An Assessment of Mental Health Services for Veterans in the State of Texas

This report describes the complex challenges faced by veterans and their families in seeking, navigating, and attaining adequate mental health care in Texas. There are 1.7 million veterans in Texas, comprising 8.6 percent of the adult population. According to the U.S. Department of Veteran Affairs (VA), the number of veterans requiring mental health services has grown dramatically and will continue to increase, making veterans’ mental health care an urgent issue in Texas. The federal agencies responsible for military and veterans mental health care, the U.S. Department of Defense (DoD) and the VA, have created new programs and invested significant financial and staff resources. Despite barriers to addressing veterans mental health needs. Texas state agencies have increased funding and instituted new mental health programs supporting returning veterans. Nonprofit agencies focused on veteran’s mental health have multiplied across Texas and the U.S. over the past decade to fill gaps in care. While these organizations provide a growing and increasingly diverse set of resources for veterans to extend the scope of support, volunteer efforts can suffer from fragmentation and overlap. The report identifies current practices, challenges, and opportunities within and across each group of service providers. The report draws on government reports, scholarly literature, and agency websites, as well as interviews with counselors, Veteran Service Officers, nonprofit providers, state officials, and veterans themselves. This report offers five recommendations toward the goal that veterans’ mental health care in Texas become comprehensive, inclusive, effective, and efficient. First, there is a need for greater inter-agency communication across organizations, improved outreach efforts, and increased services for hard-to-reach populations, such as homeless veterans. Second, federal agencies ought to address staff shortages, improve the transition from DoD to VA care, and increase feedback. Third, at the state level, specialized services are needed to address unique veterans’ needs concentrated in cities across Texas as well as those dispersed in rural areas. Fourth, providers can improve mental health care by integrating social services and law enforcement. Fifth, both veterans and providers can benefit if they recognize opportunities for cooperation and coordination and work towards long-term goals that emphasize outcomes that improve the lives of returning veterans. This research was funded in part by the Jack S. Blanton Research Fellowship and the George A. Roberts Research Fellowship of the IC² Institute.IC2 Institut

Who Benefits from Postsecondary Occupational Education? Findings from the1980s and 1990s

Technological changes in the workplace have placed considerable pressure on the U.S. educational system to prepare students for increasingly skillbased occupations. Employers reward new hires for having the skills or credentials needed for their job, underscoring the importance of having either the requisite “tools in your toolbox,” or some basic academic preparation to continue on into postsecondary education. This stress on knowledge acquisition has contributed to a growing wage gap between high school and college graduates. Whether occupational education at the high school level, with its focus on immediate workforce entry after high school, adequately prepares students for college is a public concern. Since students who enroll in these programs are less likely to transfer to a four-year college to obtain a bachelor’s degree, occupational education is criticized for hampering their future earnings. Some of the criticisms of postsecondary occupational education could be allayed if the economic benefits were equal to (or greater than) those of other types of education. This brief investigates the economic benefits of a community college education by analyzing the effects on post-college earnings of a student’s program of study (occupational or academic), the amount of schooling accumulated with and without attaining a degree, and the type of credential earned

L’exercice comme approche alternative dans la gestion des algies vasculaires de la face: étude de cas

Introduction : Plusieurs traitements pharmacologi- ques sont utilisés pour soulager la douleur et réduire la durée et la fréquence des crises d’algie vasculaire de la face (CH), mais ces traitements demeurent partiellement efficaces pour plusieurs patients. L’exercice aérobie est actuellement pro- posé pour réduire la prévalence et la gravité des symptômes associés à d’autres types de céphalées, mais son efficacité concernant la gestion des CH n’a pas encore été documentée. Représentation du cas : Cet article décrit le cas d’un homme de 24 ans chez qui on a diagnostiqué des CH épisodiques (1/jour ; > 1 heure). Treize jours après le premier épisode, des exercices aérobies d’intensité modérée étaient effectués (10 à 30 minutes) au début des crises. L’exercice aérobie a réduit à la fois la sévérité et la durée des crises de CH. Conclusion : Cette étude de cas suggère que la réalisation d’exercices aérobies d’intensité modérée au début d’une crise de CH pourrait être une intervention non pharmacolo- gique complémentaire intéressante pour diminuer les symp- tômes douloureux liés à cette condition.Abstract : Background: Various pharmacological treatments have been used to relieve pain and reduce the duration and occurrence of cluster headache (CH) attacks, but these treatments remain partially effective for many patients. Aerobic exercises have been proposed to decrease the prevalence and severity of symptoms associated with other types of headaches, but the effectiveness of aerobic exercise for CH management has not yet been investigated. Case presentation: This report describes the case of a 24 year-old male patient diagnosed with episodic CH (1/day; > 1h). Thirteen days after the first episode, moderate-intensity continuous aerobic exercise was performed (10-30 minutes) at the onset of CH attack. Aerobic exercise reduced both severity and duration of CH attacks. Conclusions: This case report suggests that performing moderate-intensity aerobic exercise at the onset of a CH attack may be an interesting non-pharmacologic intervention that can be used to ease pain symptoms

Efficiency of spinal anesthesia versus general anesthesia for lumbar spinal surgery: a retrospective analysis of 544 patients.

