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Objective Evaluate self-reported electronic screening (eScreening) in a VA Transition Care Management Program (TCM) to improve the accuracy and completeness of administrative ethnicity and race data. Materials and Methods We compared missing, declined, and complete (neither missing nor declined) rates between (1) TCM-eScreening (ethnicity and race entered into electronic tablet directly by patient using eScreening), (2) TCM-EHR (Veteran-completed paper form plus interview, data entered by staff), and (3) Standard-EHR (multiple processes, data entered by staff). The TCM-eScreening (n = 7113) and TCM-EHR groups (n = 7113) included post-9/11 Veterans. Standard-EHR Veterans included all non-TCM Gulf War and post-9/11 Veterans at VA San Diego (n = 92 921). Results Ethnicity: TCM-eScreening had lower rates of missingness than TCM-EHR and Standard-EHR (3.0% vs 5.3% and 8.6%, respectively, P .05) or data completeness (89.9% vs 91%, P > .05). Both had better data completeness than Standard-EHR (P Conculsions eScreening is a promising method for improving ethnicity and race data accuracy and completeness in VA.

New sensor solutions are under development in the context of digitalization in order to integrate sensory functions into systems. When integrating sensors, the three domains of mechanical, electrical and information engineering must be considered. This results in complex development processes that require suitable procedure models. However, specific procedure models for sensor selection and integration are missing. This contribution proposes a procedure model for sensor selection and integration on the basis of the Munich Procedure Model (MPM) and gives an outlook on open research questions.

In particle-laden turbulence, the Fourier Lagrangian spectrum of each phase is regularly computed, and analytically derived response functions relate the Lagrangian spectrum of the fluid- and the particle phase. However, due to the periodic nature of the Fourier basis, the analysis is restricted to statistically stationary flows. In the present work, utilizing the bases of time-focalized proper orthogonal decomposition (POD), this analysis is extended to temporally non-stationary turbulence. Studying two-way coupled particle-laden decaying homogeneous isotropic turbulence for various Stokes numbers, it is demonstrated that the temporal POD modes extracted from the dispersed phase may be used for the expansion of both fluid- and particle velocities. The POD Lagrangian spectrum of each phase may thus be computed from the same set of modal building blocks, allowing the evaluation of response functions in a POD frame of reference. Based on empirical evaluations, a model for response functions in non-stationary flows is proposed. The related energies of the two phases is well approximated by simple analytical expressions dependent on the particle Stokes number. It is found that the analytical expressions closely resemble those derived through Fourier analysis of statistically stationary flows. These results suggest the existence of an inherent spectral symmetry underlying the dynamical systems consisting of particle-laden turbulence, a symmetry which spans across stationary/non-stationary particle-laden flow states., 11 pages, 10 Figures

Objective To evaluate race and gender variations in complementary and alternative medicine (CAM) use for knee osteoarthritis (OA) (unadjusted and adjusted for demographic and clinical factors). Methods A secondary analysis of cross‐sectional data was conducted. The sample included Veterans Affairs patients 50 years of age or older with symptomatic knee OA. Current use of various CAM therapies was assessed at baseline. Logistic regression models were used to compare race and gender differences in the use of specific CAMs. Results The sample included 517 participants (52.2% identified as African American [AA]; 27.1% identified as female). After adjusting for demographic and clinical factors, AA participants, compared with white participants, were less likely to use joint supplements (odds ratio [OR]: 0.53; 95% confidence interval [CI], 0.31‐0.90]); yoga, tai chi, or pilates (OR: 0.39; 95% CI: 0.19‐0.77); and chiropractic care (OR: 0.51; 95% CI: 0.26‐1.00). However, they were more likely to participate in spiritual activities (OR: 2.02; 95% CI: 1.39‐2.94). Women, compared with men, were more likely to use herbs (OR: 2.42; 95% CI: 1.41‐4.14); yoga, tai chi, or pilates (OR: 2.09; 95% CI: 1.04‐4.19); acupuncture, acupressure, or massage (OR: 2.45; 95% CI: 1.28‐4.67); and spiritual activities (OR: 1.68; 95% CI: 1.09‐2.60). The interactive effects of race and gender were significant in the use of herbs (P = 0.008); yoga, tai chi, or pilates (P = 0.011); acupuncture, acupressure or massage (P = 0.038); and spiritual activities (P < 0.001). Conclusion There are race and gender differences in the use of various CAMs for OA. As benefits and limitations of CAM therapies vary, clinicians must be aware of these differences.

