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Introduction We explore disparities in awarding post-traumatic stress disorder (PTSD) service-connected disability benefits (SCDB) to veterans based on gender, race/ethnicity, and misconduct separation. Methods Department of Defense data on service members who separated from October 1, 2001 to May 2017 were linked to Veterans Administration (VA) administrative data. Using adjusted logistic regression models, we determined the odds of receiving a PTSD SCDB conditional on a VA diagnosis of PTSD. Results A total of 1,558,449 (79% of separating service members) had at least one encounter in VA during the study period (12% female, 4.5% misconduct separations). Females (OR 0.72) and Blacks (OR 0.93) were less likely to receive a PTSD award and were nearly equally likely to receive a PTSD diagnosis (OR 0.97, 1.01). Other racial/ethnic minorities were more likely to receive an award and diagnosis, as were those with misconduct separations (award OR 1.3, diagnosis 2.17). Conclusions Despite being diagnosed with PTSD at similar rates to their referent categories, females and Black veterans are less likely to receive PTSD disability awards. Other racial/ethnic minorities and those with misconduct separations were more likely to receive PTSD diagnoses and awards. Further study is merited to explore variation in awarding SCDB.

Introduction Musculoskeletal (MSK) conditions are commonly seen among military service members (SM) and Veterans. We explored correlates of award of MSK-related service-connected disability benefits (SCDB) among SM seeking care in Veterans Affairs (VA) hospitals. Materials and Methods Department of Defense data on SM who separated from October 1, 2001 to May 2017 were linked to VA administrative data. Using adjusted logistic regression models, we determined the odds of receiving MSK SCDB. Results A total of 1,558,449 (79% of separating SM) had at least one encounter in VA during the study period (7.8% disability separations). Overall, 51% of this cohort had at least one MSK SCDB (88% among disability separations, 48% among normal). Those with disability separations (as compared to normal separations) were significantly more likely to receive MSK SCDB (odds ratio 2.37) as were females (compared to males, odds ratio 1.15). Conclusions Although active duty SM with disability separations were more likely to receive MSK-related service-connected disability ratings in the VA, those with normal separations also received such awards. Identifying those at highest risk for MSK-related disability could lead to improved surveillance and prevention strategies in the Department of Defense and VA health care systems to prevent further damage and disability.

Women Veterans who experience homelessness are at high risk of unintended pregnancy and adverse outcomes. Contraception could mitigate risks, yet access barriers exist across the Veterans Health Administration (VHA). We identified all US women Veterans, age 18–44y with evidence of homelessness in VHA administrative data between fiscal years 2002–2015, in order to document the geographic distribution of ever-homeless women Veterans in relation to VA Medical Centers (VAMCs) and assess geographic associations between long acting reversible contraceptives (LARC) or permanent contraception (PC) use. We calculated VAMC travel distance from last known ZIP Code. We used multivariate logistic regression models to explore contraceptive method associations. We included 41,722 ever-homeless women Veterans; 9.2% had LARC exposure and 7.5% PC. We found 29% of ever-homeless women Veterans resided >40miles from the nearest VAMC and increasing drive distance was negatively correlated with contraceptive exposure, especially for Veterans residing >100miles from a VAMC. Increasing distance to the nearest VAMC results in a geographic barrier to the most effective contraceptive options for women Veterans. The VHA is uniquely positioned to leverage its rural and homeless healthcare expertise to address geographic barriers and integrate comprehensive contraceptive services into established programs for high-risk Veterans.

A microstrip rectenna for WLAN wireless energy harvesting is proposed in this paper. The rectenna is composed of a microstrip antenna and a rectifier. The operating frequency of the receiving microstrip antenna is from 2.418GHz to 2.458GHz which the reflection coefficient is below −10dB. The circuit of rectifier is based on single stage double voltage rectifying structure. The working bandwidth of the rectifier is 40MHz. When the input power is −15dBm and the load resistance is $4\mathrm{K}\Omega$ , the output voltage of the rectenna at 2.44GHz is 0.11V.

Background A better understanding of the long-term health effects of combat injury is important for the management of veterans’ health in the Department of Defense (DoD) and Veterans Affairs (VA) health care systems and may have implications for primary care management of civilian trauma patients. Objective To determine the impact of traumatic injury on the subsequent development of hypertension (HTN), diabetes mellitus (DM), and coronary artery disease (CAD) after adjustment for sociodemographic, health behavior, and mental health factors. Design Retrospective cohort study of current and former US military personnel with data obtained from both the DoD and VA health care systems. Participants Combat injured (n = 8727) service members between 1 February 2002 and 14 June 2016 randomly selected from the DoD Trauma Registry matched 1:1 based on year of birth, sex, and branch of service to subjects that deployed to a combat zone but were not injured. Main Measures Traumatic injury, stratified by severity, compared with no documented injury. Diagnoses of HTN, DM, and CAD defined by International Classification of Diseases 9th or 10th Revision Clinical Modification codes. Key Results After adjustment, severe traumatic injury was significantly associated with HTN (HR 2.78, 95% CI 2.18–3.55), DM (HR 4.45, 95% CI 2.15–9.18), and CAD (HR 4.87, 95% CI 2.11–11.25), compared with no injury. Less severe injury was associated with HTN (HR 1.14, 95% CI 1.05–1.24) and CAD (HR 1.62, 95% CI 1.11–2.37). Conclusions Severe traumatic injury is associated with the subsequent development of HTN, DM, and CAD. These findings have profound implications for the primary care of injured service members in both the DoD/VA health systems and may be applicable to civilian trauma patients as well. Further exploration of pathophysiologic, health behavior, and mental health changes after trauma is warranted to guide future intervention strategies.

