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Teams are the fundamental element of work in the contemporary clinical setting. As interdisciplinary teams become an essential component of the evidence-based framework for clinical practice, their formalization, integration, and synthesis within the practice framework will become increasingly mandatory. Outlined here is a contextual model for team action that is formalized as the organizational leadership continuously addresses the structural and process components of team dynamics in a continuous and cybernetic frame that assures all of the elements of effective teamwork. The theoretical foundations for team modeling are explicated, the elements of the systems approach to team process are outlined, and a necessary synthesis of team processes is described and established as a foundation for evidence-based clinical practice. [ABSTRACT FROM AUTHOR]

The influence of economic and demographic variables on household food purchases, frequently termed Engel analysis, has been studied extensively. Similarly, analysis of time allocation and household production activities holds a prominent place in the economics literature. This article examines a household non-market activity-the frequency of grocery shopping-and factors influencing it. Specifically, is the number of major grocery shopping trips made by a household within a specific time frame explainable on economic grounds? Alternatively, why do some households elect to shop more or less frequently than others and what effect do household characteristics have on shopping frequency? Finally, what is the effect of shopping frequency on food expenditures?
Shopping behaviour has been studied often in the marketing literature. However, these studies do not have the structure associated with economic models. This results in few testable hypotheses relating to the effects of household characteristics on behaviour and accounts for the focus on non-economic factors as explanatory variables (Bagozzi, 1984). Previous economic research on shopping behaviour has been limited. Blaylock and Smallwood (1987) focused on the selection of a shopper (i.e., male or female) within a household and Doff and Sharir (1981) attempted to quantify the impact of household characteristics on the time spent in a grocery store and the size of a purchase on a single shopping trip. The latter study used a small sample (100 households) collected by the researchers in a single grocery store.
To study the above issues, a constrained utility maximization model is established, its equilibrium conditions are derived, and the implied hypotheses for shopping frequency are tested using a simultaneous equations model. The theoretical model is developed in Section II. Sections III and IV describe the empirical model and estimation results. A brief summary concludes the paper. [ABSTRACT FROM AUTHOR]

This paper extends and generalizes a simple framework developed by Blaylock and Smallwood (1986) for evaluating and comparing via probability statements the adequacy of household food supplies at alternative levels of household income. In particular, the Blaylock and Smallwood methodology, termed the Index of Adequacy (IA), is generalized to focus on food expenditures and the effects of demographic variables. This makes the methodology applicable for addressing issues surrounding food programmes such as those posed above. Extending the IA method to include the effects of demographic variables isolates the effects of income and food expenditures and provides comparison of welfare levels across household characteristics. The IA framework focuses on the minimum household income (or food expenditures in the present analysis) necessary to purchase food supplies which are evaluated with a given degree of confidence by individuals in society as being barely adequate. Income (food expenditure) poverty lines are developed which are direct measures of welfare (with respect to food) as opposed to the indirect measure represented by the Orshansky method. These poverty thresholds and their variants have a number of uses in addition to providing insight into the issues raised above. [ABSTRACT FROM AUTHOR]

Use of HIV pre-exposure prophylaxis (PrEP) among U.S. military service members at high risk for HIV infection remains suboptimal, resulting in preventable new HIV infections and decreased medical readiness among service members. PrEP coverage should be increased to the greatest extent possible to prevent HIV infection and support the Military Health System (MHS) quadruple aim. This policy analysis employed the Centers for Disease Control and Prevention (CDC)'s Policy Analytical Framework to develop several policy options based upon the evidence summary and interventions described. Evaluation criteria based on the CDC's Policy Analytical Framework incorporated all elements of the Military Health System (MHS)'s quadruple aim, including impact on population health and readiness, impact on the experience of care, and value in terms of cost-effectiveness. An additional criterion of feasibility was also added to account for cultural, societal, and political factors influencing this policy decision. This policy analysis suggests that HIV PrEP coverage in the MHS remains suboptimal, while several available interventions could result in substantial increases in PrEP coverage that would, in turn, result in further reductions in new service member HIV infections and increased medical readiness.

Background: The consequences of low-level viremia in people with HIV are unclear. We used data from the US Military HIV Natural History Study to examine the association of low-level viremia (LLV) and serious non-AIDS events (SNAEs)., Methods: Included participants initiated antiretroviral therapy after 1996 and had ≥3 viral loads (VLs) measured, using an assay with a lower limit of detection of <50 copies/mL, ≥6 months after antiretroviral therapy initiation. VLs were categorized as lower levels of LLV (51-199 copies/mL), higher level of low-level viremia (HLLV; 200-999 copies/mL), and (VF; ≥200 copies/mL on 2 or more successive determinations or a single VL ≥1000 copies/mL), and virologic suppression (VS; ie, VL <50 copies/mL). Viral blips (ie, VLs between 50 and 999 copies/mL that are preceded and succeeded by VL <50 copies/mL) were analyzed in the VS category. Cox proportional hazards models were used to examine the association of LLV and SNAEs, adjusted hazard ratios and 95% confidence intervals are presented., Results: A total of 439 (17.4%) SNAEs were recorded among the 2528 participants (93% male, 40% Caucasian, 43% African American) followed for a median of 11 years. In 8.5% and 4.6% of the participants, respectively, LLV and HLLV were the highest recorded viremia strata. Compared with VS, SNAEs were associated with LLV (1.3 [1.2-1.4]), HLLV (1.6 [1.5-1.7]), and virologic failure (1.7 [1.7-1.8])., Conclusions: The results of this study suggest that LLV is associated with the occurrence of SNAEs and needs further study., Competing Interests: Potential conflicts of interest. All authors: No reported conflicts., (© The Author(s) 2024. Published by Oxford University Press on behalf of Infectious Diseases Society of America.)