As many health systems have been working to become high-reliability organizations (HROs), health equity has been largely absent from discussions and applications of HRO principles. This is a serious oversight. Disparities in health and health care represent systematic failures to achieve reliable outcomes for certain groups. Acceptance of disparities is antithetical to the essential HRO goal of "zero harm." We propose adding Equity to HROs in the most literal sense by designating it as a key component and achieving High Equity Reliability Organizations. We describe how equity should be a crucial element of all 5 HRO core concepts: sensitivity to operations, preoccupation with failure, deference to expertise, resilience, and reluctance to simplify.

Nanostructuring of a bulk material is used to change its mechanical, optical, and electronic properties and to enable many new applications. We present a scalable fabrication technique that enables the creation of densely packed diamond nanopillars for quantum technology applications. The process yields tunable feature sizes without the employment of lithographic techniques. High-aspect-ratio pillars are created through oxygen-plasma etching of diamond with a dewetted palladium film as an etch mask. We demonstrate an iterative renewal of the palladium etch mask, by which the initial mask thickness is not the limiting factor for the etch depth. Following the process, 300-400 million densely packed 100 nm wide and 1 μm tall diamond pillars were created on a 3 × 3 mm

Supplemental Digital Content is available in the text., Background: On April 23, 2014, US media outlets broadcast reports of excessive wait times and “secret” waitlists at some Veterans Affairs (VA) hospitals, precipitating legislation to increase Veterans’ access to private sector health care. Objective: The aims were to assess changes in Veterans’ distrust in the VA health care system before and after the media coverage and explore sex and racial/ethnic differences in the temporal patterns. Methods: Veterans completed semistructured interviews on health care satisfaction from June 2013 to January 2015, including a validated scale of health system distrust (range: 1–5). We used linear splines with knots at 90-day intervals to assess changes in distrust before and after April 23, 2014 (“day 0”) in linear mixed models. To explore sex and racial/ethnic differences in temporal patterns, we stratified models by sex and tested for interactions of race/ethnicity with time. Results: For women (n=600), distrust scores (mean=2.09) increased by 0.45 in days 0–90 (P

Objective Opioid specialty clinics have emerged as an approach for mitigating the risks associated with opioid therapies. Many opioid specialty clinics within the Department of Veterans Affairs (VA) have been described in the extant literature, yet veterans’ experiences of these remain absent. This research study was undertaken to describe veterans’ responses (e.g., knowledge, attitudes, and beliefs) toward being evaluated in an opioid specialty clinic. Design Qualitative descriptive research study. Setting A VA medical center in the northeast United States. Subjects Twenty veterans were interviewed between December 2017 and May 2018. Methods Veterans’ characteristics were extracted from the VA’s electronic health record and analyzed with descriptive statistics. Qualitative data about veterans’ experiences with the opioid specialty clinic were collected via semistructured interviews (in person or via telephone) and were analyzed with qualitative content analysis. Results Most participants were older, non-Hispanic or non-Latino white men. Generally, veterans had positive experiences in the opioid specialty clinic. However, there was wide variation in their understanding of the purpose of the clinic, who staffed the clinic, and why they had been referred to the clinic. Conclusions For veterans prescribed opioid therapies, this clinic served as an adjunct service for ensuring appropriate and safe prescribing. Data from this study can be used to inform interventions to promote veterans’ understanding across the total opioid safety clinic experience—referral, actual visit, and follow-up.