Background While patients with substance use disorders (SUDs) are thought to encounter poor primary care experiences, the perspectives of patients with opioid use disorder (OUD), specifically, are unknown. This study compares the primary care experiences of patients with OUD, other SUDs and no SUD in the Veterans Health Administration. Methods The sample included Veterans who responded to the national Patient-Centered Medical Home Survey of Healthcare Experiences of Patients, 2013–2015. Respondents included 3554 patients with OUD, 36,175 with other SUDs, and 756,386 with no SUD; 742 OUD-diagnosed patients received buprenorphine. Multivariable multinomial logistic regressions estimated differences in the probability of reporting positive and negative experiences (0–100 scale) for patients with OUD, compared to patients with other SUDs and no SUD, and for OUD-diagnosed patients treated versus not treated with buprenorphine. Results Of all domains, patients with OUD reported the least positive experiences with access (31%) and medication decision-making (35%), and the most negative experiences with self-management support (35%) and provider communication (23%). Compared to the other groups, patients diagnosed with OUD reported fewer positive and/or more negative experiences with access, communication, office staff, provider ratings, comprehensiveness, care coordination, and self-management support (adjusted risk differences[aRDs] range from |2.9| to |7.0|). Among OUD-diagnosed patients, buprenorphine was associated with more positive experiences with comprehensiveness (aRD = 8.3) and self-management support (aRD = 7.1), and less negative experiences with care coordination (aRD = −4.9) and medication shared decision-making (aRD = −5.4). Conclusions In a national sample, patients diagnosed with OUD encounter less positive and more negative experiences than other primary care patients, including those with other SUDs. Buprenorphine treatment relates positively to experiences with care comprehensiveness, medication decisions, and care coordination. As stakeholders encourage more primary care providers to manage OUD, it will be important for healthcare systems to attend to patient access and experiences with care in these settings.

BACKGROUND Homeless patients describe poor experiences with primary care. In 2012, the Veterans Health Administration (VHA) implemented homeless-tailored primary care teams (Homeless Patient Aligned Care Team, HPACTs) that could improve the primary care experience for homeless patients. OBJECTIVE To assess differences in primary care experiences between homeless and nonhomeless Veterans receiving care in VHA facilities that had HPACTs available (HPACT facilities) and in VHA facilities lacking HPACTs (non-HPACT facilities). RESEARCH DESIGN We used multivariable multinomial regressions to estimate homeless versus nonhomeless patient differences in primary care experiences (categorized as negative/moderate/positive) reported on a national VHA survey. We compared the homeless versus nonhomeless risk differences (RDs) in reporting negative or positive experiences in 25 HPACT facilities versus 485 non-HPACT facilities. SUBJECTS Survey respondents from non-HPACT facilities (homeless: n=10,148; nonhomeless: n=309,779) and HPACT facilities (homeless: n=2022; nonhomeless: n=20,941). MEASURES Negative and positive experiences with access, communication, office staff, provider rating, comprehensiveness, coordination, shared decision-making, and self-management support. RESULTS In non-HPACT facilities, homeless patients reported more negative and fewer positive experiences than nonhomeless patients. However, these patterns of homeless versus nonhomeless differences were reversed in HPACT facilities for the domains of communication (positive experience RDs in non-HPACT versus HPACT facilities=-2.0 and 2.0, respectively); comprehensiveness (negative RDs=2.1 and -2.3), shared decision-making (negative RDs=1.2 and -1.8), and self-management support (negative RDs=0.1 and -4.5; positive RDs=0.5 and 8.0). CONCLUSIONS VHA facilities with HPACT programs appear to offer a better primary care experience for homeless versus nonhomeless Veterans, reversing the pattern of relatively poor primary care experiences often associated with homelessness.

Housing stability is an important determinant of health. The US Department of Veterans Affairs (VA) administers several programs to assist Veterans experiencing unstable housing. Measuring long-term housing stability of Veterans who receive assistance from VA is difficult due to a lack of standardized structured documentation in the Electronic Health Record (EHR). However, the text of clinical notes often contains detailed information about Veterans’ housing situations that may be extracted using natural language processing (NLP). We present a novel NLP-based measurement of Veteran housing stability: Relative Housing Stability in Electronic Documentation (ReHouSED). We first develop and evaluate a system for classifying documents containing information about Veterans’ housing situations. Next, we aggregate information from multiple documents to derive a patient-level measurement of housing stability. Finally, we demonstrate this method’s ability to differentiate between Veterans who are stably and unstably housed. Thus, ReHouSED provides an important methodological framework for the study of long-term housing stability among Veterans receiving housing assistance.

