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Engaging veterans in research has gained momentum in the Veterans Health Administration (VHA) in recent years. Engagement ensures that health services research is more relevant and tailored to the unique needs of veteran populations. VHA research centers promote engagement through the development of veteran engagement groups (VEGs). Members engage with researchers in organized meetings to review research proposals or projects, and provide individual feedback to improve veteran-centricity. This article shares important lessons learned in implementing VEGs locally from the liaisons who serve as a bridge between researchers and the veterans involved in these groups. Five steps in the VEG formation process are discussed: (1) regulatory considerations (e.g., compliance issues, ethics); (2) recruitment of VEG members (e.g., group size, demographic characteristics); (3) structure and governance (e.g., meeting logistics, participation, and privacy/confidentiality); (4) orientation and training (e.g., orienting veterans and researchers to the engagement process); and (5) evaluation and feedback (e.g., the effectiveness of engagement and tracking the incorporation of veteran feedback in the research). While all VEGs go through identical steps in the formation process, local implementation varies contextually by research center location. To illustrate the diversity in the formation methods, we present a series of case studies throughout this article: Denver, Colorado; Portland, Oregon; Hines, Illinois; West Haven, Connecticut; Iowa City, Iowa; and Houston, Texas. Normalization of veteran engagement in VHA health services research will require a cultural shift to one that embraces veterans' perspectives and results in a more collaborative partnership between VHA leadership, researchers, and veterans. [ABSTRACT FROM AUTHOR]

Acceptance of the COVID-19 vaccination becomes more critical as new variants continue to evolve and the United States (US) attempts to move from pandemic response to management and control. COVID-19 stands out in the unique way it has polarized patients and generated sustained vaccine hesitancy over time. We sought to understand differences in perceptions and acceptance of COVID-19 vaccination between vaccine hesitant and non-hesitant patients, with the goal of informing communication and implementation strategies to increase uptake of COVID-19 vaccines in Veteran and non-Veteran communities. This qualitative study used interview data from focus groups conducted by the Department of Veterans Affairs (VA) and the University of Utah; all focus groups were conducted using the same script March-July 2021. Groups included forty-six United States Veterans receiving care at 28 VA facilities across the country and 166 non-Veterans across Utah for a total of 36 one-hour focus groups. We identified perceptions and attitudes toward COVID-19 vaccination through qualitative analysis of focus group participant remarks, grouping connections with identified themes within domains developed based on the questions asked in the focus group guide. Responses suggest participant attitudes toward the COVID-19 vaccine were shaped primarily by vaccine attitude changes over time, impacted by perceived vaccine benefits, risks, differing sources of vaccine information and political ideology. Veterans appeared more polarized, being either largely non-hesitant, or hesitant, whereas non-Veterans had a wider range of hesitancy, with more participants identifying minor doubts and concerns about receiving the vaccine, or simply being altogether unsure about receiving it. Development of COVID-19 vaccine communication strategies in Veteran and non-Veteran communities should anticipate incongruous sources of information and explicitly target community differences in perceptions of risks and benefits associated with the vaccine to generate candid discussions and repair individuals' trust. We believe this could accelerate vaccine acceptance over time. [ABSTRACT FROM AUTHOR]

We used Veterans Health Administration (VHA) national administrative data files to identify a cohort (fiscal years 2005–2014) of veterans with spinal cord injuries and disorders (SCID) to determine risk factors for and consequences of lower extremity fracture nonunions. Odds ratios (OR) for fracture nonunion were computed using multivariable‐adjusted logistic regression models. We identified three risk factors for nonunion: (i) older age (OR = 2.29; 95% confidence interval [CI] 1.21–4.33), (ii) longer duration of SCID (OR = 1.02; 95% CI 1.00–1.04), and (iii) fracture site (distal femur), with OR (comparison distal femur) including distal tibia/fibula (OR = 0.14; 95% CI 0.09–0.24), proximal tibia/fibula (OR = 0.19; 95% CI 0.09–0.38), proximal femur (OR = 0.10; 95% CI 0.04–0.21), and hip (OR = 0.13; 95% CI 0.07–0.26). Nonunions resulted in multiple complications, with upwards of 1/3 developing a pressure injury, 13% osteomyelitis, and almost 25% requiring a subsequent amputation. Our data have identified a high‐risk population for fracture nonunion of older veterans with a long duration of SCID who sustain a distal femur fracture. In view of the serious complications of these nonunions, targeted interventions in these high‐risk individuals who have any signs of delayed union should be considered. © 2021 The Authors. JBMR Plus published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research. This article has been contributed to by US Government employees and their work is in the public domain in the USA. [ABSTRACT FROM AUTHOR]

