain with increasing temperature for all humidities, reveals a number of inconsistencies. Probably the most important of these is that the Langmuir capacity constant apparently becomes zero at the glass transition temperature of dry wool. This is at variance with the idea of specific molecular sites of water sorption, which is inherent to the model. Other inconsistencies relate to the small van't Hoff enthalpies and possible compensation effects for various parameters. These observations indicate that the D'Arcy/Watt theory, despite its physicochemical plausibility and empirical success, overinterprets the complexity of the mechanisms underlying the sorption behavior of wool and other α-keratin fibers. © 2000 John Wiley & Sons, Inc. J Appl Polym Sci 79: 1054–1061, 2001

Pressure ulcer development in the VA: characteristics of nursing homes providing best care.

This study identifies structural characteristics of VA nursing homes that are associated with the best patient outcomes. We evaluated risk-adjusted rates of pressure ulcer development in VA nursing homes and related these rates to facility size, staffing patterns, teaching nursing home status, and rural versus urban locale. Higher rates of pressure ulcer development were seen among urban teaching nursing homes and among nursing homes associated with both larger and smaller VA hospitals. Staffing patterns had a complex association with pressure ulcer development, and smaller nursing home staffs were not clearly associated with higher rates. For multivariate modeling, only hospital size and staffing remained significant independent predictors of pressure ulcer development. These results emphasize that while structural characteristics of VA nursing homes can provide insights about care, improving the quality of care in this setting will require a much greater understanding of how nursing homes are organized to meet patient needs.

Temperature Dependence and Sequence Specificity of DNA Triplex Formation: An Analysis Using Isothermal Titration Calorimetry

We have investigated the thermodynamics and specificity of DNA triplex formation with isothermal titration calorimetry (ITC). The triplex formation between a 23-mer double-stranded homopurine−homopyrimidine and a 15-mer single-stranded homopyrimidine oligonucleotide forming T·AT and C+·GC triads at pH 4.8 is driven by a large negative calorimetric enthalpy change, ΔHcal, of the order of −80 kcal/mol. ΔHcal is strongly temperature dependent, yielding a heat capacity change, ΔCp, of about −1 (kcal/mol)K-1. The equilibrium association constant, K, obtained from the titration curve is about 9 × 107 M-1 at 25 °C (binding free energy change, ΔG, is about −11 kcal/mol). Thus, the triplex formation is accompanied by a negative entropy change (ΔS = −245 (cal/mol)K-1 at 25 °C). We found that K is insensitive to temperature near room temperature, leading to an apparently small van't Hoff enthalpy change (ΔHvH), in sharp contrast with the large negative ΔHcal. Together, the analyses of the observed temperature dependences of K and ΔH and the large negative ΔCp suggest that the triplex formation is a coupled process between conformational transitions in single-stranded DNA and its binding with double-stranded DNA. The examination of single mismatches in the triplex formation has shown that K and ΔG are not strongly affected by the particular combination of triad sequences (differences in ΔG are within 1.2 kcal/mol). In contrast, single mismatches affected ΔHcal to a greater extent (up to 7-kcal/mol differences). We discuss possible means to enhance specificity in triplex formation, implied by the present findings.

Interaction between Hydromagnetic Waves and the Anisotropically Conducting Ionosphere.

The self-consistent ionospheric boundary conditions, which describe the interaction between hydromagnetic (HM) waves and the anisotropically conducting ionosphere, have been derived in the form convenient for the eigenmode analysis of coupled HM waves in the magnetosphere-ionosphere system. These conditions consist of (a) the continuity of the horizontal perturbation electric field across the ionosphere, (b) the divergence of a vector formula relating a jump of the horizontal perturbation magnetic field across the ionosphere to the sheet current flowing therein and (c) the normal component of the rotation of the vector formula to the ionosphere. In order to emphasize a significant role of the derived self-consistent conditions, under the assumption that there exists no parallel inhomogeneity but a radial one of the Alfven velocity VA and the ionospheric conductivities in both hemispheres are uniform and symmetric, the coupling between the axisymmetric fast and Alfven waves via the ionospheric Hall current has been investigated in case of no energy dissipation (or zero Pedersen conductivity). It is suggested that for a given fundamental eigenfrequency, the Alfven mode perturbation is sharply enhanced with a finite amplitude at a field line position which is deviated from the position predicted by the classical field line resonance theory that the resonant frequency is determined only from the distribution of VA along the field line and its length l|| between the northern and southern ionospheres. Such a deviation is due to the divergent Hall current and occurs toward the direction in which VA increases. Further, the Alfven mode perturbation has no phase shift across the enhancement position. It is also suggested that the parallel wavelength of the fast mode perturbation is slightly greater than 2l|| in the region with smaller VA and 2l||/3 in the region with larger VA, respectively, and it changes rapidly from ∼2l|| to r 2l||/3 through l|| as VA grows large, where the wavelength l|| appears just at the enhancement position.

The spirituality and religiosity of veterans.

This article reports on the author's clinical observations of certain religious and spiritual interests of one hundred and twenty-five veteran patients at a small VA hospital. Definitions of both spirituality and religiosity are presented to indicate that they are not the same phenomenon. A list of questions routinely used by the author in doing an assessment of a patient's religiosity and spirituality is provided. Impressions of the veteran patients' religious and/or spiritual needs and concerns are summarized. Suggestions for future research are outlined.