Objective To determine whether persistent opioid use after injury is associated with subsequent long-term development of clinically recognized opioid abuse. Summary background data Opioid abuse is an epidemic in the United States and trauma can initiate persistent use; however, it remains unclear whether persistent opioid use contributes to the subsequent development of opioid abuse. The care of combat casualties by the Departments of Defense and Veterans Affairs uniquely allows investigation of this long-term outcome. Methods This retrospective cohort study randomly selected 10,000 battle-injured United States military personnel. We excluded patients who died during initial hospitalization or within 180 days of discharge, had a preinjury opioid abuse diagnosis, or had missing data in a preselected variable. We defined persistent opioid use as filling an opioid prescription 3 to 6 months after discharge and recorded clinically recognized opioid abuse using relevant diagnosis codes. Results After exclusion, 9284 subjects were analyzed, 2167 (23.3%) of whom developed persistent opioid use. During a median follow-up time of 8 years, 631 (6.8%) patients developed clinically recognized opioid abuse with a median time to diagnosis of 3 years. Injury severity and discharge opioid prescription amount were associated with persistent opioid use after trauma. After adjusting for patient and injury-specific factors, persistent opioid use was associated with the long-term development of clinically recognized opioid abuse (adjusted hazard ratio, 2.39; 95% confidence interval, 1.99-2.86). Conclusions Nearly a quarter of patients filled an opioid prescription 3 to 6 months after discharge, and this persistent use was associated with long-term development of opioid abuse.

This paper presents a multi-beam planar lens antenna based on frequency selective surface (FSS)operating at 6GHz. The proposed C-band multi-beam planar lens antenna exhibits the advantages of low profile and ease of manufacture, with good transmission characteristics at 6 GHz. A rectangular waveguide of 40.386mm×20.193mm is used as the feed. The gain of designed C-band multi-beam planar lens antenna reaches 14.4dBi, which shows an increment of 7.9dBi compared with the gain of rectangular waveguide. The simulation results confirm the wide-angle scanning properties of the proposed C-band multi-beam planar lens antenna in the ±30° range with gain scanning loss less than 0.6dBi.

In this paper, a dual-band band-stop frequency selective surface(FSS) is designed. Structure of the FSS is composed of upper and lower metal patches on a dielectric substrate. The metal patches consist of a square metal strip on one side of the dielectric substrate and a folded ring part on both sides of the dielectric substrate. The dual-band FSS can operate on 1.6 GHz and 2.4 GHz which TE mode bandwidth is 0.1 GHz~0.18GHz and 0.4 GHz~0.68GHz (-15dB stop-band bandwidth), and TM mode bandwidth is 0.04 GHz~0.1GHz and 0.2 GHz~0.4GHz (-15dB stop-band bandwidth), respectively. The whole dimension of miniaturized unit cell of elements is 0.085λ × 0.085λ. The miniaturization element of FSS and stable center frequency is achieved.

In this paper, a high gain planar antenna with parabolic reflector made by metalized via-holes is proposed. An H-plane horn antenna based on the substrate integrated waveguide is used as a feed on offset focus position of the parabolic shaped metalized via-holes. Reflection coefficient of the antenna is below -10dB from 20 GHz to 30 GHz. The gain of the planar antenna is 17 dB at the frequency of 25 GHz, which is 8.5 dB higher than the gain of the feed of H-plane horn antenna.

Background In 2012, select Veterans Health Administration (VHA) facilities implemented a homeless-tailored medical home model, called Homeless Patient Aligned Care Teams (H-PACT), to improve care processes and outcomes for homeless Veterans. Objective The main aim of this study was to determine whether H-PACT offers a better patient experience than standard VHA primary care. Research design We used multivariable logistic regressions to estimate differences in the probability of reporting positive primary care experiences on a national survey. Subjects Homeless-experienced survey respondents enrolled in H-PACT (n=251) or standard primary care in facilities with H-PACT available (n=1527) and facilities without H-PACT (n=10,079). Measures Patient experiences in 8 domains from the Consumer Assessment of Healthcare Provider and Systems surveys. Domain scores were categorized as positive versus nonpositive. Results H-PACT patients were less likely than standard primary care patients to be female, have 4-year college degrees, or to have served in recent military conflicts; they received more primary care visits and social services. H-PACT patients were more likely than standard primary care patients in the same facilities to report positive experiences with access [adjusted risk difference (RD)=17.4], communication (RD=13.9), office staff (RD=13.1), provider ratings (RD=11.0), and comprehensiveness (RD=9.3). Standard primary care patients in facilities with H-PACT available were more likely than those from facilities without H-PACT to report positive experiences with communication (RD=4.7) and self-management support (RD=4.6). Conclusions Patient-centered medical homes designed to address the social determinants of health offer a better care experience for homeless patients, when compared with standard primary care approaches. The lessons learned from H-PACT can be applied throughout VHA and to other health care settings.