To investigate the association between prescriptions for bisphosphonates; calcium and vitamin D supplements; and receipt of dual-energy x-ray absorptiometry (DXA) screening, and incident fracture risk in men and women with a spinal cord injury (SCI) or disorder (SCID). Propensity-matched case-control analyses. United States Veterans Affairs (VA) facilities. A total of 7989 men and 849 women with an SCID included in VA administrative databases between October 1, 2005 and October 1, 2015 were identified (N=8838). Cases included 267 men and 59 women with a bisphosphonate prescription propensity matched with up to 4 controls. Not applicable. Incident lower extremity fractures. There was no significant association between prescriptions for bisphosphonates and incident lower extremity fractures in men (odds ratio [OR], 1.04; 95% confidence interval [CI], 0.62-1.77) or women (OR, 1.02; 95% CI, 0.28-3.75). In men, similar null associations were seen among those who were adherent to bisphosphonate therapy (OR, 1.25; 95% CI, 0.73-2.16), were concomitant users of vitamin D and calcium and a bisphosphonate (OR, 1.05; 95% CI, 0.57-1.96), had more than 1 fracture on different dates during the study period (OR, 0.13; 95% CI, 0.02-1.16) and in those who had undergone DXA testing prior to the date of the bisphosphonate prescription and incident fracture (OR, 1.26; 95% CI, 0.69-2.32). In men with a traumatic SCI and women with a traumatic SCID, bisphosphonate therapies for osteoporosis do not appear to significantly affect fracture risk. Adequately powered randomized controlled trials are needed to definitively demonstrate efficacy of bisphosphonates for fracture prevention in this population. There is a compelling need to identify new medications to prevent fractures in this high-risk population. [ABSTRACT FROM AUTHOR]

Despite the abundance of evidence demonstrating a dedicated link between positive and negative affect and specific ways of thinking, not all findings are consistent with this view. New research suggests that the relationship between affect and thinking can be altered and often reversed, by varying the mental context in which affect is experienced. The affect-as-cognitive-feedback account can explain a wide range of phenomena, including both prior findings and this more recent research, and generate new predictions. According to this account, affective reactions confer value on accessible information processing strategies (e.g., global vs. local processing) and other mental content that happens to be accessible at the time. This view underscores that the relationship between affect and cognition is not fixed but instead is highly malleable. We present evidence that supports this account, along with new findings that suggest a malleable influence of specific affective states on cognition. [ABSTRACT FROM AUTHOR]

Past research on affiliative social tuning has shown that individuals who experience affiliative motivation toward another person come to exhibit implicit prejudice consistent with the apparent beliefs of that person. The present research seeks to elucidate the mechanism by which such malleability occurs. Is it interpersonally cued cognitive control, consistent with dual-process models of prejudice regulation, or a contextual change in automatic associations, consistent with shared reality theory? QUAD modeling of participants’ responses revealed that affiliative social tuning of implicit prejudice was solely a function of changing associations (Studies 1–3). Furthermore, instructions to try to inhibit prejudice within a particular interpersonal context did not yield implicit attitude change (Study 2). [ABSTRACT FROM AUTHOR]

Context: Antimicrobial Stewardship Programs (ASPs) are crucial to optimizing antibiotic use. ASPs are implemented in the Veterans Health Administration (VAs), but they do not target the needs of populations at high risk for resistant infections, such as spinal cord injury and disorder (SCI/D)., Objective: The goal of this study was to assess key ASP leader and SCI/D clinicians' perceived level of implementation and impact of 33 Antimicrobial Stewardship (AS) strategies., Method: SCI/D clinicians and ASP leaders across 24 VA facilities with SCI/D units were surveyed. Participants rated their perceived level of impact ("high", "mild", "low") and perceived level of implementation ("not", "partially", "fully") for 33 AS strategies in SCI/D units in VAs. Strategies were grouped into core elements which they support. We conducted a Fisher's exact test to assess differences between respondent perceptions based on role (SCI/D clinicians versus ASP leaders)., Results: AS strategy implementation varied across VA facilities. Of the AS strategies, pre-authorization was perceived to be highly impactful (78%) and fully implemented (82%). SCI/D clinicians and ASP leaders rated AS strategies differently such that SCI/D clinicians were less aware of implementation of AS strategies related to reporting requirements; further, SCI/D clinicians rated strategies which guide treatment duration and which limit C. difficile antibiotic exposure as more impactful than ASP leaders. Ratings for facility-wide and SCI/D unit ratings did not significantly differ for impact or implementation., Conclusion: Implementation practices varied across VA facilities. Future work should implement highly impactful AS strategies according to facility and unit needs.

Considerable research shows that positive affect improves performance on creative tasks and negative affect improves performance on analytic tasks. The present research entertained the idea that affective feelings have flexible, rather than fixed, effects on cognitive performance. Consistent with the idea that positive and negative affect signal the value of accessible processing inclinations, the influence of affective feelings on performance on analytic or creative tasks was found to be flexibly responsive to the relative accessibility of different styles of processing (i.e., heuristic vs. systematic, global vs. local). When a global processing orientation was accessible happy participants generated more creative uses for a brick (Experiment 1), successfully solved more remote associates and insight problems (Experiment 2) and displayed broader categorization (Experiment 3) than those in sad moods. When a local processing orientation was accessible this pattern reversed. When a heuristic processing style was accessible happy participants were more likely to commit the conjunction fallacy (Experiment 3) and showed less pronounced anchoring effects (Experiment 4) than sad participants. When a systematic processing style was accessible this pattern reversed. Implications of these results for relevant affect-cognition models are discussed. (PsycINFO Database Record, ((c) 2016 APA, all rights reserved).)