Two marine invertebrate fossil assemblages from the Late Triassic Cassian Formation (Dolomites, northern Italy) were examined to assess their diversity and palaeoecology. Surface and bulk samples from the localities Misurina Landslide and Lago Antorno were taken and analysed separately. Both benthic assemblages are relatively similar in taxonomic composition. Gastropods form the most abundant and diverse group, followed by bivalves. Disarticulated echinoderm ossicles are also common in the bulk sample from Misurina Landslide, but they are rare at Lago Antorno. The Misurina Landslide outcrop has yielded two echinoderm Palaeozoic holdovers, the ophiocistioid Linguaserra triassica and plates of putative proterocidarids, supporting the earlier hypothesis that such basins acted as refugia. The gastropod species Coelostylina conica, Prostylifer paludinaris, and Ampezzopleura hybridopsis are characteristic elements of both assemblages. The gastropod Jurilda elongata, however, is the most abundant species at Misurina Landslide, whereas juveniles of the gastropod species Dentineritaria neritina dominate the assemblage from Lago Antorno. Newly described gastropod taxa are Angulatella bizzarinii Nützel and Hausmann gen. et sp. nov., Bandellina compacta Nützel and Hausmann sp. nov., and Ampezzogyra angulata Nützel and Hausmann sp. nov. Fifty-seven invertebrate species were found in the bulk sample from Misurina Landslide and 26 species were recovered from the bulk sample from Lago Antorno. However, sample size from Lago Antorno was much smaller than that from Misurina. Diversity indices (Shannon, Simpson, Berger-Parker) show similar moderate diversities in both assemblages. Rarefaction curves and rank-abundance distributions also point to very similar diversities and ecological structures of the fossil assemblages. Both assemblages are autochthonous or parautochthonous, stemming from basinal, soft-bottom habitats. Their taxonomic composition differs significantly from that of other faunas known from the Cassian Formation. The tropical marine Cassian palaeoecosystem was highly complex and its diversity is still far from being fully explored.

Objective The objective of this study was to evaluate how patient knowledge and beliefs regarding nonsteroidal anti‐inflammatory drugs (NSAIDs) may influence the use of NSAIDs for osteoarthritis (OA). Methods Surveys of 334 adults with knee and/or hip OA were analyzed in this cross‐sectional study. Familiarity with and perceptions of benefits/risks of NSAID use were measured to assess associations with the use of prescription and nonprescription oral NSAIDs. Multinomial logistic regression models were adjusted for sociodemographic and clinical variables. Results In this sample, 35.9% and 35.6% reported use of oral prescription and nonprescription‐only NSAIDs, respectively. Hispanic participants, compared with non‐Hispanic White participants, had lower perceived benefit (P = 0.005) and risk (P = 0.001) of prescription NSAIDs. The following were associated with prescription NSAID use instead of no NSAID use: having family/friends who used prescription (relative risk ratio [RRR] 3.91; 95% confidence interval [CI] 2.05‐7.47) and over‐the‐counter (OTC) (RRR 3.10; 95% CI 1.65‐5.83) NSAIDs for OA, understanding the consequences of using both prescription (RRR 3.50; 95% CI 1.79‐6.86) and OTC (RRR 2.80; 95% CI 1.39‐5.65) NSAIDs, higher perceived benefit of both prescription (RRR 2.51; 95% CI 1.71‐3.66) and OTC (RRR 1.44; 95% CI 1.01‐2.06) NSAIDs, and lower perceived risk of both types of NSAIDs (prescription: RRR 0.63 [95% CI 0.46‐0.87]; OTC: RRR 0.53 [95% CI 0.37‐0.75]). Similar results were found when we assessed the relationship between these variables and OTC NSAID use versus no oral NSAID use. Conclusion Adults with knee and/or hip OA were more likely to use NSAIDs if they were more familiar with, had an increased perceived benefit of, and had a decreased perceived risk of these drugs. Patients’ perceptions and beliefs about NSAIDs should be evaluated when considering them for treatment.

African Americans are more likely than members of other racial groups to report perceived discrimination in health care settings, and discrimination is linked to depression. Using data from a randomized controlled trial of pain coping skills training (PCST) for African Americans with osteoarthritis (N=164), we evaluated the interaction between discrimination experiences and experimental condition (PCST or control group) in linear regression models predicting depressive symptoms. There was a significant interaction between personal discrimination and experimental condition on depressive symptoms (interaction term coefficient: b=-3.2, 95% CI [- 6.4, - .02], p=.05). Discrimination was associated with depressive symptoms among those in the control group but not among those who received PCST. Participation in a PCST intervention may have reduced the association between discrimination experiences and depressive symptoms among participants in this sample. Future research should explore whether interventions aimed at teaching coping skills may be effective in ameliorating the harmful mental health effects of perceived discrimination.

