Alexandria VA Medical Center

Traditionally, youth with learning, cognitive, and intellectual disabilities (LCID) have not been given the option of participating in and thus benefiting from a postsecondary education. There are school districts and community colleges across the country, however, that are creating opportunities for these youth to have the option of meaningful participation in a postsecondary education while still in secondary school (i.e., Dual Enrollment). The present study involved a national survey of 25 postsecondary education options that support youth with LCID in postsecondary education while still enrolled in secondary school as an empirical foundation for future research on these service models. The main findings indicate that although most programs provide some combination of “life-skills” training and community-based instruction combined with employment training, some innovative service models (i.e., Inclusive Programs) focus primarily on inclusive postsecondary educational services for students with LCID. Inclusive programs tend to be relatively new, to serve fewer individuals than other service models, and are more collaborative (i.e., high schools, colleges and adult service agencies support students). Main survey findings are presented and discussed, followed by detailed profiles of six programs, and recommendations for future research are presented.

Abstract Flow is a construct developed by Mihály Csíkszentmihályi that describes a psychological state of optimal attention and engagement. Creativity and improved well-being have been empirically linked to the flow experience; therefore, the study of flow has implications for art therapy research and practice. Art therapists may facilitate personal growth by helping individuals enter and maintain a state of flow in their art making. This article reviews the literature on the characteristics of the flow experience and its neurological functions and suggests applications to art therapy theory and practice. Acknowledgments Editor's Note: Gioia Chilton, MA, ATR-BC, is a doctoral candidate in the Creative Arts Therapies Program at Drexel University, Philadelphia, PA, and an adjunct instructor at The George Washington University in the Washington, DC area.

Abstract As a growing movement in the larger field of mental health, positive psychology has much to offer the art therapy profession, which in turn is uniquely poised to contribute to the study of optimal functioning. This article discusses the relationship of positive psychology to art therapy and its capacity to mobilize client strengths, to induce experiences of flow and positive emotions, and to express life purpose and meaning as well as positive emotions. Suggested research and practical applications illuminate the potential of positive art therapy to move individuals, groups, and communities beyond solely the relief of suffering to a state of flourishing. Acknowledgments Editor's Note: Rebecca A. Wilkinson, MA, ATR-BC, is an adjunct instructor at the George Washington University, Alexandria, VA, and executive director of Creative Wellbeing Workshops, LLC. Gioia Chilton, MA, ATR-BC, is a doctoral candidate in the Creative Arts Therapies Program at Drexel University, Philadelphia, PA, and an adjunct instructor at the George Washington University.

A novel, comprehensive decision-making and treatment algorithm was established within a US government-run military veteran hospital in an attempt to standardize the process of outpatient wound care and streamline costs. All patients were systematically evaluated and treated using the comprehensive algorithm over a span of nine months. After three months of adherence to the algorithm, the algorithm was modified to include ovine-based collagen extracellular matrix (CECM) dressings as a first-line conventional treatment strategy for all appropriate wounds. The purpose of this retrospective analysis was to evaluate the hospital's change in cellular and/or tissue-based graft usage and cost, as well as wound healing outcomes following modification of the wound care standardization algorithm. Data from the first quarter (Q1; three months) of protocol implementation were compared to the subsequent two quarters (six months), during which time the first-line dressing modification of the protocol was implemented. Results showed that between quarters 1 and 3, the percentage of wounds healed increased by 95.5% (24/64 to 80/109), and the average time to heal each wound decreased by 22.6% (78.8 days to 61.0 days). Cellular and/or tissue-based graft unit usage decreased by 59.7% (144 units to 58 units), and expenditures on cellular and/or tissue-based grafts decreased by 66.0% ($212,893 to $72,412). Results of this analysis displayed a trend toward decreased expenditures, faster healing times, and a greater number of healed wounds following modification of an evidence-based algorithm to incorporate CECM dressings as a first-line treatment strategy in managing chronic wounds.

