A National Summit on Women Veteran Homelessness: A Leadership Dialogue

The National Summit on Women Veteran Homelessness brought together noted researchers, policy and practice experts, and women veterans with the lived experience of homelessness in a day and a half of facilitated dialogue sessions. Our purpose was threefold. First, we wanted to call attention to the growing national problem of homelessness among women veterans. Second, we wanted to better understand the unique challenges facing women veterans who have lost their homes or are at risk of homelessness. Finally, we sought to gather information and ideas for solutions to prevent and end homelessness among women veterans. Rich information was obtained from these sessions that will help us to understand the complex conditions that can result in women veteran homelessness, isolate the key areas where action to remediate the issues is required and create comprehensive and sustainable solutions that reduce the risk of women veteran homelessness and help those who are already homeless to achieve full reintegration into their communities. This report begins with a summary of presentations delivered by three experts who provided background on the demographics of homeless veterans, key programs at the U.S. Department of Veterans Affairs (VA), a research perspective on the challenges homeless women veterans face and litigation and advocacy as tools for change. The core of the report, called the Summit Dialogue Sessions, summarizes three roundtable discussions centered on the following themes: 1) pathways to homelessness for women veterans; 2) strategies for exiting homelessness; and 3) approaches to preventing women veterans from falling into homelessness. The report then turns attention to the list of actionable tasks which grew out of the roundtables, as well as two facilitated "fishbowls" in which subgroups of Summit participants explored specific issues related to policy, practice and research. Together, these offer not only a record of the work accomplished at the Summit, but also a pathway to future research, policy and program initiatives that hold the hope and potential for preventing and ending women veteran homelessness

Entrepreneurship for Veterans with Disabilities: Lessons Learned from the Field

A 2009 research brief produced for the NTAR Leadership Center, a consortium led by the John H. Heldrich Center for Workforce Development at Rutgers, The State University of New Jersey. Founded in 2007 under a grant/contract with the Office of Disability Employment Policy at the U.S. Department of Labor, the NTAR Leadership Center's mission is to build capacity and leadership at the federal, state, and local levels to enable change across workforce development and disability-specific systems that will increase employment and economic self-sufficiency for adults with disabilities. This brief examines entrepreneurship as a viable option for veterans with disabilities, particularly those returning from the present-day conflicts in the Middle East. As entrepreneurs, veterans have an array of opportunities to customize their employment, accommodate their challenges, maximize their strengths and skills, and achieve their financial and career goals. This brief takes a close look at one program -- the Entrepreneurship Boot Camp -- and discusses some lessons learned from the operation of this program

How Military Service Influences the Transition to Adulthood Among Post-911 Young Adult Female Veterans with Service Related Disabilities

Over 280,000 female servicemembers have served in the Iraq and Afghanistan conflicts, and a significant number of them are experiencing hidden and/or visible wounds of war. Recent reports indicate that female servicemembers have service-connected disability ratings higher than that of their male counterparts. Female servicemembers often find themselves negotiating roles that are at once ‘inside’ as well as ‘outside’ of a hierarchical, proscribed military institution whose rituals, norms, and hierarchies privilege males in positions of power. Their transition to adulthood as young veterans with service-related disabilities, within a present-day civilian society that can be more ambiguous and discontinuous than in the past decades can often be difficult; particularly during the early years after separation. Fifteen young, female veterans with service-related disabilities, who have left active duty within three years were interviewed for this study, of which 12 met the study criteria. The narratives of their pre-during-and post-military lives contribute to a grounded theory of female veteran transition to adulthood that validates the integration of the Life Course Perspective, Disability Theory, Role/Exit Theory, and theories of Identity and Belonging in ways heretofore unexplored. This study also validates the premise that the female veteran experience is sufficiently different from the male veteran experience in substantive ways. Finally, this research suggests that transition planning and post-military service supports should be customized specifically to address the needs of female servicemembers with disabilities, oriented towards preparing them to resume their civilian lives after exiting the military institution