During area-selective atomic layer deposition (ALD) based on growth inhibitors, nucleation eventually occurs as the metal precursor reacts with the surface through secondary pathways. We show that ALD of Al

In 2008, Michigan State University was selected to establish the Facility for Rare Isotope Beams (FRIB). Construction of the FRIB accelerator was completed in January 2022. Phased accelerator commissioning with heavy ion beams started in 2017 with the normal-conducting ion source and radio-frequency quadrupole. In April 2021, the full FRIB driver linear accelerator (linac) was commissioned, with heavy ion beams accelerated to energies above 200 MeV/nucleon by 324 superconducting radiofrequency (SRF) resonators operating at 2 K and 4 K with liquid-helium cooling. In preparation for high-power operation, a liquid lithium charge stripper was commissioned with heavy ion beams up to uranium-238, followed by the simultaneous acceleration of multiple-charge-state heavy ion beams to energies above 200 MeV/nucleon. In December 2021, selenium-84 was produced with the FRIB target using a krypton-86 primary beam, demonstrating FRIB’s capability for scientific discovery.

Objective: To identify sociodemographic profiles of patients prescribed high-dose opioids . Design: Cross-sectional cohort study. Setting/Patients: Veterans dually-enrolled in Veterans Health Administration and Medicare Part D, with ≥ 1 opioid prescription in 2012. Main Outcome Measures: We identified five patient-level demographic characteristics and 12 community variables reflective of region, socioeconomic deprivation, safety, and internet connectivity. Our outcome was the proportion of veterans receiving >120 morphine milligram equivalents (MME) for ≥ 90 consecutive days, a Pharmacy Quality Alliance measure of chronic high-dose opioid prescribing. We used classification and regression tree (CART) methods to identify risk of chronic high-dose opioid prescribing for sociodemographic subgroups. Results: Overall, 17,271 (3.3 percent) of 525,716 dually enrolled veterans were prescribed chronic high-dose opioids. CART analyses identified 35 subgroups using four sociodemographic and five community-level measures, with high-dose opioid prescribing ranging from 0.28 percent to 12.1 percent. The subgroup (n = 16,302) with highest frequency of the outcome included veterans who were with disability, age 18-64 years, white or other race, and lived in the Western Census region. The subgroup (n = 14,835) with the lowest frequency of the outcome included veterans who were without disability, did not receive Medicare Part D Low Income Subsidy, were >85 years old, and lived in communities within the second and sixth to tenth deciles of community public assistance. Conclusions: Using CART analyses with sociodemographic and community-level variables only, we identified subgroups of veterans with a 43-fold difference in chronic high-dose opioid prescriptions. Interactions among disability, age, race/ ethnicity, and region should be considered when identifying high-risk subgroups in large populations.

The Facility for Rare Isotope Beams will be completed in late 2021. We report here on the current efforts to commission the first stages of the 200-MeV/u superconducting, continuous wave heavy-ion linac. The statuses of the cryogenic plant and its distribution system, the accelerator cryomodule commissioning and operations, the ion source and front end transport development, the radio-frequency quadrupole commissioning, and thenbeam dynamics development to support high-power operation are reviewed. Plans for commissioning the remainder of the linac systems are presented.

Monolayer and multilayer dodecanethiols (DDT) can be assembled onto a copper surface from the vapor phase depending on the initial oxidation state of the copper. The ability of the copper-bound dodecanethiolates to block atomic layer deposition (ALD) and the resulting behavior at the interfaces of Cu/SiO