Simulation projects are usually cooperative endeavors that involve not only the work on the simulation model itself but also a lot of communication among project partners. In the past, support for communication and cooperation in simulation projects has been poor to non-existent. The Web Based Simulation Center is designed to bring simulation and cooperation together. Because this approach requires and benefits from making simulation tools available on the Web, it is also a first step toward introducing application service providing (ASP) for simulation.

In this paper, we report findings from a micro CPV module, employing 170 μm GaAs-based 2J CPV cells, assembled on glass substrates using micro-transfer printing. The CPV array uses all-glass lens arrays to focus the light with a geometric concentration ratio of 740 suns, and a bifacial, monocrystalline silicon solar cell behind the substrate to capture the diffuse component of the light. We found that the diffuse capture creates a significant performance boost over CPV alone, and study the role of bifacial capture on the overall performance. The highest combined efficiency with respect to global normal irradiance was 25.4% for the module, measured by outdoor testing in Washington, DC.

AIMS: To analyze the association between provider, healthcare costs, and glycemic control for patients with diabetes mellitus (DM). MATERIALS AND METHODS: This cross-sectional study identified adults with type 1 or 2 DM (T1D, T2D) in the Optum database. The main independent variable was provider (endocrinologist or primary care). Regression analysis compared total medical and pharmacy costs, adjusting for health status and other patient differences, by provider. RESULTS: For all patients, HbA1C improvement was greater, and medical costs significantly lower with an endocrinologist rather than a primary care provider. The largest HbA1C improvement (4%) occurred for insulin-dependent patients seen by endocrinologists. Significant medical savings with endocrinologist management occurred within the Medicare Advantage population in every sub-group of patients, with 14% lower costs ($4,767) for patients with T1D, 11% lower costs ($3,160) for patients with macro- and microvascular complications, and 10% lower costs ($2,237) for insulin-dependent patients. Within the commercial insurance population, medical costs were reduced by ≥9% in every sub-group of patients, with a 20% reduction ($8,450) for patients with micro- and macrovascular complications. Overall total costs (medical and pharmacy) were 8% ($1,541) higher for patients receiving endocrinologist rather than primary care, although endocrinologist care resulted in a 9% reduction (-$3,710) in costs for Medicare Advantage patients with T1D. Total medical costs (excluding pharmacy costs) may be a more accurate indicator of costs associated with patients in various stages of DM. LIMITATIONS: There was insufficient data to develop risk-adjustment payments for pharmacy costs based on disease severity. The cross-sectional design identifies associations and not cause-effect relationships. CONCLUSION: DM management by an endocrinologist was associated with greater HbA1C improvement and significantly lower medical costs. Total costs were higher with an endocrinologist, but for patients with T1D lower costs were seen, ranging from 2-9% regardless of insurance type.

Before planning for provision of Consumer Health Information Services, the librarian and administration must anticipate the problems encountered in sharing funds, personnel, space, and materials with an existing medical or patient education library. Establishing new space within or outside the hospital, or participating in community projects which meet consumer health information needs, are important considerations for planners. This article sets forth the place of some CHI services in the hospital setting, and how they relate to other library services. Differences between hospital library support for Patient Education and for Consumer Health Information services are discussed.