ACG Clinical Guideline: Diagnosis and Management of Barrett’s Esophagus

Barrett's esophagus (BE) is among the most common conditions encountered by the gastroenterologist. In this document, the American College of Gastroenterology updates its guidance for the best practices in caring for these patients. These guidelines continue to endorse screening of high-risk patients for BE; however, routine screening is limited to men with reflux symptoms and multiple other risk factors. Acknowledging recent data on the low risk of malignant progression in patients with nondysplastic BE, endoscopic surveillance intervals are attenuated in this population; patients with nondysplastic BE should undergo endoscopic surveillance no more frequently than every 3-5 years. Neither routine use of biomarker panels nor advanced endoscopic imaging techniques (beyond high-definition endoscopy) is recommended at this time. Endoscopic ablative therapy is recommended for patients with BE and high-grade dysplasia, as well as T1a esophageal adenocarcinoma. Based on recent level 1 evidence, endoscopic ablative therapy is also recommended for patients with BE and low-grade dysplasia, although endoscopic surveillance continues to be an acceptable alternative. Given the relatively common recurrence of BE after ablation, we suggest postablation endoscopic surveillance intervals. Although many of the recommendations provided are based on weak evidence or expert opinion, this document provides a pragmatic framework for the care of the patient with BE

Caretaker Expectations Regarding the Management of Pediatric Asthma Scale (CE)

Asthma, a very serious health condition in the United States, results in morbidity and mortality that disproportionately affect children living in inner-city areas. The National Cooperative Inner-City Asthma Study (NCICAS) examined a variety of factors related to pediatric asthma. The CE scale was developed in the NCICAS study and is designed to assess three psychological factors in caretakers of children with asthma (self-efficacy, outcome expectations, and response difficulty). The scale is provided here and background is available in: Holden, G., Wade, S., Mitchell, H., Ewart, C., Islam, S. (1998). Caretaker expectations and the management of pediatric asthma in the inner-city: A scale development study. Social Work Research, 22, 51-59. or from the lead author: [email protected] by grants UO1 A1-30751, A1-30752, A1-30756, A1-30772, A1-30773-01, A1-30777, A1-30779, A1-30780, NO1 A1-15105 from the National Institute of Allergy and Infectious Disease (National Institutes of Health, Bethesda, MD)

Aligning Medical Student Curriculum with Practice Quality Goals: Impacts on Quality Metrics and Practice Capacity for Students

The practice of medicine occurs primarily in the ambulatory environment where providers have many competing demands, including health record documentation and patient volume expectations. Subsequently, medical student education has not been a priority for providers, health systems, or community practices. Yet, accrediting and professional organizations, such as the Association of American Medical Colleges, American Academy of Family Physicians, Ambulatory Pediatric Association, Society of General Internal Medicine, and the Liaison Committee on Medical Education, recommend education in ambulatory settings

Students Adding Value: Improving Patient Care Measures While Learning Valuable Population Health Skills

Medical students are potential resources for ambulatory primary care practices if learning goals can align with clinical needs. The authors introduced a quality improvement (QI) curriculum in the ambulatory clinical rotation that matched student learning expectations with practice needs. In 2016-2017, 128 students were assigned to academic, university affiliated, community health, and private practices. Student project measures were matched with appropriate outcome measures on monthly practice dashboards. Binomial mixed effects models were used to model QI measures. For university collaborative practices with student involvement, the estimated odds of a patient being screened for breast cancer in March 2017 was approximately 2 times greater than in 2016. This odds ratio was 36.2% greater than the comparable odds ratio for collaborative practices without student involvement (95% confidence interval = 22.7% to 51.2% greater). When student curriculum and assignments align with practice needs, practice metrics improve and students contribute to improvements in real-world settings

Assessing the effect of organic residue quality on active decomposing fungi in a tropical Vertisol using 15N-DNA stable isotope probing

