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Close attention to technical quality or image optimization in transthoracic echocardiography (TTE) is important for the acquisition of high-quality diagnostic images and to ensure that measurements are accurately performed. For this purpose, the echocardiographer must be familiar with all the controls on the ultrasound machine that can be manipulated to optimize the two-dimensional (2D) images, color Doppler images, and spectral Doppler traces...

Background: Many echocardiographic parameters have been proposed to evaluate right ventricular (RV) systolic function. We comprehensively assessed a wide range of quantitative echocardiographic parameters in a single cohort compared with same-day cardiovascular magnetic resonance (CMR). Methods and results: 92 subjects were examined prospectively: Group 1 consisted of 46 healthy controls (21 males, 33.4 ± 11.4 years), Group 2 consisted of 46 patients (20 males, 38.5 ± 18.9 years) undergoing RV functional assessment by CMR (1.5 T). Echocardiography was performed on the same day as CMR; fractional area change (RVFAC), myocardial performance index via spectral Doppler (RVMPI), RVMPI via Doppler tissue imaging (RVMPI-DTI), peak systolic myocardial velocity by DTI (RVSm), tricuspid annular plane systolic excursion (TAPSE), speckle tracking strain, and three dimensional right ventricular ejection fraction (3DE-RV). Linear regression, Bland-Altman and receiver-operator-characteristic (ROC) analyses were performed. At ROC analysis, the most predictive echocardiographic methods were; RVFAC (AUC = 0.892), RVMPI (AUC 0.785), TAPSE (AUC 0.849) and 3DE-RV (AUC 0.909). 3DE-RV appeared the most accurate compared to CMR, although underestimated true RV volumes. Conclusion: As compared to CMR; 3DE-RV, RVFAC, TAPSE and RVMPI were the most reliable predictors of RV function. These parameters can be recommended for clinical use.

VA estimates that approximately 10 percent of the veterans in the United States, or over 2.1 million veterans, did not have reasonable access to burial options in a veterans cemetery at the end of fiscal year 2013. In 2012, VA announced an initiative to improve access to burial options for veterans living in rural areas. Subsequently, in Public Law 113-6, Congress mandated that VA develop a strategy to serve the burial needs of rural veterans. The law also mandated GAO to review VA s strategy to ensure that it included all of the elements required by the law. This report includes, among other things, an evaluation of the extent to which (1) NCA s methodology identifies whether veterans have reasonable access to burial options and supports future cemetery location decisions, and (2) VA s rural burial strategy includes the eight elements required by law. GAO reviewed NCA s methodology for estimating the percentage of veterans who have reasonable access to burial options for fiscal year 2017. GAO also reviewed VA s rural burial strategy, and spoke with agency officials responsible for developing and implementing the rural burial strategy., Report to Congressional Committees

The book is mostly designed for students of echocardiography, teachers of echocardiography and cardiac sonographers working in routine clinical practice, but will also be very useful to echocardiologists and cardiac registrars. The goal of the text is to provide a comprehensive review of transthoracic echocardiography in the assessment of various cardiac pathologies. Refresher notes on cardiac anatomy and the relevant cardiac physiology and pathophysiology are included to expand the cardiac sonographer’s knowledge in this area and further their understanding of various diseases, disease processes and associated findings.

As part of its plan to reduce its active duty force by 80,000 personnel by 2017, the Army will be inactivating 10 BCTs currently stationed in the United States and reorganizing the remaining BCTs. The Army conducted analyses of different stationing options, which included the use of its military value analysis model to compare installations based on their ability to support BCTs. GAO was asked to review the decision making process the Army used for its BCT stationing decisions, including its military value analysis model. This report does the following: (1) describes the analyses the Army conducted to make its BCT decisions, and (2) evaluates the extent to which the Army has established guidance and processes related to the use of the military value analysis model as a part of its stationing decisions. GAO reviewed the Army's stationing guidance, current and previous versions of the military value analysis model, documents on the BCT decisions, and spoke with cognizant officials. GAO recommends that the Army develop and implement guidance related to when community input should be obtained for stationing decisions, and related to the use of its military value analysis model, such as when it should be used, the level of approval required for changes to the model, and how certain training areas should be considered, as well as processes for updating and reviewing the model. The Army concurred with GAO's recommendations and explained how they will be implemented., Report to the Subcommittee on Airland, Committee on Armed Services, United States Senate.

Through BRAC and other growth initiatives, DOD has made significant changes to its force structure, affecting communities around DOD installations. To help transition toward a smaller, more agile force, DOD has requested new BRAC authority. House Report 112-479, accompanying the fiscal year 2013 National Defense Authorization Act, directed GAO to study the practices and strategies that communities have used to cope with installation closure or growth. This report (1) describes the practices and strategies communities have used in dealing with base closures and growth since 2005 and economic and population data in those communities and (2) presents information on communities needs in adjusting to installation closure and growth. GAO interviewed DOD, service, and installation officials; interviewed and surveyed community representatives; reviewed relevant guidance; and visited select installations. DOD concurred with GAO s recommendation that the Army issue guidance on maintenance levels to be provided during the base closure process. DOD partially concurred that it should establish procedures for sharing additional information with growth communities and designate a civilian point of contact at growth installations. GAO believes action by DOD prior to future installation growth will help forestall future challenges., Report to Congressional Committees.