This cohort study examines the association of temporary financial assistance with housing stability among US veterans who are homeless or at risk for homelessness., Key Points Question Is temporary financial assistance (TFA) associated with improved housing outcomes among US veterans experiencing housing instability? Findings In this cohort study of 41 969 veterans enrolled in the Supportive Services for Veteran Families program, veterans who received TFA were significantly more likely than those who did not receive TFA to exit the program with a stable housing destination. Meaning Results of this study suggest that short-term financial assistance for housing-related expenses may be a useful tool for addressing homelessness., Importance Temporary financial assistance (TFA) for housing-related expenses is a key component of interventions to prevent homelessness or to quickly house those who have become homeless. Through the US Department of Veterans Affairs (VA) Supportive Services for Veteran Families (SSVF) program, the department provides TFA to veterans in need of housing assistance. Objective To assess the association between TFA and housing stability among US veterans enrolled in the SSVF program. Design, Setting, and Participants This retrospective cohort study analyzed data on veterans who were enrolled in the SSVF program at 1 of 203 partner organizations in 49 US states and territories. Some veterans had repeat SSVF episodes, but only the first episodes were included in this analysis. An episode was defined as the period between entry into and exit from the program occurring between October 1, 2015, and September 30, 2018. Exposures Receipt of TFA. Main Outcomes and Measures The main outcome was stable housing, defined as permanent, independent residence with payment by the program client or housing subsidy after exit from the SSVF program. Covariates included demographic characteristics, monthly income and source, public benefits, health insurance, use of other VA programs for homelessness, comorbidities, and geographic location. Multivariable mixed-effects logistic regression, inverse probability of treatment weighting, and instrumental variable approaches were used. Results The overall cohort consisted of 41 969 veterans enrolled in the SSVF program, of whom 29 184 (mean [SD] age, 50.4 [12.9] years; 25 396 men [87.0%]) received TFA and 12 785 (mean [SD] age, 50.0 [13.3] years; 11 229 men [87.8%]) did not receive TFA. The mean (SD) duration of SSVF episodes was 90.5 (57.7) days. A total of 69.5% of SSVF episodes involved receipt of TFA, and the mean (SD) amount of TFA was $6070 ($7272). Stable housing was obtained in 81.4% of the episodes. Compared with those who did not receive TFA, veterans who received TFA were significantly more likely to have stable housing outcomes (risk difference, 0.253; 95% CI, 0.240-0.265). An association between the amount of TFA received and stable housing was also found, with risk differences ranging from 0.168 (95% CI, 0.149-0.188) for those who received $0 to $2000 in TFA to 0.226 (95% CI, 0.203-0.249) for those who received more than $2000 to $4000 in TFA. Conclusions and Relevance This study found that receipt of TFA through the SSVF program was associated with increased rates of stable housing. These results may inform national policy debates regarding the optimal solutions to prevent and reduce housing instability.

Purpose Posttraumatic stress disorder (PTSD), depressive disorders (DD), and substance use disorders (SUD) are prevalent among veterans. A positive military sexual trauma (MST) screen is associated with higher likelihood of each of these disorders. The current study examined the associations between MST, gender, and co-occurring PTSD, DD, and SUD among veterans receiving services at the Department of Veterans Affairs to inform assessment and treatment. We were specifically interested in the interactions between MST and gender on co-occurring disorders. Methods The sample included 494,822 Department of Veterans Affairs service–seeking veterans (12.5% women) deployed to Iraq and Afghanistan who recently separated from the military and were screened for MST between 2004 and 2013. Main Findings Veterans with positive MST screens had higher odds than those with negative screens of individual and co-occurring PTSD, DD, and SUD. The association between positive MST screens and diagnostic outcomes, including PTSD, was stronger for women than for men, and the association between positive MST screens and some diagnostic outcomes, including DD, was stronger for men than for women. Conclusions These results highlight the importance of assessing for and recognizing the potential MST and gender interactions in the clinical context among veterans with co-occurring PTSD, DD, and/or SUD.

Objective To estimate health care utilization and costs incurred by homeless Veterans relative to nonhomeless Veterans and to examine the impact of a VA homelessness program on these outcomes. Data sources/study setting Combined Department of Veterans Affairs (VA) administrative and Medicare claims data. Study design Observational study using longitudinal data from Veterans engaged with the VA system and enrolled in Medicare. Veterans with administrative evidence of homelessness at any point during 2006-2010 were matched on period of military service to Veterans with no evidence of homelessness. Principal findings Experience of homelessness was associated with 1.37 (95 percent CI = 1.34-1.40) and 0.16 (95 percent CI = 0.14-0.17) more outpatient encounters per quarter in VA and non-VA settings, respectively, and 1.31 (95 percent CI = 1.30-1.32) and 0.49 (95 percent CI = 0.48-0.49) more inpatient days per quarter in VA and non-VA hospitals, respectively. These were associated with higher costs. Relative to stably housed Veterans less than 65 years of age, those enrolled in a VA homelessness program had 94.4 percent (95 percent CI = 90.7 percent-98.1 percent) more VA outpatient visits but 5.5 percent (95 percent CI = 3.0 percent-7.9 percent) fewer Medicare outpatient visits. Conclusions Homelessness was associated with an increase in VA and Medicare utilization and cost. A VA homelessness program decreased use of Medicare outpatient services.

A novel dual-band frequency selective surface based on combined element of 2.5 dimensional spiral ring and crossed dipole is proposed. The simulation results indicate that the dual-bandstop frequency selective surface operates at the frequency of 2.3GHz and 5.9GHz, and is independent of incident angle and polarization. The whole dimension of the miniaturized unit cell is 0.051 X 0.051 (λ is free space wavelength on first resonant band). Its resonance mechanism is analyzed by the current distributions of the element at the two resonance frequencies.

In this paper, a new octagonal artificial magnetic conductor unit is proposed. The bandwidth of in-phase reflection characteristics is from 8.36GHz to 9.55GHz. Then a circularly polarized microstrip antenna loading a C-shaped slot in the circular microstrip patch with 7×7 artificial magnetic conductor is designed. Simulation results show that the antenna operates in 7.42 GHz~ 10.74 GHz with return loss less than −10dB. And relative bandwidth of the antenna is 36.6%. The frequency range is from 8.30 GHz to 9.37 GHz which axial ratio is less than 3 dB. Gain of the antenna is more than 6dB in the bandwidth.

This paper proposes a dual-band conformal antenna which resonates at lower WLAN (2.4 GHz) and high WLAN (5.8 GHz) frequency bands. And for both the bands, the conformal antenna has perfect omnidirectional radiation pattern. The proposed antenna is conformed onto a cylindrical structure of radius 200 mm. And the electromagnetic model and parametric analysis of the proposed antenna is developed in HFSS for optimization and analysis. The performance simulation results of the antenna are presented.

