Exploring Clinician Perceptions of a Veteran Peer Support Intervention to Inform Implementation

poster abstractIntroduction Chronic pain affects a large number of veterans and negatively impacts their quality of life. To address chronic pain, peer support models have been utilized and show promising results. ECLIPSE (Evaluation of a Coach--‐Led Intervention to Improve Pain Symptoms) is focused on a peer support intervention that involves peer delivery of pain self--‐management strategies for veterans dealing with chronic musculoskeletal pain. This intervention aims to positively impact overall pain levels, as well as self--‐efficacy, social support, pain coping, patient activation, health--‐related quality of life, and health service utilization. The current study serves the pre--‐implementation aim of ECLIPSE; the purpose of this study was to explore clinician perceptions regarding ECLIPSE to inform implementation into VA clinics. Methods This study utilized a qualitative approach to interview clinicians at a single US VA Medical Center. A research assistant conducted individual, in--‐person, semi--‐structured interviews with clinicians, which fulfills the third aim of a larger research project. Analysis consisted of developing descriptive coding and themes emerged through the evaluation of coded segments. Results Preliminary results for n=9 (second round of interviews to be completed in the summer) have revealed 4 themes. Clinicians: i) have an overall positive view of this type of intervention; ii) believe peer coaches should be properly selected and supported; iii) have valuable feedback on aspects of implementing and maintaining this type of intervention within clinics; and iv) have considerations for maximizing intervention utility. Conclusions Interventions that involve peer coaching may be incredibly beneficial for those suffering with chronic pain. However, to determine the ease of implementation of these types of interventions into clinic settings, understanding clinician viewpoints is a necessary aspect to ensure success. Feedback collected in this study can also facilitate implementation on a broader scale, allowing more veterans to benefit from this peer support intervention

Therapeutic Massage Combined with Mirror Therapy for Phantom Limb Pain: Two Experimental Cases

poster abstractPhantom limb pain (PLP) is a common and difficult to treat issue for individuals with amputations. Current PLP treatments (primarily pharmaceutical) are only modestly effective and often have negative side-effects. Massage has been self-reported as beneficial for PLP but no research has examined massage specifically for PLP. Mirror therapy’s evidence base for PLP is building. Combining massage (which alone may impact PLP via Pfleger’s law of symmetry) with mirror therapy may allow practitioners to apply massage for a painful area that cannot actually be touched. The current quasi-experimental A-B-A withdrawal case series sought to descriptively examine outcomes of therapeutic massage combined with mirror therapy (TMwMT) for individuals with persistent lower limb PLP and establish feasibility of intervention delivery. Each study phase was four weeks long with bi-weekly, individualized 20-25 minute TMwMT sessions during the treatment (B) phase. TMwMT sessions were developed and applied to address the specific participant PLP experience as if the pain were experienced by the intact limb. During masked TMwMT sessions, participants viewed a real-time mirror image of their intact leg receiving massage in the place of their missing limb. Measures: bi-weekly PLP severity via VAS; PLP intensity and interference collected at beginning/end of each phase via Brief Pain Inventory. Two men completed the study protocol. PLP severity decreased during treatment for both participants with effects beginning to diminish by week two of the withdrawal phase. By the study’s conclusion, PLP severity had not elevated back to average levels of initial phase A. Pain intensity for both participants improved during phase B but results were mixed for pain interference. These individuals had not responded to previous treatments for their PLP; our experimental, non-pharmacological and targeted TMwMT treatment was beneficial in the short-term. Our intervention is theoretically sound, reflects aspects of real-world massage delivery, and needs further investigation

Climate change and the duties of the disadvantaged: reply to Caney

Discussions of where the costs of climate change adaptation and mitigation should fall often focus on the ‘polluter pays principle’ or the ‘ability to pay principle’. Simon Caney has recently defended a ‘hybrid view’, which includes versions of both of these principles. This article argues that Caney’s view succeeds in overcoming several shortfalls of both principles, but is nevertheless subject to three important objections: first, it does not distinguish between those emissions which are hard to avoid and those which are easy to avoid; second, its only partial reference to all-things-considered justice means it cannot provide a full account even of climate justice; and third, it assigns to the poor very limited duties to meet climate change costs, even where they have created those costs, which may incentivise them to increase emissions. An alternative pluralistic account which avoids these objections is presented

Allocating the Burdens of Climate Action: Consumption-Based Carbon Accounting and the Polluter-Pays Principle