High ambient summertime temperatures are an increasing health concern with climate change. This is a particular concern for minoritized households in the United States, for which differential energy burden may compromise adaptive capacity to high temperatures. Our research question was: Do minoritized groups experience hotter summers than the area average, and do non-Hispanic white people experience cooler summers? Using a fine-scaled spatiotemporal air temperature model and U.S. census data, we examined local (within-county) differences in warm season cooling degree days (CDDs) by ethnoracial group as a proxy for local energy demand for space cooling across states of the northeast and mid-Atlantic U.S. in 2003-2019. Using state-specific regression models adjusted for year and county, we found that Black and Latino people consistently experienced more CDDs, non-Hispanic white people experienced fewer CDDs, and Asian populations showed mixed results. We also explored a concentration-based measure of residential segregation for each ethnoracial group as one possible pathway towards temperature disparities. We included the segregation measure as a smooth term in a regression model adjusted for county and year. The results were nonlinear, but higher concentrations of white people were associated with lower annual CDDs and higher concentrations of Latino people were associated with higher annual CDDs than the county average. Concentrations for Black and Asian people were nonmonotonic, sometimes with bowed associations. These findings suggest that present-day residential segregation, as modeled by spatially smoothed ethnoracial subgroup concentrations, may contribute to summertime air temperature disparities and influence adaptive capacity. We hope these findings can support place-based interventions, including targeting of energy insecurity relief programs.

Fee-for-service and capitation payment methods create different financial incentives for healthcare providers, and the objectives of utilization management differ under each payment method. These differences can be reconciled, however, by incorporating the strengths of utilization management programs associated with both methods into an overarching program that focuses on the continuum of care. Such a program should be focused on achieving the optimal outcomes for patients by identifying the appropriate level of care, who should provide it, and when and where it should be provided. Essential to this effort is access to comprehensive clinical and financial data through an integrated information system. In addition, financial incentives need to be aligned through such means as risk pools, compensation arrangements tied to achievement of medical management goals, and clearly defined policies and procedures.

This paper provides a general introduction to the SeamlessAccess (SA) initiative, covering the following four topics: Why are we here? A recap of why was SA created and the history of this initiative to date; How does it work? A walk through how Federated Authentication and SA work, so you are familiar with some of the technical terms and we can build on that knowledge when we address privacy and security; What is the current status? An update on the status of this initiative; How do I participate? Information on how you can participate to deliver more seamless access to your users.

Specialty physicians are feeling the heat from managed care because of shrinking reimbursement, selective paneling and clinical re-engineering. They have felt the need to leverage their influence by developing specialty groups and networks. While each network is unique in its external circumstances, there are several common elements to successful specialty networks, including having a clear network mission, obtaining adequate capitalization, obtaining equity, accepting only a manageable amount of risk, gaining member volume establishing and maintaining payer diversity, being high quality and efficient, developing and using information tools, supporting network efficiencies, allying with other physician organizations, exercising network panel selection and deselection, and empowering physicians with knowledge.

For the next several years, capitation of specialties will increasingly influence contracting arrangements. Specialists and their networks must position themselves to operate in this environment amid a shrinking market for their services and consolidation of delivery systems and accepting capitation can be a necessary step. The specialties that can quantify the costs of specific services within a defined range, and can manage appropriate utilization of those services within acceptable parameters through wellness, patient intervention and disease management techniques, are most likely to be successful in risk contracting. This article presents how to investigate risk contracting in specialty networks and what infrastructure is required for successful risk contracting.

OBJECTIVES: Few studies of exposure therapy with adults 85 years and older exist. This case report presents results of prolonged exposure (PE) for posttraumatic stress disorder (PTSD) modified for an 85-year-old Native American Cajun man with late-onset deafness, who used a cochlear implant, and reported high Western/non-Native American acculturation. The following modifications were made primarily in response to the client's individual, disability-related barriers to completing the standard PE protocol: (a) inclusion of the client's spouse in aspects of treatment planning and homework assignments; (b) variable session length and frequency; (c) homework was limited to the daily practice of breathing retraining and in vivo exposure to triggering images; and (d) therapist reliance on nonverbal indicators of distress during imaginal exposures. METHODS: The PTSD Checklist for DSM-5 (PCL-5) and 15-item Geriatric Depression Scale (GSD-15) were primary progress and outcome measures. RESULTS: The modified treatment was associated with clinically significant decreases in baseline PTSD (19 points) and depressive (8 points) symptoms. CONCLUSIONS: PE protocol modifications did not compromise treatment outcomes for this client. CLINICAL IMPLICATIONS: PE protocols should be modified based on the individual needs of diverse older adults underrepresented in efficacy research.