Vanadium-Related Deep Levels in n-Silicon Detected by Junction Capacitance Waveform Analysis

Multiexponential (ME-) and spectral analysis (SA-) Deep Level Transient Spectroscopy (DLTS) are made on vanadium-related deep levels in n-silicon. We resolved three traps with large amplitude and three more traps with comparatively small amplitude, VA (ΔE=0.08 eV, σ=3.2×10-18 cm2), VB (ΔE=0.28 eV, σ=2.6×10-14 cm2) and VC (ΔE=0.24 eV, σ=8.4×10-18 cm2). These vanadium-related levels do not have appreciable broadening of the emission rate spectrum.

Interaction between VA RNA and the lupus antigen La: formation of a ribonucleoprotein particle in vitro.

The small adenovirus-encoded VA RNAs occur as ribonucleoprotein (RNP) particles in association with a cellular protein antigen, La, recognized by the anti-La class of lupus sera [Lerner, M. R., Boyle, J. A., Hardin, J. A. & Steitz, J. A. (1981) Science 211, 400-402]. We have tentatively identified the La antigen as a HeLa cell phosphoprotein of Mr approximately equal to 45,000, present in infected and uninfected cells. The antigen appears not to be required for the transcription of VA RNAs in vitro. RNP particles that contain newly synthesized VA RNAs assemble rapidly in transcription extracts making VA RNA and also can be reconstituted from purified VA RNA and a source of La antigen. Variant forms of VA RNAI with sequence deletions and substitutions bind to the La antigen, suggesting that the recognition site includes the RNA termini or the sequences corresponding to the internal control region (promoter), or both. Upon reconstitution with fragments of VA RNAI, oligonucleotides from both the 5' and 3' termini bind to the antigen, but those from the control region do not. The terminal oligonucleotides of wild-type VA RNA can form a basepaired stem, but structures of comparable stability cannot be formed by the chimeric variant molecules. Therefore, the recognition site is probably the terminal nucleotides themselves rather than the stem structure.

A cross-cultural MMPI comparison of alcoholics.

MMPI Profiles of 11 Caucasian, 11 Hispanic American, and 11 American Indian alcoholics were compared. The subjects were chosen randomly from among veterans in treatment for alcoholism at a small VA Medical Center. Subjects represented similar secondary diagnoses and did not differ significantly in age or education. One-way nonrepeated-measures analyses of variance on validity, clinical and the MacAndrews Alcoholism Scales showed significance only for Scale 2 scores, elevated for the Hispanic American group but within the normal range. Examination of dominant highpoint code types in each group indicated primarily 4 or 49 for the Caucasians and 24 for the Hispanic Americans. American Indian subjects were more heterogeneous with 1, 6, or 9 highpoints. Generally, the resultant profiles conform to previously published alcoholic MMPI prototypes, supporting use of the MMPI for the population studied. The results do not support development of separate MMPI norms for psychiatric subjects from these minority groups, but cross-validation on a larger sample is required.

Wall heat/mass transfer in pulsatile flow

Heat/mass transfer is considered from a solid surface to a fluid undergoing pulsatile flow, consisting of sinusoidal pulsations superimposed on a mean flow. Mass transfer was measured from small strips using the diffusion-controlled electrode method for both non-reversing and reversing flows, corresponding to small and large pulsation amplitudes, respectively. Heat/mass transfer rates from the surface consist of a mean component, with a superimposed oscillatory component that is dependent on the amplitude, α, of the fluctuating wall shear rate, and the dimensionless frequency parameter, F p . For small α, the amplitude and phase of the first harmonic of the measured transfer rates agree well with the theory of Mizush for all values of F p . The same is true for larger α (< 1), only when F p is also large; for large α and small F p , there is significant deviation from theory. In the latter case, the experimentally measured amplitudes of the second harmonic become large, and the assumptions the theory are no longer valid. For α > 1, flow reversal occurs, and the theory again does not apply. For α < 1, the shapes of the mass transfe time curve are almost sinusoidal, and space-and-time-averaged transfer rates decrease slightly compared to steady flow as α increases. For a > 1, f takes place, and as α increases to about 1.5–2, the average transfer rates increase and become equal to those in steady flow. For α > 2 the tra become greater than the steady flow values and the second harmonic of the fluctuating transfer rate is as significant as the first harmonic. The change of the transfer rate vs time curves is quite significant, with two maxima and minima appearing in a period compared to the single maximum and minimum w characteristic of small α. These changes in average transfer rates and in the shapes of the transfer rate vs time curves are substantial for small va frequency parameter, F p . As F p is increased, the changes become less pronounced, and the trend of the data indicates that for F p large enough, there is no increase in the transfer rate in pulsatile flow, and this appears to be independent of the value of α.

Small nuclear RNA and VA RNA in nuclear ribonucleoprotein fibrils from adenovirus-2 infected HeLa cells

The small RNA of hnRNP 1 1 Abbreviations used: hnRNP: ribonucleoprotein containing heterogeneous nuclear RNA, snRNA: small nuclear RNA; VA RNA: virus associated RNA. were studied in HeLa cells infected with adenovirus-2. At 15 h post-infection, when 50–60 % of the hnRNA was of viral origin, all the small nuclear RNA of hnRNP from non-infected cells were present in hnRNP from infected cells. The small, virus-encoded VA RNA could not be detected by staining like the snRNA but only after labeling. It represented less than 1 % of the small nuclear RNA in hnRNP. The low level of VA RNA in hnRNP as compared to that of the small nuclear RNA does not favor the hypothesis of a similar function for these 2 classes of small RNA.