In an effort to improve military readiness, in 2014 the US Air Force reduced the frequency of mandated HIV medical evaluation visits from every 6 months to every 12 months. We employ this natural experiment using data for 2676 active-duty Military Health System beneficiaries living with HIV with a difference-in-differences empirical strategy using the Army, Navy, and Marines as a control group to estimate the causal effect of reducing the frequency of mandated evaluation visits on the quality and cost of medical care for active-duty military members living with HIV. We find that reducing the frequency of mandated HIV medical evaluation visits reduced the likelihood of regular HIV visits by 23 percentage points but did not affect the likelihood of receiving other preventive care, adhering to HIV therapy, or maintaining viral testing and suppression. The study finds evidence that the recommended level of regular HIV visits may be higher than necessary. The reduction in regular HIV visits was not associated with a similar reduction in the studied quality of care measures, therefore, the effect of alleviating the mandate was overall positive in terms of reducing healthcare utilization without adversely affecting preventive care, HIV therapy, or viral testing and suppression., (© 2023 The Henry M. Jackson Foundation. Health Economics published by John Wiley & Sons Ltd. This article has been contributed to by U.S. Government employees and their work is in the public domain in the USA.)

Background: As morbidity due to viral coinfections declines among HIV-infected persons, changes in liver-related morbidity are anticipated. We examined data from the US Military HIV Natural History Study (NHS), a cohort of military beneficiaries, to evaluate incidence and risk factors associated with chronic liver enzyme elevation (cLEE) in HIV-monoinfected patients in the combination antiretroviral therapy (cART) era., Methods: Participants who were hepatitis B virus and hepatitis C virus seronegative with follow-up after 1996 were included. We defined chronic liver enzyme elevation (cLEE) as alanine aminotransferase elevations ≥1.25 times the upper limit of normal on at least 2 visits, for a duration of ≥6 months within 2 years. We used multivariate Cox proportional hazards models to examine risk factors for cLEE., Results: Of 2779 participants, 309 (11%) met criteria for cLEE for an incidence of 1.28/100 PYFU (1.28-1.29/100 PYFU). In an adjusted model, cLEE was associated with Hispanic/other ethnicity (reference Caucasian: hazard ratio [HR], 1.744; 95% CI, 1.270-2.395), non-nucleoside reverse transcriptase inhibitor-based cART (reference boosted protease inhibitors: HR, 2.232; 95% CI, 1.378-3.616), being cART naïve (HR, 6.046; 95% CI, 3.686-9.915), or having cART interruptions (HR, 8.671; 95% CI, 4.651-16.164). African American race (HR, 0.669; 95% CI, 0.510-0.877) and integrase strand transfer inhibitor (INSTI)-based cART (HR, 0.222; 95% CI, 0.104-0.474) were protective., Conclusions: Our findings demonstrate that initiation and continued use of cART are protective against cLEE and support the hypothesis that HIV infection directly impacts the liver. INSTI-based regimens were protective and could be considered in persons with cLEE., (© The Author(s) 2021. Published by Oxford University Press on behalf of Infectious Diseases Society of America.)

Introduction: The new initiative by the Department of Health and Human Services (DHHS) aims to decrease new HIV infections in the U.S. by 75% within 5 years and 90% within 10 years. Our objective was to evaluate whether the U.S. military provides a good example of the benefits of such policies., Materials and Methods: We conducted an analysis of a cohort of 1,405 active duty military personnel with HIV enrolled in the Natural History Study who were diagnosed between 2003 and 2015 at six U.S. military medical centers. The study was approved by institutional review boards at the Uniformed Services University of the Health Sciences and each of the sites. We evaluated the impact of Department of Defense (DoD) HIV care policies, including screening, linkage to care, treatment eligibility, and combined antiretroviral therapy (cART) initiation on achieving viral suppression (VS) within 3 years of diagnosis. As a secondary outcome, we evaluated the DoD's achievement of UNAIDS 90-90-90 targets., Results: Nearly all (99%) were linked to care within 60 days. Among patients diagnosed in 2003-2009, 77.5% (95% confidence intervals (CI) 73.9-80.6%) became eligible for cART within 3 years of diagnosis, 70.6% (95% CI 66.6-74.1%) overall initiated cART, and 64.2% (95% CI 60.1-68.0%) overall achieved VS. Among patients diagnosed in 2010-2015, 98.7% (95% CI 96.7-99.5%) became eligible for cART within 3 years of diagnosis, 98.5% (95% CI 96.4-99.4%) overall initiated cART, and 89.8% (95% CI 86.0-92.5%) overall achieved VS., Conclusions: U.S. military HIV policies have been highly successful in achieving VS goals, exceeding the UNAIDS 90-90-90 targets. In spite of limitations, including generalizability, this example demonstrates the feasibility of the DHHS initiative to decrease new infections through testing, early treatment, and retention in care., (Published by Oxford University Press on behalf of the Association of Military Surgeons of the United States 2020. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)