BACKGROUND: Previous studies have shown varying results in selected outcomes when directly comparing spinal anesthesia to general in lumbar surgery. Some studies have shown reduced surgical time, postoperative pain, time in the postanesthesia care unit (PACU), incidence of urinary retention, postoperative nausea, and more favorable cost-effectiveness with spinal anesthesia. Despite these results, the current literature has also shown contradictory results in between-group comparisons. MATERIALS AND METHODS: A retrospective analysis was performed by querying the electronic medical record database for surgeries performed by a single surgeon between 2007 and 2011 using procedural codes 63030 for diskectomy and 63047 for laminectomy: 544 lumbar laminectomy and diskectomy surgeries were identified, with 183 undergoing general anesthesia and 361 undergoing spinal anesthesia (SA). Linear and multivariate regression analyses were performed to identify differences in blood loss, operative time, time from entering the operating room (OR) until incision, time from bandage placement to exiting the OR, total anesthesia time, PACU time, and total hospital stay. Secondary outcomes of interest included incidence of postoperative spinal hematoma and death, incidence of paraparesis, plegia, post-dural puncture headache, and paresthesia, among the SA patients. RESULTS: SA was associated with significantly lower operative time, blood loss, total anesthesia time, time from entering the OR until incision, time from bandage placement until exiting the OR, and total duration of hospital stay, but a longer stay in the PACU. The SA group experienced one spinal hematoma, which was evacuated without any long-term neurological deficits, and neither group experienced a death. The SA group had no episodes of paraparesis or plegia, post-dural puncture headaches, or episodes of persistent postoperative paresthesia or weakness. CONCLUSION: SA is effective for use in patients undergoing elective lumbar laminectomy and/or diskectomy spinal surgery, and was shown to be the more expedient anesthetic choice in the perioperative setting

Novel Ground-State Crystals with Controlled Vacancy Concentrations: From Kagom\'{e} to Honeycomb to Stripes

We introduce a one-parameter family, $0 \leq H \leq 1$, of pair potential functions with a single relative energy minimum that stabilize a range of vacancy-riddled crystals as ground states. The "quintic potential" is a short-ranged, nonnegative pair potential with a single local minimum of height $H$ at unit distance and vanishes cubically at a distance of \rt. We have developed this potential to produce ground states with the symmetry of the triangular lattice while favoring the presence of vacancies. After an exhaustive search using various optimization and simulation methods, we believe that we have determined the ground states for all pressures, densities, and $0 \leq H \leq 1$. For specific areas below 3\rt/2, the ground states of the "quintic potential" include high-density and low-density triangular lattices, kagom\'{e} and honeycomb crystals, and stripes. We find that these ground states are mechanically stable but are difficult to self-assemble in computer simulations without defects. For specific areas above 3\rt/2, these systems have a ground-state phase diagram that corresponds to hard disks with radius \rt. For the special case of H=0, a broad range of ground states is available. Analysis of this case suggests that among many ground states, a high-density triangular lattice, low-density triangular lattice, and striped phases have the highest entropy for certain densities. The simplicity of this potential makes it an attractive candidate for experimental realization with application to the development of novel colloidal crystals or photonic materials.Comment: 25 pages, 11 figure

Pseudomonas aeruginosa Enhances Production of a Non-Alginate Exopolysaccharide during Long-Term Colonization of the Cystic Fibrosis Lung

The gram-negative opportunistic pathogen Pseudomonas aeruginosa is the primary cause of chronic respiratory infections in individuals with the heritable disease cystic fibrosis (CF). These infections can last for decades, during which time P. aeruginosa has been proposed to acquire beneficial traits via adaptive evolution. Because CF lacks an animal model that can acquire chronic P. aeruginosa infections, identifying genes important for long-term in vivo fitness remains difficult. However, since clonal, chronological samples can be obtained from chronically infected individuals, traits undergoing adaptive evolution can be identified. Recently we identified 24 P. aeruginosa gene expression traits undergoing parallel evolution in vivo in multiple individuals, suggesting they are beneficial to the bacterium. The goal of this study was to determine if these genes impact P. aeruginosa phenotypes important for survival in the CF lung. By using a gain-of-function genetic screen, we found that 4 genes and 2 operons undergoing parallel evolution in vivo promote P. aeruginosa biofilm formation. These genes/operons promote biofilm formation by increasing levels of the non-alginate exopolysaccharide Psl. One of these genes, phaF, enhances Psl production via a post-transcriptional mechanism, while the other 5 genes/operons do not act on either psl transcription or translation. Together, these data demonstrate that P. aeruginosa has evolved at least two pathways to over-produce a non-alginate exopolysaccharide during long-term colonization of the CF lung. More broadly, this approach allowed us to attribute a biological significance to genes with unknown function, demonstrating the power of using evolution as a guide for targeted genetic studies.open6

