AN ANALYSIS OF THE DEFENSE HEALTH AGENCY TRANSITION PLAN WITH REGARD TO THE IMPACT ON CONTRACTING OPERATIONS WITHIN THE MILITARY HEALTH SYSTEM

This analysis examines the Defense Health Agency’s (DHA) transition plan with regard to contracting operations within the Military Health System (MHS). First, the study addresses various Government Accountability Office (GAO) cases relating to healthcare reform. The documents establish a pattern of the government’s attempt to address needed change in the MHS. Next, the analysis provides an overview of contracting capabilities from each service component. The findings highlight the impact of these capabilities as a result of DHA’s authority, direction, and control (ADC) of the MTFs. Third, the analysis addresses the efficiencies in the acquisition process. The findings identify any gained efficiencies as described in DHA’s Quadruple Aim initiative. Additionally, the analysis addresses the Medical Q-Service contracting vehicle. The results highlight cost-savings using this strategic, contract vehicle and compare the data to market trends and government expenditures. The results of this study will lend a better understanding of the operational and strategic impact of the DHA transition plan. Last, the recommendations focus on optimizing existing operational capabilities and processes, and increasing contracting efficiencies. The goal is to improve the overall ability to conduct medical contracting operations effectively while reducing costs and maintaining a high level of medical capability.Major, United States ArmyMajor, United States ArmyApproved for public release. distribution is unlimite

2018 Atmospheric Motion Vector (AMV): intercomparison study

Atmospheric Motion Vectors (AMVs) calculated by six different institutions (Brazil Center for Weather Prediction and Climate Studies/CPTEC/INPE, European Organization for the Exploitation of Meteorological Satellites/EUMETSAT, Japan Meteorological Agency/JMA, Korea Meteorological Administration/KMA, Unites States National Oceanic and Atmospheric Administration/NOAA, and the Satellite Application Facility on Support to Nowcasting and Very short range forecasting/NWCSAF) with JMA’s Himawari-8 satellite data and other common input data are here compared. The comparison is based on two different AMV input datasets, calculated with two different image triplets for 21 July 2016, and the use of a prescribed and a specific configuration. The main results of the study are summarized as follows: (1) the differences in the AMV datasets depend very much on the ‘AMV height assignment’ used and much less on the use of a prescribed or specific configuration; (2) the use of the ‘Common Quality Indicator (CQI)’ has a quantified skill in filtering collocated AMVs for an improved statistical agreement between centers; (3) Among the six AMV operational algorithms verified by this AMV Intercomparison, JMA AMV algorithm has the best overall performance considering all validation metrics, mainly due to its new height assignment method: ‘Optimal estimation method considering the observed infrared radiances, the vertical profile of the Numerical Weather Prediction wind, and the estimated brightness temperature using a radiative transfer model’.The “Space Science and Engineering Center” (SSEC) of the “University ofWisconsin-Madison” (UW) was funded to do this research by the “European Organization for the Exploitation of Meteorological Satellites (EUMETSAT)”, through the “Satellite Application Facility on Support to Nowcasting and Very short range forecasting (NWCSAF)” “Visiting Scientist Activity (VSA)” program

Acquired Type III Secretion System Determines Environmental Fitness of Epidemic Vibrio parahaemolyticus in the Interaction with Bacterivorous Protists

Genome analyses of marine microbial communities have revealed the widespread occurrence of genomic islands (GIs), many of which encode for protein secretion machineries described in the context of bacteria-eukaryote interactions. Yet experimental support for the specific roles of such GIs in aquatic community interactions remains scarce. Here, we test for the contribution of type III secretion systems (T3SS) to the environmental fitness of epidemic Vibrio parahaemolyticus. Comparisons of V. parahaemolyticus wild types and T3SS-defective mutants demonstrate that the T3SS encoded on genome island VPaI-7 (T3SS-2) promotes survival of V. parahaemolyticus in the interaction with diverse protist taxa. Enhanced persistence was found to be due to T3SS-2 mediated cytotoxicity and facultative parasitism of V. parahaemolyticus on coexisting protists. Growth in the presence of bacterivorous protists and the T3SS-2 genotype showed a strong correlation across environmental and clinical isolates of V. parahaemolyticus. Short-term microcosm experiments provide evidence that protistan hosts facilitate the invasion of T3SS-2 positive V. parahaemolyticus into a coastal plankton community, and that water temperature and productivity further promote enhanced survival of T3SS-2 positive V. parahaemolyticus. This study is the first to describe the fitness advantage of GI-encoded functions in a microbial food web, which may provide a mechanistic explanation for the global spread and the seasonal dynamics of V. parahaemolyticus pathotypes, including the pandemic serotype cluster O3:K6, in aquatic environments