Action must be taken to combat climate change. Yet, how the costs of climate action should be allocated among states remains a question. One popular answer—the polluter-pays principle (PPP)—stipulates that those responsible for causing the problem should pay to address it. While intuitively plausible, the PPP has been subjected to withering criticism in recent years. It is timely, following the Paris Agreement, to develop a new version: one that does not focus on historical production-based emissions but rather allocates climate burdens in proportion to each state’s annual consumption-based emissions. This change in carbon accounting results in a fairer and more environmentally effective principle for distributing climate duties

Reducing veterans’ risk for suicidal behaviors: a qualitative study to inform development of the RECLAIM health promotion program

Background In an effort to reduce the high rate of suicide among post-9/11 veterans, a collaborative team within the Department of Veterans Affairs (VA) has developed a holistic community-based health promotion program designed to facilitate social and self-connectedness. The purpose of this study was to elicit veteran and stakeholder feedback to prepare the program for piloting and implementation. Methods Focus groups and interviews were conducted with post-9/11 veterans and veteran stakeholders (e.g., VA clinicians) to elicit feedback regarding the health promotion program. Focus groups and interviews were audio-recorded and transcribed. Qualitative thematic analysis identified key themes emerging from the focus groups and interviews. Results Seven focus groups (3 Veteran groups, 4 stakeholder groups) and 3 interviews (2 Veterans, 1 stakeholder) were conducted with 41 participants (14 veterans, 27 stakeholders). Overall, participants had a positive perception of the program. Thematic analysis revealed shared perspectives that provided insight into 1) enhancing program recruitment and retention, 2) the perceived ability of a health promotion program to provide more holistic, veteran-centered care, and 3) using health promotion programs to help veterans establish structure in their daily lives. Conclusions Findings indicated an overall acceptance of the program, and participants’ perspectives on how to reduce barriers and enhance facilitators can inform the development of a larger-scale health promotion program that can be tested through future research. While discussion questions were specifically focused on the program in this study, findings can be considered more broadly for the design and implementation of related programs to effectively improve the health and wellness of post-9/11 veterans

Plasmalemmal Vesicle Associated Protein-1 (PV-1) is a marker of blood-brain barrier disruption in rodent models

<p>Abstract</p> <p>Background</p> <p><it>Plasmalemmal vesicle associated protein-1 </it>(<it>PV-1</it>) is selectively expressed in human brain microvascular endothelial cells derived from clinical specimens of primary and secondary malignant brain tumors, cerebral ischemia, and other central nervous system (CNS) diseases associated with blood-brain barrier breakdown. In this study, we characterize the murine CNS expression pattern of <it>PV-1 </it>to determine whether localized <it>PV-1 </it>induction is conserved across species and disease state.</p> <p>Results</p> <p>We demonstrate that <it>PV-1 </it>is selectively upregulated in mouse blood vessels recruited by brain tumor xenografts at the RNA and protein levels, but is not detected in non-neoplastic brain. Additionally, <it>PV-1 </it>is induced in a mouse model of acute ischemia. Expression is confined to the cerebovasculature within the region of infarct and is temporally regulated.</p> <p>Conclusion</p> <p>Our results confirm that <it>PV-1 </it>is preferentially induced in the endothelium of mouse brain tumors and acute ischemic brain tissue and corresponds to blood-brain barrier disruption in a fashion analogous to human patients. Characterization of <it>PV-1 </it>expression in mouse brain is the first step towards development of rodent models for testing anti-edema and anti-angiogenesis therapeutic strategies based on this molecule.</p

Microwave and Millimeter Wave Techniques

Contains reports on four research projects.Joint Services Electronics Program (Contract DAAB07-74-C-0630)National Science Foundation (Grant MPS-73-05043-A01

MeV magnetosheath ions energized at the bow shock

A causal relationship between midlatitude magnetosheath energetic ions and bow shock magnetic geometry was previously established for ion energy up to 200 keV e−1 for the May 4, 1998, storm event. This study demonstrates that magnetosheath ions with energies above 200 keV up to 1 MeV simply extend the ion spectrum to form a power law tail. Results of cross-correlation analysis suggest that these ions also come directly from the quasi-parallel bow shock, not the magnetosphere. This is confirmed by a comparison of energetic ion fluxes simultaneously measured in the magnetosheath and at the quasi-parallel bow shock when both regions are likely connected by the magnetic field lines. We suggest that ions are accelerated at the quasi-parallel bow shock to energies as high as 1 MeV and subsequently transported into the magnetosheath during this event