Our objective was to determine if there are ethnic differences in the use of over-the-counter (OTC) and prescription oral nonsteroidal anti-inflammatory drugs (NSAIDs) and if observed ethnic differences persist after adjustment for sociodemographic and clinical factors.Knee and hip osteoarthritis study participants were identified. Surveys were administered to collect sociodemographics, clinical information, and oral treatment methods for arthritis. Multivariable logistic regression models were created using a fully conditional method.Hispanics (n = 130), compared to non-Hispanic whites (n = 204), were less likely to have a high school education (26.9% vs 63.2%, P0.001), less likely to have private medical insurance (P0.001), and more likely to have worse health (P = 0.004). OTC oral NSAID use was less common (52.9% vs 66.3%, P = 0.019), whereas prescription oral NSAID use was more common (43.4% vs 31.7%, P = 0.042) among Hispanics than non-Hispanic whites in the last 6 months. The ethnic difference in using an OTC NSAID instead of not using any oral NSAID was attenuated and no longer significant when adjusted for age, sex, education, and medical insurance (odds ratio [OR] 0.54 [95% confidence interval [CI]: 0.28-1.02]). The odds of using a prescription instead of an OTC NSAID remained significantly higher among Hispanics than non-Hispanic whites when adjusted for the same variables (odds ratio 2.17 [95% confidence interval: 1.16-4.05]).Among patients with osteoarthritis, OTC NSAIDs were less commonly used but prescription NSAIDs were more commonly used by Hispanics than non-Hispanic whites. Sociodemographic factors partially mediate ethnic differences in the use of oral NSAIDs.

Area-selective atomic layer deposition (ALD) is currently attracting significant interest as a solution to the current challenges in alignment that limit the development of sub-5 nm technology nodes in nanoelectronics. Development of area-selective ALD processes with high selectivity requires understanding of the mechanisms involved in the loss of selectivity. In this work, the use of acetylacetone (Hacac) inhibitor molecules in ABC-type cycles for area-selective ALD of SiO2 is investigated as a model system to gain insights into precursor blocking. In situ infrared spectroscopy measurements show that at saturation, Hacac adsorbs in a mixture of chelate and monodentate bonding configurations. Hacac adsorbates in monodentate configuration were found to desorb as a result of purging or to be displaced by bis(diethylamino)silane (BDEAS) precursor dosing and therefore significantly contribute to the loss of selectivity during area-selective ALD. Density functional theory (DFT) calculations reveal that the observed displacement reactions originate from attractive interactions between BDEAS precursor molecules and Hacac adsorbates in monodentate configuration. Moreover, the DFT calculations show that the strength of this interaction is dependent on the chemical structure of the precursor molecule. The obtained insights indicate that careful selection of both inhibitor and precursor molecules is required to improve the selectivity of area-selective ALD.

Objective To examine the relationship between body mass index (BMI) and pain intensity among veterans with musculoskeletal disorder diagnoses (MSDs; nontraumatic joint disorder; osteoarthritis; low back, back, and neck pain). Setting Administrative and electronic health record data from the Veterans Health Administration (VHA). Subjects A national cohort of US military veterans with MSDs in VHA care during 2001–2012 (N = 1,759,338). Methods These cross-sectional data were analyzed using hurdle negative binomial models of pain intensity as a function of BMI, adjusted for comorbidities and demographics. Results The sample had a mean age of 59.4, 95% were male, 77% were white/Non-Hispanic, 79% were overweight or obese, and 42% reported no pain at index MSD diagnosis. Overall, there was a J-shaped relationship between BMI and pain (nadir = 27 kg/m2), with the severely obese (BMI ≥ 40 kg/m2) being most likely to report any pain (OR vs normal weight = 1.23, 95% confidence interval = 1.21–1.26). The association between BMI and pain varied by MSD, with a stronger relationship in the osteoarthritis group and a less pronounced relationship in the back and low back pain groups. Conclusions There was a high prevalence of overweight/obesity among veterans with MSD. High levels of BMI (>27 kg/m2) were associated with increased odds of pain, most markedly among veterans with osteoarthritis.

