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Recent documents in eScholarship@UMMS
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Understanding Reproductive Healthcare and Outcomes Among Women Veterans: A Review of Recent Research and Future Opportunities

Mon, 08/11/2014 - 1:36pm

Presentation focused on reproductive health issues among women Veterans in VA care. In particular, examines patterns of healthcare utilization for gender-specific conditions among women Veterans, as well as beliefs and preferences for reproductive health care services within the VA healthcare system. Then explores innovative new research aimed at better understanding reproductive health services and outcomes among women Veterans.

Pregnancy and Mental Health Care Among Women Veterans Returning from Iraq and Afghanistan

Mon, 08/11/2014 - 1:36pm

Presentation looking at pregnancy and mental health care in the VA system. Documents a study examining the prevalence of pregnancy care and comparing the mental health diagnoses among pregnant and non-pregnant women in VA care. Then examining the degree to which pregnant veterans receive VA mental health care during their pregnancy. Concludes that pregnant women veterans using VA care have a substantial mental health burden.

Principles of Multidisciplinary Management

Mon, 08/11/2014 - 10:45am

This chapter in the Cancer Concepts textbook describes the principles of multi-disciplinary management, meaning multi-specialty physician management of malignancies. Tumor Boards are the model for multi-disciplinary management. They may be site specific or include the entire spectrum of malignancy. At Tumor Boards, staging workup and treatment recommendations are made collectively, and then the treatments are delivered by the respective modality specialists and their individual teams. Improved clinical decision making leading to superior survival for patients with some diseases and better quality of life has been documented with multi-disciplinary management. Just like curative patients, palliative patients require multi-disciplinary management.

Rapid prototyping amphiphilic polymer/hydroxyapatite composite scaffolds with hydration-induced self-fixation behavior

Mon, 08/11/2014 - 8:17am

Two major factors hampering the broad use of rapid prototyped biomaterials for tissue engineering applications are the requirement for custom-designed or expensive research-grade three-dimensional (3-D) printers and the limited selection of suitable thermoplastic biomaterials exhibiting physical characteristics desired for facile surgical handling and biological properties encouraging tissue integration. Properly designed thermoplastic biodegradable amphiphilic polymers can exhibit hydration-dependent hydrophilicity changes and stiffening behavior, which may be exploited to facilitate the surgical delivery/self-fixation of the scaffold within a physiological tissue environment. Compared to conventional hydrophobic polyesters, they also present significant advantages in blending with hydrophilic osteoconductive minerals with improved interfacial adhesion for bone tissue engineering applications. Here we demonstrated the excellent blending of biodegradable, amphiphilic PLA-PEG-PLA (PELA) triblock co-polymer with hydroxyapatite (HA) and the fabrication of high-quality rapid prototyped 3-D macroporous composite scaffolds using an unmodified consumer-grade 3-D printer. The rapid prototyped HA-PELA composite scaffolds and the PELA control (without HA) swelled (66% and 44% volume increases, respectively) and stiffened (1.38-fold and 4-fold increases in compressive modulus, respectively) in water. To test the hypothesis that the hydration-induced physical changes can translate into self-fixation properties of the scaffolds within a confined defect, a straightforward in vitro pull-out test was designed to quantify the peak force required to dislodge these scaffolds from a simulated cylindrical defect at dry vs. wet states. Consistent with our hypothesis, the peak fixation force measured for the PELA and HA-PELA scaffolds increased 6-fold and 15-fold upon hydration, respectively. Furthermore, we showed that the low-fouling 3-D PELA inhibited the attachment of NIH3T3 fibroblasts or MSCs while the HA-PELA readily supported cellular attachment and osteogenic differentiation. Finally, we demonstrated the feasibility of rapid prototyping biphasic PELA/HA-PELA scaffolds for potential guided bone regeneration where an osteoconductive scaffold interior encouraging osteointegration and a non-adhesive surface discouraging fibrous tissue encapsulation is desired. This work demonstrated that by combining facile and readily translatable rapid prototyping approaches with unique biomaterial designs, biodegradable composite scaffolds with well-controlled macroporosities, spatially defined biological microenvironment, and useful handling characteristics can be developed.

Understanding Health-Care Needs of Sexual and Gender Minority Veterans: How Targeted Research and Policy Can Improve Health

Fri, 08/08/2014 - 9:58am

Given the size of the patient population of the Veterans Health Administration (VHA), it is likely the largest single provider of health care for sexual and gender minority (SGM) individuals in the United States, including lesbian, gay, bisexual, and transgender persons. However, current VHA demographic data-collection strategies limit the understanding of how many SGM veterans there are, thereby making a population-based understanding of the health needs of SGM veterans receiving care in VHA difficult. In this article, we summarize the emergent research findings about SGM veterans and the first initiatives that have been implemented by VHA to promote quality care. Though the research on SGM veterans is in its infancy, it suggests that SGM veterans share some of the health risks noted in veterans generally and also risks associated with SGM status. Some promising resiliency factors have also been identified. These findings have implications for both VHA and non-VHA systems in the treatment of SGM veterans. However, more research on the unique needs of SGM veterans is needed to fully understand their health risks and resiliencies in addition to health-care utilization patterns.