Post-Operative Functional Outcomes in Early Age Onset Rectal Cancer

Background: Impairment of bowel, urogenital and fertility-related function in patients treated for rectal cancer is common. While the rate of rectal cancer in the young (<50 years) is rising, there is little data on functional outcomes in this group. Methods: The REACCT international collaborative database was reviewed and data on eligible patients analysed. Inclusion criteria comprised patients with a histologically confirmed rectal cancer, <50 years of age at time of diagnosis and with documented follow-up including functional outcomes. Results: A total of 1428 (n=1428) patients met the eligibility criteria and were included in the final analysis. Metastatic disease was present at diagnosis in 13%. Of these, 40% received neoadjuvant therapy and 50% adjuvant chemotherapy. The incidence of post-operative major morbidity was 10%. A defunctioning stoma was placed for 621 patients (43%); 534 of these proceeded to elective restoration of bowel continuity. The median follow-up time was 42 months. Of this cohort, a total of 415 (29%) reported persistent impairment of functional outcomes, the most frequent of which was bowel dysfunction (16%), followed by bladder dysfunction (7%), sexual dysfunction (4.5%) and infertility (1%). Conclusion: A substantial proportion of patients with early-onset rectal cancer who undergo surgery report persistent impairment of functional status. Patients should be involved in the discussion regarding their treatment options and potential impact on quality of life. Functional outcomes should be routinely recorded as part of follow up alongside oncological parameters

Finishing the euchromatic sequence of the human genome

The sequence of the human genome encodes the genetic instructions for human physiology, as well as rich information about human evolution. In 2001, the International Human Genome Sequencing Consortium reported a draft sequence of the euchromatic portion of the human genome. Since then, the international collaboration has worked to convert this draft into a genome sequence with high accuracy and nearly complete coverage. Here, we report the result of this finishing process. The current genome sequence (Build 35) contains 2.85 billion nucleotides interrupted by only 341 gaps. It covers ∼99% of the euchromatic genome and is accurate to an error rate of ∼1 event per 100,000 bases. Many of the remaining euchromatic gaps are associated with segmental duplications and will require focused work with new methods. The near-complete sequence, the first for a vertebrate, greatly improves the precision of biological analyses of the human genome including studies of gene number, birth and death. Notably, the human enome seems to encode only 20,000-25,000 protein-coding genes. The genome sequence reported here should serve as a firm foundation for biomedical research in the decades ahead

Determining value in health technology assessment: Stay the course or tack away?

The economic evaluation of new health technologies to assess whether the value of the expected health benefits warrants the proposed additional costs has become an essential step in making novel interventions available to patients. This assessment of value is problematic because there exists no natural means to measure it. One approach is to assume that society wishes to maximize aggregate health, measured in terms of quality-adjusted life-years (QALYs). Commonly, a single 'cost-effectiveness' threshold is used to gauge whether the intervention is sufficiently efficient in doing so. This approach has come under fire for failing to account for societal values that favor treating more severe illness and ensuring equal access to resources, regardless of pre-existing conditions or capacity to benefit. Alternatives involving expansion of the measure of benefit or adjusting the threshold have been proposed and some have advocated tacking away from the cost per QALY entirely to implement therapeutic area-specific efficiency frontiers, multicriteria decision analysis or other approaches that keep the dimensions of benefit distinct and value them separately. In this paper, each of these alternative courses is considered, based on the experiences of the authors, with a view to clarifying their implications

Not all cows are epidemiologically equal:quantifying the risks of bovine viral diarrhoea virus (BVDV) transmission through cattle movements

International audienceMany economically important cattle diseases spread between herds through livestock movements. Traditionally, most transmission models have assumed that all purchased cattle carry the same risk of generating outbreaks in the destination herd. Using data on bovine viral diarrhoea virus (BVDV) in Scotland as a case example, this study provides empirical and theoretical evidence that the risk of disease transmission varies substantially based on the animal and herd demographic characteristics at the time of purchase. Multivariable logistic regression analysis revealed that purchasing pregnant heifers and open cows sold with a calf at foot were associated with an increased risk of beef herds being seropositive for BVDV. Based on the results from a dynamic within-herd simulation model, these findings may be partly explained by the age-related probability of animals being persistently infected with BVDV as well as the herd demographic structure at the time of animal introductions. There was also evidence that an epidemiologically important network statistic, "betweenness centrality" (a measure frequently associated with the potential for herds to acquire and transmit disease), was significantly higher for herds that supplied these particular types of replacement beef cattle. The trends for dairy herds were not as clear, although there was some evidence that open heifers and open lactating cows were associated with an increased risk of BVDV. Overall, these findings have important implications for developing simulation models that more accurately reflect the industry-level transmission dynamics of infectious cattle diseases

A multi-country test of brief reappraisal interventions on emotions during the COVID-19 pandemic.

The COVID-19 pandemic has increased negative emotions and decreased positive emotions globally. Left unchecked, these emotional changes might have a wide array of adverse impacts. To reduce negative emotions and increase positive emotions, we tested the effectiveness of reappraisal, an emotion-regulation strategy that modifies how one thinks about a situation. Participants from 87 countries and regions (n = 21,644) were randomly assigned to one of two brief reappraisal interventions (reconstrual or repurposing) or one of two control conditions (active or passive). Results revealed that both reappraisal interventions (vesus both control conditions) consistently reduced negative emotions and increased positive emotions across different measures. Reconstrual and repurposing interventions had similar effects. Importantly, planned exploratory analyses indicated that reappraisal interventions did not reduce intentions to practice preventive health behaviours. The findings demonstrate the viability of creating scalable, low-cost interventions for use around the world