The Return to a Sub-Baccalaureate Education: The Effects of Schooling, Credentials and Program of Study on Economic Outcomes

Over the last 20 years, technological changes in the workplace have placed considerable pressure on the U.S. educational system to adequately prepare students for occupations that increasingly require specific skills. However, certain educators and policy-makers have raised the question of whether vocational education at the high school level, with its focus on immediately entering the workforce after high school, adequately prepares students for college. At the postsecondary level, the debate has centered on whether vocational education restricts access to a four-year college, which may hamper future earnings. This report estimates the returns to a sub-baccalaureate education. The analyses emphasize the effect of a student's program of study, the amount of schooling accumulated with and without attaining a degree, and the type of credential earned. We test whether the earnings of degree attainers are significantly larger than those of similar students with the same amount of postsecondary education but no credential. We also examine whether economic gains from occupational education are realized not only for students who concentrated on vocational education in high school but also for special subpopulations such as older students, racial-ethnic minorities, and academically or economically disadvantaged students

Validation of a liquid chromatography-tandem mass spectrometry method for analyzing cannabinoids in oral fluid.

A liquid chromatography tandem mass spectrometry method was developed for quantifying ten cannabinoids in oral fluid (OF). This method utilizes OF collected by the Quantisal™ device and concurrently quantifies cannabinol (CBN), cannabidiol (CBD), Δ9-tetrahydrocannabinol (THC), 11-hydroxy-Δ9-THC (11-OH-THC), 11-nor-9-carboxy-Δ9-THC (THC-COOH), 11-nor-9-carboxy-Δ9-THC glucuronide (THC-COOH-gluc), Δ9-THC glucuronide (THC-gluc), cannabigerol (CBG), tetrahydrocannabiverin (THCV), and Δ9-tetrahydrocannabinolic acid A (THCA-A). Solid phase extraction was optimized using Oasis Prime HLB 30 mg 96-well plates. Cannabinoids were separated by liquid chromatography over a BEH C18 column and detected by a Waters TQ-S micro tandem mass spectrometer. The lower limits of quantification (LLOQ) were 0.4 ng/mL for CBN, CBD, THC, 11-OH-THC, THC-gluc, and THCV; and 1.0 ng/mL for THC-COOH, THC-COOH-gluc, CBG and THCA-A. Linear ranges extended to 2000 ng/mL for THC and 200 ng/mL for all other analytes. Inter-day analytical bias and imprecision at three levels of quality control (QC) was within ±15%. Mean extraction efficiencies ranged from 26.0-98.8%. Applicability of this method was tested using samples collected from individuals randomly assigned to smoke either a joint containing <0.1%, 5.9%, or 13.4% THC content. This method was able to identify and calculate the concentration of 6 of 10 cannabinoids validated in this method

The DEAH-box helicase Dhr1 dissociates U3 from the pre-rRNA to promote formation of the central pseudoknot

In eukaryotes, the highly conserved U3 small nucleolar RNA (snoRNA) base-pairs to multiple sites in the pre-ribosomal RNA (pre-rRNA) to promote early cleavage and folding events. Binding of the U3 box A region to the pre-rRNA is mutually exclusive with folding of the central pseudoknot (CPK), a universally conserved rRNA structure of the small ribosomal subunit essential for protein synthesis. Here, we report that the DEAH-box helicase Dhr1 (Ecm16) is responsible for displacing U3. An active site mutant of Dhr1 blocked release of U3 from the pre-ribosome, thereby trapping a pre-40S particle. This particle had not yet achieved its mature structure because it contained U3, pre-rRNA, and a number of early-acting ribosome synthesis factors but noticeably lacked ribosomal proteins (r-proteins) that surround the CPK. Dhr1 was cross-linked in vivo to the pre-rRNA and to U3 sequences flanking regions that base-pair to the pre-rRNA including those that form the CPK. Point mutations in the box A region of U3 suppressed a cold-sensitive mutation of Dhr1, strongly indicating that U3 is an in vivo substrate of Dhr1. To support the conclusions derived from in vivo analysis we showed that Dhr1 unwinds U3-18S duplexes in vitro by using a mechanism reminiscent of DEAD box proteins