15N-DNA stable isotope probing (15N-DNA-SIP) combined with 18S rRNA gene-based community analysis was used to identify active fungi involved in decomposition of 15N-labeled maize and soybean litter in a tropical Vertisol. Phylogenetic analysis of 15N-labeled DNA subjected to 18S rRNA gene-based community fingerprinting showed that organic residue quality promoted either slow (i.e. Penicillium sp., Aspergillus sp.) or fast growing (i.e. Fusarium sp., Mortierella sp.) fungal decomposers in soils treated with maize or soybean residues, respectively, whereas Chaetomium sp. were found as dominant decomposers in both residue treatments. Therefore, we have clear evidence that specific members of the fungal community used 15N derived from the two different organic resources for growth and stimulated early decomposition of maize or soybean decomposition. In conclusion, our study showed that 15N-DNA-SIP-based community analyses cannot only follow the flow of N from organic resources into bacteria, but also into the actively decomposing fungal communities of soils

Clinical Study of Ursodeoxycholic Acid in Barrett's Esophagus Patients

Prior research strongly implicates gastric acid and bile acids, two major components of the gastroesophageal refluxate, in the development of Barrett’s esophagus (BE) and its pathogenesis. Ursodeoxycholic acid (UDCA), a hydrophilic bile acid, has been shown to protect esophageal cells against oxidative stress induced by cytotoxic bile acids. We conducted a pilot clinical study to evaluate the clinical activity of UDCA in patients with BE. Twenty-nine BE patients received UDCA treatment at a daily dose of 13–15 mg/kg/day for six months. The clinical activity of UDCA was assessed by evaluating changes in gastric bile acid composition and markers of oxidative DNA damage (8-hydroxydeoxyguanosine, 8OHdG), cell proliferation (Ki67), and apoptosis (cleaved caspase 3, CC3) in BE epithelium. The bile acid concentrations in gastric fluid were measured by liquid chromatography-mass spectrometry. At baseline, UDCA (sum of unchanged and glycine/taurine conjugates) accounted for 18.2% of total gastric bile acids. Post UDCA intervention, UDCA increased significantly to account for 93.39% of total gastric bile acids (p<0.0001). The expression of markers of oxidative DNA damage, cell proliferation, and apoptosis was assessed in the BE biopsies by immunohistochemistry. The selected tissue biomarkers were unchanged after 6 months of UDCA intervention. We conclude that high dose UDCA supplementation for six months resulted in favorable changes in gastric bile acid composition but did not modulate selected markers of oxidative DNA damage, cell proliferation, and apoptosis in the BE epithelium

Linkage and related analyses of Barrett's esophagus and its associated adenocarcinomas

BACKGROUND: Familial aggregation and segregation analysis studies have provided evidence of a genetic basis for esophageal adenocarcinoma (EAC) and its premalignant precursor, Barrett's esophagus (BE). We aim to demonstrate the utility of linkage analysis to identify the genomic regions that might contain the genetic variants that predispose individuals to this complex trait (BE and EAC). METHODS: We genotyped 144 individuals in 42 multiplex pedigrees chosen from 1000 singly ascertained BE/EAC pedigrees, and performed both model‐based and model‐free linkage analyses, using S.A.G.E. and other software. Segregation models were fitted, from the data on both the 42 pedigrees and the 1000 pedigrees, to determine parameters for performing model‐based linkage analysis. Model‐based and model‐free linkage analyses were conducted in two sets of pedigrees: the 42 pedigrees and a subset of 18 pedigrees with female affected members that are expected to be more genetically homogeneous. Genome‐wide associations were also tested in these families. RESULTS: Linkage analyses on the 42 pedigrees identified several regions consistently suggestive of linkage by different linkage analysis methods on chromosomes 2q31, 12q23, and 4p14. A linkage on 15q26 is the only consistent linkage region identified in the 18 female‐affected pedigrees, in which the linkage signal is higher than in the 42 pedigrees. Other tentative linkage signals are also reported. CONCLUSION: Our linkage study of BE/EAC pedigrees identified linkage regions on chromosomes 2, 4, 12, and 15, with some reported associations located within our linkage peaks. Our linkage results can help prioritize association tests to delineate the genetic determinants underlying susceptibility to BE and EAC