With compact folded method, a kind of folded crossed dipole ultra wideband antenna is proposed with omnidirectional radiation characteristics on the horizontal direction in this paper. The antenna is comprised of orthogonal crossed semicircular metal discs with twice 90° folded on both ends. Horizontal size is reduced obviously compared with original crossed semicircular disc antenna. This antenna operates from 3.1GHz to 17.2GHz with S11

US women Veterans are at increased risk of homelessness and chronic health conditions associated with unintended pregnancy. Veterans Health Administration (VHA) provision of long-acting reversible contraception (LARC) can assist in healthy pregnancy planning.To evaluate perinatal risk factors and LARC exposure in ever-homeless women Veterans.A retrospective cohort study of women Veterans using VHA administrative data from fiscal years 2002-2015.We included 41,747 ever-homeless women Veterans age 18-44 years and 46,391 housed women Veterans matched by military service period. A subgroup of 7773 ever-homeless and 8674 matched housed women Veterans deployed in Iraq and Afghanistan [Operations Enduring Freedom/Iraqi Freedom/New Dawn (OEF/OIF/OND)] conflicts comprised a second analytic cohort.Descriptive statistics compared demographic, military, health conditions, and LARC exposure in ever-homeless versus housed women Veterans. Multivariable logistic regression explored factors associated with LARC exposure in the OEF/OIF/OND subgroup.All health conditions were significantly higher in ever-homeless versus housed Veterans: mental health disorder in 84.5% versus 48.7% (P0.001), substance abuse in 35.8% versus 8.6% (P0.001), and medical conditions in 74.7% versus 55.6% (P0.001). LARC exposure among all VHA users was 9.3% in ever-homeless Veterans versus 5.4% in housed Veterans (P0.001). LARC exposure in the OEF/OIF/OND cohort was 14.1% in ever-homeless Veterans versus 8.2% in housed Veterans (P0.001). In the OEF/OIF/OND cohort, homelessness along Veterans with medical and mental health indicators were leading LARC exposure predictors.The VHA is successfully engaging homeless women Veterans and providing LARC access. The prevalence of perinatal risk factors in ever-homeless women Veterans highlights a need for further programmatic enhancements to improve reproductive planning.

A kind of dual-band notched ultra wideband microstrip antenna is presented in this paper. The reflectioncoefficient has goodnotched characteristics at rejection band of 3.3GHz∼3.7GHz and 5.15GHz∼5.85GHz by etching a complementary split ring in semicircular radiating patch. The stop bands cover WIMAX and WLAN frequency band. The designed antenna operates from 2.8GHzto12GHz. The gain is 2.3dB∼6.3dB in operating band, while the gain is less than 0dB in rejection band. And the antenna shows good omnidirectional radiation patterns in H-plane in the working band.

A kind of composite antenna with an artificial magnetic conductor ground is designed in this paper. This antenna consists of a 3×3 hexagonal annular gap artificial magnetic conductor unit cells and a rectangular patch antenna fed by coplanar waveguide. The in-phase reflection is suitable for the composite antenna. The distance between the patch antenna and the ground is 0.1λ at zero-phase reflection frequency for gain enhancement and low profile. The experimental results show that the relative operating bandwidth of the composite antenna is 23.3%, and the gain is more than 9dB.

Background Surveillance is an effective strategy for reducing surgical site infections (SSIs); however, current identification methods are resource-intensive. Therefore, we sought to validate an electronic SSI triaging tool for detection of probable infections and identify operational barriers and challenges. Methods A retrospective cohort study was conducted among all Veterans Affairs Surgical Quality Improvement Program (VASQIP)–reviewed surgeries at 2 Veterans Affairs medical centers from October 1, 2011-September 30, 2014. During the postoperative period, clinical and administrative variables associated with SSI (relevant microbiology order, antibiotic order, radiology order, and administrative codes) were extracted from the electronic medical record and used to score the probability (high, intermediate, and low) that an SSI occurred. VASQIP manual chart review was used as the gold standard of comparison. Results VASQIP manual review identified 118 SSIs out of 3,700 surgeries (3.2%). There were 2,041, 1,428, and 231 surgeries that met criteria for low, intermediate, and high probability for SSI. The tool's area under the curve was 0.86 (95% confidence interval, 0.82-0.89). The sensitivity among low-probability surgeries was 92.4%, and the specificity among high-probability surgeries was 95.1%. Conclusions The electronic SSI tool has the potential to be used for triaging VASQIP surveillance toward the high-probability surgeries and to avoid manual review of surgeries with low probability of SSI.