Due to the possibility of using vacuum mounting suction cups in modern construction practices, it is imperative to determine the safe threshold of point load on glass units that are vulnerable to local forces. The present paper elucidates the findings of an experimental investigation into the strength of a double-layer glass unit with an air gap under the action of a local load typical of vacuum-fixed assembly tools. The research methodology involved varying the angle of force application (0°, 45°, 90°) and the positioning of the suction cup (center/edge), while recording deflections at designated control points using electronic micrometers. It was determined that the suction cup detached when subjected to a load of 86 kg in the "90°, center" glass configuration, whereas other configurations remained undamaged up to loads of 50 kg. To ensure safety and preserve the integrity of the double-glazed unit, tests for loads greater than 50 kg were carried out only in the «90° configurations, centered at the», which was determined to be the most vulnerable based on previous tests. Other configurations showed no signs of damage up to 50 kg, and further testing was considered unnecessary due to the lower stress concentration. The findings can be used to formulate recommendations for the safe application of mounting equipment and to enhance the regulatory framework for the interaction of fasteners with transparent structures.

Fever of a malarial origin is an annual visitant, from August to the middle of October, of all that vast section comprised within the Southern Atlantic and Gulf States, and also of a large portion of the interior, comprising the Middle, Western and Southern States. The large number of cases occurring within the vast area comprised within these borders, the distress of mind and body, the loss of time by sickness, the additional expense incurred, the impairment of health and the greatest of earthly evils, the mortality resulting, combine to render this one of the most important and interesting subjects in our profession, and how successfully to prevent malarial infection and to correct it after it enters the human system, become questions of paramount importance. While this subject has for years received the closest attention from scientific and practical minds, it never loses interest or grows trite and in all

Position, navigation, and timing messages to moored, single, acoustic receivers over basin-scale distances are reported. At a 75- Hz center-frequency, the lengthy coherence time allows for successive and long-duration symbol transmissions. Analysis of 2700 spread code M-sequence transmissions from Kauai to Wake Island over a 1.5-year duration predicts a channel capacity of 0.028 bits/(s Hz). Exploiting waveform shift orthogonality properties, a low-SNR telemetry implementation is discussed and performance is estimated from 10 800 observed symbols.

Two of the byproducts of the shift to managed care--risk-based contracting and surplus specialist capacity--has fostered the growth of specialty networks. To remain competitive in a selective market for specialty services, specialists must develop the clinical an business capabilities to manage risk and outcomes and must adapt practice culture to the operational demands of managed care. Also, specialists must create effective delivery networks that meet payer and patient expectations for clinical excellence, patient access and business efficiency. This article addresses matching the specialty network to the market and building the specialty network.

No AccessJournal of Urology1 Dec 1984Renal Cell Carcinoma in a Horseshoe Kidney M. Wiener, D. Sarma, and M. Rao M. WienerM. Wiener More articles by this author , D. SarmaD. Sarma More articles by this author , and M. RaoM. Rao More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(17)50129-9AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "Renal Cell Carcinoma in a Horseshoe Kidney." The Journal of Urology, 132(6), p. 1285 © 1984 by The American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 132Issue 6December 1984Page: 1285 Advertisement Copyright & Permissions© 1984 by The American Urological Association Education and Research, Inc.MetricsAuthor Information M. Wiener More articles by this author D. Sarma More articles by this author M. Rao More articles by this author Expand All Advertisement PDF DownloadLoading ...

Although physician support programs have gained in popularity in recent years, organizations must be careful to select the most effective mix of physician relations programs. A healthcare financial manager can help create a productive physician alliance program by analyzing physicians as strategic business units, providing financial and analytical support for program assessment, screening programs for legal risks, and assessing an alliance program's risks in terms of antifraud and abuse legislation, tax laws, and private inurement issues.