BACKGROUND: Experiences of discrimination are associated with poor health behaviors and outcomes. Understanding discrimination in health care informs interventions to improve health care experiences. OBJECTIVE: Describe the prevalence of, and variables associated with, perceived gender-based discrimination in the Veterans Affairs (VA) Healthcare System among women Veterans. DESIGN: A cross-sectional, telephone-based survey of a random na- tional sample of young female Veterans. PARTICIPANTS: Female VA primary care patients aged 18–45 years. MAIN MEASURES: The primary outcome was perceived gender-based discrimination in VA health care. Logistic and linear regression models were used to determine associations between any perceived discrim- ination and cumulative perceived discrimination with patient and health service characteristics. KEY RESULTS: Among 2294 women Veterans, 33.7% perceived gender- based discrimination in VA. Perceiving gender-based discrimination was associated with medical illness [adjusted odds ratio (aOR)=1.67, 95% confidence interval (CI)=1.34, 2.08], mental illness (aOR=2.06, 95% CI=1.57, 2.69), and military sexual trauma (aOR=2.65, 95% CI= 2.11, 3.32). Receiving most health care from the same VA provider (aOR=0.73, 95% CI=0.57, 0.94) and receiving care at a VA site with a women’s health clinic (aOR=0.76, 95% CI=0.61, 0.95) were associated with reduced odds of any perceived gender-based discrim- ination. Among those who perceived gender-based discrimination (n=733), perceived discrimination scores were higher among women with increased age, medical illness, or history of military sexual trauma and lower among those who saw the same VA provider for most medical care. CONCLUSIONS: One third of women Veterans perceived gender-based discrimination in VA. Obtaining most medical care from the same VA provider and having a women’s health clinic at one’s VA were associated with less perceived discrimination.

Atrial fibrillation (AF) is a common arrhythmia, the management of which includes anticoagulation for stroke prevention. Although disparities in anticoagulant prescribing have been well documented for individual socioeconomic factors, less is known about the association of neighborhood-level disadvantage and anticoagulation for AF.To assess the association between neighborhood disadvantage and anticoagulant initiation for patients with incident AF.Retrospective cohort study.A cohort of patients enrolled in the Veterans Health Administration (VA) with incident AF from January 2014 through December 2020 from the Race, Ethnicity, and Anticoagulant CHoice in Atrial Fibrillation (REACH-AF) Study.The primary exposure was neighborhood disadvantage quantified using area deprivation index (ADI), classified by quintiles (Q). The outcomes were initiation of any anticoagulant therapy (warfarin or direct oral anticoagulant, DOAC) within 90 days of AF diagnosis and DOAC use among initiators. We used mixed effects logistic regression to assess the association between ADI and anticoagulant therapy, incorporating a fixed effect for treatment site and baseline patient, provider, and facility covariates.Among 161,089 patients, 105,489 (65.5%) initiated any anticoagulant therapy, and 78,903 (74.8%) used DOACs. Any anticoagulant therapy increased 3.2 percentage points (63.0% to 66.2%; p.001) from Q1 to Q5, whereas DOAC use decreased 8.2 percentage points (79.4% to 71.2%; p.0001) across quintiles. The adjusted odd ratios of any anticoagulant therapy were non-significantly different for Q2-Q5 than Q1. The adjusted odds of DOAC use decreased progressively from 0.89 (95% CI, 0.84-0.94) in Q2 to 0.77 (95% CI, 0.73-0.83) in Q5 compared to Q1 (p.0001).Among Veterans with incident AF, we observed similar initiation of any anticoagulant, though neighborhood deprivation was associated with decreased DOAC use among anticoagulant initiators. Future interventions to improve pharmacoequity in anticoagulant prescribing for AF should consider the role of neighborhood-level determinants of health inequities.

Particle proper orthogonal decomposition (PPOD) is demonstrated as a method for extraction of temporal statistical information on dispersed (discrete) phases of multiphase flows. PPOD is an extension of the classical Eulerian POD, differentiating itself by its Lagrangian formulation and applicability to discrete phases in both stationary and non-stationary flows. The method is demonstrated on a test case of decaying homogeneous isotropic turbulence, where particle data are generated by one-way coupled simulations. Here, particle positions and velocities are integrated forward in time in a Lagrangian manner. The results demonstrate a proof of concept of the PPOD, and its potential for applicability. It is demonstrated that PPOD modes are able to capture both large scale temporal flow features as well as smaller scale variations. Additionally, particle trajectories/velocities are approximated using a subset of the PPOD basis where convergence is demonstrated. In the application of PPOD on multiple particle realizations, an increase in the convergence rate is observed as the initial particle separation is decreased. When decomposing both solid (rigid) and fluid particle velocities, the method provides the possibility of modal analysis of fluid–particle interactions in multiphase flows. For various configurations of rigid particle densities, the modal parallelity between the two phases is mapped, revealing a higher parallelity when the rigid particles are neutrally buoyant.