Severe mental illness (SMI) and substance use disorders (SUD) are among the more chronic and costly mental health conditions treated in the Department of Veterans Affairs (VA). Service use patterns of returning veterans with SMI and SUD have received little attention. We examined gender differences in the utilization of VA services among a national sample of Operations Enduring Freedom, Iraqi Freedom, and New Dawn (OEF/OIF/OND) VA patients with SMI, SUD, and their comorbidity (SMI/SUD) in their first year of established VA care (N = 24,166). Outpatient services and acute-residential stays were modeled using negative binomial and logistic regression, respectively. Among all diagnostic categories, men used outpatient services less often than did women, including primary care (adjusted rate ratio [ARR] = .71, 95% confidence interval CI [.68, .74]), mental health (ARR = .85, 95% CI [.80, .91]), and addiction (ARR = .91, 95% CI [.83, .99]) services. For emergency department (ED) and psychiatric inpatient services, gender interacted significantly with diagnosis. The combination of SMI/SUD compared to either SMI or SUD conferred greater risk of ED utilization among men than women (adjusted odds ratio [AOR] = 2.09, 95% CI [1.24, 3.51], and 1.95, 95% CI [1.17, 3.26], respectively). SMI versus SUD conferred greater risk of psychiatric inpatient utilization among men than women (AOR = 1.83, 95% CI [1.43, 2.34]). Our findings point to gender differences in outpatient and acute service utilization among OEF/OIF/OND VA patients with some of the more chronic and costly mental health conditions. Further investigation of health care utilization patterns is needed to understand factors driving these gender differences to ensure that veterans have appropriate access to the services they need. (PsycINFO Database Record

The Health Insurance Portability and Accountability Act (HIPAA) Safe Harbor method requires removal of 18 types of protected health information (PHI) from clinical documents to be considered “de-identified” prior to use for research purposes. Human review of PHI elements from a large corpus of clinical documents can be tedious and error-prone. Indeed, multiple annotators may be required to consistently redact information that represents each PHI class. Automated de-identification has the potential to improve annotation quality and reduce annotation time. For instance, using machine-assisted annotation by combining de-identification system outputs used as pre-annotations and an interactive annotation interface to provide annotators with PHI annotations for “curation” rather than manual annotation from “scratch” on raw clinical documents. In order to assess whether machine-assisted annotation improves the reliability and accuracy of the reference standard quality and reduces annotation effort, we conducted an annotation experiment. In this annotation study, we assessed the generalizability of the VA Consortium for Healthcare Informatics Research (CHIR) annotation schema and guidelines applied to a corpus of publicly available clinical documents called MTSamples. Specifically, our goals were to (1) characterize a heterogeneous corpus of clinical documents manually annotated for risk-ranked PHI and other annotation types (clinical eponyms and person relations), (2) evaluate how well annotators apply the CHIR schema to the heterogeneous corpus, (3) compare whether machine-assisted annotation (experiment) improves annotation quality and reduces annotation time compared to manual annotation (control), and (4) assess the change in quality of reference standard coverage with each added annotator’s annotations.

Introduction: Multiple case reports have described lymphomas and plasma cell neoplasms developing after trauma 1-4. It has been hypothesized that trauma-induced inflammation may contribute to the neoplasia, and that the site of trauma may serve as the nidus (locus minoris resistentiae) 1, 5. However, to our knowledge there are no studies demonstrating causality. Traumatic injuries sustained during combat have been linked with higher rates of hypertension, coronary artery disease, diabetes mellitus and chronic kidney disease 6. Whether severe injury also increases the risk of hematologic malignancies is unknown. We hypothesized that combat injured veterans have higher rates of lymphoma and plasma cell dyscrasias than un-injured combat veterans. Methods: This was a retrospective cohort study of US military personnel injured during combat operations in Iraq or Afghanistan from 2002-2015 extracted from the Department of Defense (DoD) Trauma Registry. Patients were excluded if they died in theater, had multiple battle injuries, had pre-existing cancer diagnoses or missing data. A comparator arm of deployed and un-injured Iraq and Afghanistan combat veterans was obtained from the Military Health System Data Repository (MDR) matched for year of birth, branch of service, and sex. Cancer diagnoses were defined using International Classification of Diseases, Ninth Revision (ICD-9) and Tenth Revision (ICD-10) Clinical Modification codes obtained from both the DoD and the Veterans Health Administration through the MDR and the Veterans Informatics and Computing Infrastructure, respectively. Malignancy classifications by ICD codes are demonstrated in Table 1 and broken down into aggressive B-cell lymphomas, indolent B-cell lymphomas, Hodgkin lymphoma, T-cell lymphomas and plasma cell dyscrasias. Statistical analyses were performed with the chi-square test and fisher's exact test. This study was approved by the IRB at David Grant USAF Medical Center. Results: There were 9,654 subjects each in the injured and un-injured cohorts. Baseline demographics are demonstrated in Table 2. The mean age was 26 and most patients were junior enlisted, members of the Army, males, and of non-Hispanic white ethnicity/race. The average post-trauma follow-up time was 5.3 years. Overall rates of aggressive B-cell lymphomas, indolent B-cell lymphomas, Hodgkin lymphoma, T-cell lymphomas and plasma cell dyscrasias were low, as demonstrated in Table 3, and there were no statistically significant differences in incidence rates between the two cohorts. Discussion: Traumatic injuries can activate innate immune responses involving inflammatory cytokines, complement, coagulation and dendritic cells, resulting in a pro-inflammatory state 7. Preclinical studies reveal that such inflammation may hamper T-cell immune-surveillance needed to eradicate malignancy 8. However, in our cohort of severely injured combat veterans, rates of lymphomas and plasma cell dyscrasias were not increased over un-injured combat veterans. Strengths of this study include a well-characterized cohort with a matched comparator arm enabling vigorous examination of the impacts of traumatic injuries on cancer. Limitations include retrospective design and relatively short follow up. It is possible that differences will emerge with longer follow up. Conclusions: Despite critical combat trauma injuries being associated with a heightened risk of multiple chronic comorbidities, they do not appear to heighten the risk of lymphoid or plasma cell neoplasms within the first 5-years. The opinions and assertions expressed herein are those of the authors and do not necessarily reflect the official policy or position of the U.S. Air Force, David Grant USAF Medical Center, the Uniformed Services University or the Department of Defense. References: 1. Kriwalsky MS, Oral Surg, 2010. 2. Huang J, Medicine, 2019. 3. Stemberga V, Hematol Oncol, 2003. 4. Erdogan B, Eur Spine J, 2005. 5. Lo Schiavo A, Clin Dermatol, 2014. 6. Stewart IJ, Circulation, 2015. 7. Huber-Lang M, Nature Immunology, 2018. 8. Krall J, Science, 2018. Disclosures No relevant conflicts of interest to declare.