Echocardiography is the commonest form of non-invasive cardiac imaging and is fundamental to patient management. However, due to its methodology, it is also operator dependent. There are well defined pathways in training and ongoing accreditation to achieve and maintain competency. To satisfy these requirements, significant time has to be dedicated to scanning patients, often in the time pressured clinical environment. Alternative, computer based training methods are being considered to augment echocardiographic training. Numerous advances in technology have resulted in the development of interactive programmes and simulators to teach trainees the skills to perform particular procedures, including transthoracic and transoesophageal echocardiography. 82 sonographers and TOE proceduralists utilised an echocardiographic simulator and assessed its utility using defined criteria. 40 trainee sonographers assessed the simulator and were taught how to obtain an apical 2 chamber (A2C) view and image the superior vena cava (SVC). 100% and 88% found the simulator useful in obtaining the SVC or A2C view respectively. All users found it easy to use and the majority found it helped with image acquisition and interpretation. 42 attendees of a TOE training day utilising the simulator assessed the simulator with 100% finding it easy to use, as well as the augmented reality graphics benefiting image acquisition. 90% felt that it was realistic. This study revealed that both trainee sonographers and TOE proceduralists found the simulation process was realistic, helped in image acquisition and improved assessment of spatial relationships. Echocardiographic simulators may play an important role in the future training of echocardiographic skills.

Under the Uniformed and Overseas Citizens Absentee Voting Act (UOCAVA), citizens covered are permitted to register and vote absentee. The Secretary of Defense has the primary responsibility for federal UOCAVA functions, and the Department of Defense's (DOD) Federal Voting Assistance Program (FVAP) facilitates absentee voters' participation in federal elections. Since 2001, the DOD Office of Inspector General and GAO have reviewed FVAP's efforts and recommended improvements to its procedures and the direction FVAP provides to the services. In response to a congressional request, this report evaluates how FVAP (1) addresses its mission and evaluates efforts to conduct it, (2) aligns budget priorities with strategic goals, and (3) implemented DOD Office of Inspector General and GAO recommendations made from 2001 through 2009. GAO analyzed FVAP's performance measures, relevant DOD directives, FVAP's strategic plans, budgets, and past audit reports. Also, GAO interviewed agency officials., Report to Congressional Requesters.

From fiscal year 2005 through fiscal year 2008, the military services received about $295 million in monetary and nonmonetary gifts from individuals and organizations wishing to donate gifts to the Department of Defense (DoD). Section 2601(a) of Title 10, U.S. Code, is a long-standing authority under which the secretaries overseeing DoD, the military services, and the Coast Guard may accept a gift on the condition that the gift be used for the benefit of, or in connection with, the establishment, operation, or maintenance of schools, hospitals, libraries, museums, cemeteries, or other institutions or organizations under the jurisdiction of the secretary concerned. In 2008, gifts to benefit such institutions or organizations included a monetary gift to construct an education center and nonmonetary gifts of a bronze statue and granite benches. In 2006, Congress enacted additional authority, under 10 U.S.C. Section 2601(b), to allow the acceptance of gifts and services to benefit certain members of the armed forces and civilian employees of DoD who incurred a wound, injury, or illness in the line of duty and to benefit the dependents and survivors of those who are killed or wounded. The Office of the Under Secretary of Defense (USD) (Comptroller) revised its gift fund policy on February 27, 2009 to address GAO's recommended actions. Specifically, the revised policy (1) assigns responsibility to DFAS (Standards and Compliance) to consolidate the services' DFAS gift fund submissions into one quarterly report to the USD (Comptroller) and to develop a standardized reporting format for the military services to start using when assembling the reporting requirements, and (2) directs the military services to maintain documentation in gift fund records that nonmonetary gifts have been transferred to the property records.

Since September 11, 2001, the Department of Defense (DOD) has relied on more than 650,000 members of the National Guard and Reserve to support operations at home and abroad. As demobilized reservists return to civilian life and their civilian employment, the difficulties some face in maintaining positive working relationships with their employers is an area of interest. Maintaining employers' continued support for their reservist employees will be critical if DOD is to retain experienced reservists in these times of longer and more frequent deployments.

The Department of Defense (DoD) manages and operates about 577,000 structures worldwide, valued at about $712 billion. DoD has worked for several years to develop models that can reliably estimate the installation support funds needed to sustain these facilities, and plans to spend over $55 billion to support these facilities and operate its bases in fiscal year 2008. Because GAO has identified support infrastructure as a high-risk area that affects DoD's ability to devote funds to other more critical needs, GAO initiated this review under the Comptroller General's authority. This report discusses the following: (1) the reliability of the annual funding estimates produced by the facilities sustainment model, (2) DoD's progress in meeting funding goals for facility sustainment and recapitalization, (3) the extent to which DoD has addressed deferred facility sustainment funding needs, and (4) the status of DoD's efforts to develop a new installation services model. To address these objectives, GAO reviewed the accuracy and support for the model's key inputs, analyzed pertinent documents, and visited eight selected installations. GAO recommends that DoD take several actions to increase the facilities sustainment model's reliability, address deferred facility sustainment funding requirements, and advance progress in implementing the installation services model. DoD generally agreed with the recommendations., Report to Congressional Committees.