Sourcebook: Women Veterans in the Veterans Health Administration. Volume 2: Sociodemographics and Use of VHA and Non-VA Care (Fee)

Fri, 08/08/2014 - 9:58am

Describes sociodemographic characteristics and health care utilization patterns of women Veteran patients in the VHA. Its primary purpose is to present data to inform policy and program planning as VHA implements and evaluates new ways of providing care to women Veterans. Provides data about women residing in rural versus urban areas and by examining use of health care through VHA’s “Non-VA Care (Fee)” system, which is comprised of services provided to Veterans by non-VHA providers but reimbursed through VHA.

Produced by the Women’s Health Evaluation Initiative, Women’s Health Services, Veterans Health Administration, Department of Veterans Affairs, Washington DC.

Cynicism: Incident diabetes and worsening of metabolic syndrome in postmenopausal women

Thu, 08/07/2014 - 3:15pm

Objective: To determine if self-reported cynical hostility predicted incident diabetes or increase in number of symptoms associated with metabolic syndrome in postmenopausal women.

Design: Prospective study of a subsample of women (n = 3,658) participating in the Women's Health Initiative Clinical Trial.

Methods: Subjects: Postmenopausal women aged 50 to 79 years at baseline who were enrolled in the Women's Health Initiative Dietary Modification Trial, Hormone Trial or both. Measures: The Cynicism subscale of the Cook-Medley Hostility Questionnaire was used to assess cynical hostility at baseline. Incident diabetes was ascertained by self-report of treatment with insulin or oral hypoglycemic medication at one year. Metabolic syndrome was defined based on number of Adult Treatment Panel (ATP) III criteria met at one year.Statistical Analysis: The relationship between baseline cynical hostility and incident diabetes and worsening of metabolic syndrome was assessed from baseline to one year using multivariable Cox proportional hazards models and multivariable logistic regression models, respectively.

Results: Incident diabetes was 36% higher among women in the upper tertile for baseline cynical hostility compared to the lowest tertile (p-trend = 0.05). The odds of a worsening of metabolic syndrome was 27% greater in the highest cynical hostility tertile compared to the lowest tertile (p-trend = 0.04).

Conclusions: Cynical hostility may increase the risk for developing diabetes and worsening of the metabolic syndrome in postmenopausal women.

Prevention and Management of Chronic Disease through Worksite Health Promotion

Thu, 08/07/2014 - 3:15pm

Summarizes the rationale and scientific evidence for providing health promotion programs at worksites.

Collaborative Connection to the Past and Future: Introducing an Archival Program and Creating a History and Image Web Exhibit

Thu, 08/07/2014 - 7:33am

Objectives: Establishing an archival program and creating a digital exhibit highlighting the history of an institution provides invaluable outreach and support. There are opportunities for significant collaboration between affiliated organizations by building relationships and sharing expertise. This paper provides a project description and product evaluation of the collaboration between a large academic medical library and archives and an affiliated vaccine manufacturer. The planning, implementation, and outcomes are discussed, with generally applicable components of this project detailed. Finally, recommendations for similar project implementations are given.

Methods and Results: In collaboration with a medical library and archives, an affiliated, historic vaccine manufacturer developed a project to preserve and publicize its long, rich history. While initially there were many goals for the project, an archivist was hired for only 900 hours. Priorities, a timeline, and deliverables had to be negotiated. The result was the development of an institutional archival program and an online history and image exhibit, both serving as powerful outreach and marketing tools. The project had 2 notable components: the establishment of traditional archival procedures and activities, including supporting documentation for future work; and the research, selection, and implementation of an appropriate web platform supporting an image exhibit, comprehensive timeline, and narrative history. By developing a web exhibit, the vaccine manufacturer now has a visible product used for outreach and promotion. The creative manipulation of an open source, simple web service served the needs of the archivist, the institution, and the budget. Collaboration between the manufacturer and the medical school has increased general communication and connection between the two. Finally, by providing very clear guidelines, education, and documentation for the project and all aspects of archival work, invested parties could make more appropriate planning decisions and be better prepared to continue the project in the future. Collaboration, communication, and creativity by all parties grounded and guided this project and are crucial to any success in projects of this type.

Conclusions: The creative use of resources and the creation of clear foundational policies and procedures--while also providing education about the nature, importance, and work expectations of archives--led to valued deliverables and a successful project. While not all initial goals were able to be addressed, by creating realistic expectations and timelines, and producing an appreciated, visible product, the project was ultimately extended with additional funding and labor.