e13049 Background: Early-onset breast cancer has more aggressive clinicopathological characteristics and worse prognosis. The peak age of breast cancer in China is about 40 years old, 10 years ahead of that in Europe and the United States. PTCH2 was characterized as susceptibility gene in early-onset breast cancer by whole exons sequencing in preliminary work. PTCH2 performs as a tumor suppressor in the Hedgehog signaling pathway, but it has never been reported in breast cancer. Methods: 259 women with early-onset breast cancer and 571 women with non-early-onset breast cancer with peripheral blood samples were included for genetic testing. According to the ACMG guidlines, PTCH2 1172-1173delCT was defined as likely pathogenic mutation. To make an in-depth exploration of the function and molecular mechanism of PTCH2 gene, we performed experiments at molcular, cellular and animal level. Results: The frequency 2.3%(6/259)of PTCH2 germline mutation in early-onset breast cancer was significantly higher than that(2/571) in non-early-onset breast cancer( P ＜ 0.05), and increased with the age at diagnosis younger. Bioinformatics analysis showed that the patients with lower expression of PTCH2 had worse prognosis. PTCH2 knockout cells lines promoted the cell proliferation and enhanced the ability of colony formation and tumorigenic ability of nude mice. Furthermore, the expression level of pten in the PTCH2 knockout cell lines was significantly downregulated. Conclusions: Patients with PTCH2 1172-1173delCT mutation had aggressive clinicopathological characteristics and worse prognosis. As a tumor suppressor gene, PTCH2 may promote the incidence of early-onset breast cancer by downregulating the expression of pten and cross-regulating Hedgehog and PI3K/AKT signaling pathways. PTCH2 could be acted as a diagnostic and prognostic biomarker for early-onset breast cancer.

TEM horn antenna is one kind of directional Ultra-wideband antenna with simple structure. Based on the design method of TEM horn antenna, satisfied impedance and radiation character are obtained by simulation and experiment research. On this basis, by means of metal ridged loaded, background dielectric material loaded and distributed lossy metal loaded respectively, the miniaturization character is realized. The simulation analysis results show that load of traditional TEM horn antenna can get efficiently improvement in structure and performance which have widely application foreground in pulse radiation communication system and ultra-wideband radar system.

The TDMM was successfully used to analyze the capacitance, the electric field, and the ESD current of an ESD suppressor. The obtained capacitance was also validated by measurement data. It is found that the maximum electric fields in the air gap between two discharge electrodes for the air gap width of 5–50 μm are much higher than the threshold electric field for air breakdown. A maximum ESD current of 4.7 mA was obtained during an ESD event, which may be sufficient to cause a malfunction in a high sensitivity integrated circuit.

A substrate integrated waveguide Vivaldi array antenna is designed and analyzed. The array antenna is made of two Vivaldi structure radiation elements, and the antenna is fed by an equal power divider with substrate integrated waveguide technology. Each radiation element is index gradient antipodal structure are on both sides of substrate. The reflection coefficient of the array antenna is less than −10 dB from 8.6 GHz to 10 GHz. The gain of the array antenna is 10.3dB.

Importance Military sexual trauma (MST) is associated with adverse physical and mental health outcomes following military separation. Recent research suggests that MST may be a determinant in several factors associated with postdeployment homelessness. Objective To evaluate MST as an independent risk factor for homelessness and to determine whether risk varies by sex. Design, Setting, and Participants A retrospective cohort study of US veterans who used Veterans Health Administration (VHA) services between fiscal years 2004 and 2013 was conducted using administrative data from the Department of Defense and VHA. Included in the study were 601 892 US veterans deployed in Iraq or Afghanistan who separated from the military between fiscal years 2001 and 2011 and subsequently used VHA services. Exposure Positive response to screen for MST administered in VHA facilities. Main Outcomes and Measures Administrative evidence of homelessness within 30 days, 1 year, and 5 years following the first VHA encounter after last deployment. Results The mean (SD) age of the 601 892 participants was 38.9 (9.4) years, 527 874 (87.7%) were male, 310 854 (51.6%) were white, and 382 361 (63.5%) were enlisted in the Army. Among veterans with a positive screen for MST, rates of homelessness were 1.6% within 30 days, 4.4% within 1 year, and 9.6% within 5 years, more than double the rates of veterans with a negative MST screen (0.7%, 1.8%, and 4.3%, respectively). A positive screen for MST was significantly and independently associated with postdeployment homelessness. In regression models adjusted for demographic and military service characteristics, odds of experiencing homelessness were higher among those who screened positive for MST compared with those who screened negative (30-day: adjusted odds ratio [AOR], 1.89; 95% CI, 1.58-2.24; 1-year: AOR, 2.27; 95% CI, 2.04-2.53; and 5-year: AOR, 2.63; 95% CI, 2.36-2.93). Military sexual trauma screen status remained independently associated with homelessness after adjusting for co-occurring mental health and substance abuse diagnoses in follow-up regression models (30-day: AOR, 1.62; 95% CI, 1.36-1.93; 1-year: AOR, 1.49; 95% CI, 1.33-1.66; and 5-year: AOR, 1.39; 95% CI, 1.24-1.55). In the fully adjusted models, the interaction between MST status and sex was significant in the 30-day and 1-year cohorts (30-day: AOR, 1.54; 95% CI, 1.18-2.02; and 1-year: AOR, 1.46; 95% CI, 1.23-1.74), denoting higher risk for homelessness among males with a positive screen for MST. Conclusions and Relevance A positive screen for MST was independently associated with postdeployment homelessness, with male veterans at greater risk than female veterans. These results underscore the importance of the MST screen as a clinically important marker of reintegration outcomes among veterans. These findings demonstrate significant long-term negative effects and inform our understanding of the public health implications of sexual abuse and harassment.

Production and application electromagnetic Pulse is paid more attention home and aboard. A novel switch-type exploding electromagnetic pulse generator is put forward in this paper. Based on its equivalent circuit theory, mathematics model is given and calculate. By proper parameter and structure design and optimize, this model can increase the electromagnetic pulse frequency range covering and extend its operation time.

The time-domain moment method was successfully used to analyze the capacitance, the electric field, and the electrostatic discharge (ESD) current of an ESD suppressor used for integrated circuit (IC) protection. The obtained capacitance of this ESD suppressor was also validated by measurement data. From simulation results, it is found that the maximum electric field of 354000 kV/m occurs at 2 ns which is much higher than the threshold electric field of 2900 kV/m for air breakdown. The ESD current with pulse waveform has a maximum value of 4.7 mA at 0.2 ns and has a very short duration time of about 20 ns before the ESD current approaches zero.

High gain sphererical reflecting antenna working at frequency band of 6.0GHz to 8.0GHz is simulated with the application of CST MIROWAVE STUDIO® software. By the merits of sphere reflector, this designed antenna can realize wide angle scan, circular polarization, and high gain character. Future plan is to investigate the effect of phase difference on focus character.

In order to measure signal which has 0.5–20GHz bandwidth, TEM horn antenna is a good choose for the high requirement both in low and high frequency. In this paper, a planar TEM horn antenna is presented in the paper which is similar to Vivaldi antenna, but has better quality in low frequency and a 0.5–25GHz bandwidth. The model is established with CST@ software and the parameters are optimized to decrease its size. In the end a better result is obtained.

TEM horn antenna which is using as accurate measurement technology for high power ultra-wide spectrum electromagnetic pulse space radiation field is proposed. To decrease the size of measurement antenna, triangular ridged structure is used. By research and design, these two models can both realize the same radial character, get a satisfied gain and the bandwidth is enough for practical operation.

TEM horn antennas for ultra wideband (UWB) system applications are proposed in which offer unique advantages by their own structure characters. To realize ultra wideband and high gain operations, some antennas are designed and compared in this paper. By optimization, two classes of antennas can both realize the same radial character, get a satisfied gain and the bandwidth is enough for practical operation. As the UWB antenna, the group delay time is considered specially. The simulation results and analyses at 1-18 GHz frequency band of the TEM horn antenna are presented.

Based on the ultra-wideband ridged horn antenna theory in communication system, a new quad-ridged horn antenna with a lens is described in this paper, which consists of a quad-ridged horn and a dielectric hemispheric lens. By simulation and optimization with CST MWS software which is based on the finite integration technique, a dual polarization dielectric lens loaded quad-ridged horn antenna can realize higher gain and ultra-wideband character. The result shows that in ideal state, the dielectric lens can increase the gain of quad-ridged horn antenna with 3 dB and the 15 dB gain is very important in some application. Besides, the volume of the system does not enlarge much. The simulated return loss S11 of the horn antenna system is better than -10 dB during the operating frequency band from 2 GHz to 18 GHz. Also, for its own structure of the quad-ridged horn antenna, it can realize dual polarization character as describe in this paper. The simulation results and analyses of the ultra-wideband quad-ridged horn antenna are presented.

In this paper, a novel high gain hemispherical lens antenna based on the theory of geometrical optics is presented. Hemispherical dielectric lens antenna with ground plane is discussed. To achieve beam scanning operation, the proposed hemispherical dielectric lens antenna is feed by a microstrip slot antenna. Proposed antenna is simulated by finite integration technique. The highest gain is 24 dB at 10.6 GHz at X band, and the beam reflecting result can be used in multi-beam operation. The simulated results and analyses are presented

Two classes of lens antennas in transportation system are described in which offer unique advantages by their own structure characters. To realize wide band and high gain operations for the transportation system, some antennas are designed and compared in this paper. By optimization, the two classes of antennas can both realize the same radial character and the bandwidth is enough for practical operation. The simulation results and analyses of the Luneburg lens and the optimum two-shell dielectric sphere lens antenna are presented.

Two classes of circularly polarized antennas for triple-frequency operation are presented and discussed in this paper. To achieve triple-frequency operation, the proposed microstrip antenna has three layers, and each arm of the quadrifilar helical antenna consists of three elements with different length. The two triple-frequency antennas can both get circular polarized hemispherical pattern with miniaturized compact size. The bandwidth of VSWR < 2 at each frequency is enough for practical operation. The simulation results and analysis are presented.