993 resultados para United States. Dept. of Veterans Affairs


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Mode of access: Internet.

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Shipping list no.: 90-0177-P.

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Includes bibliographical references and index.

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Vol. 2 has title: Land laws : regulations and decisions, being a continuation of acts of Congress respecting the sale and disposition of public lands and embracing land laws passed ... from December , 1859, to January 1, 1870

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The goal of this study was to investigate the use of custom-made orthopedic shoes (OS) and the association between the use of OS and the most relevant aspects of their usability. Over a 6-month period, patients meeting the inclusion criteria were recruited by 12 orthopedic shoe companies scattered throughout the Netherlands and asked to complete a questionnaire composed of a pre- and post-OS section. Patients with different pathologies were included in the study (n = 339; response 67%). Mean age of the patients was 63 +/- 15 years, and 38% were male. Three months after delivery, 81% of the patients used their OS frequently (4-7 days/week), 13% occasionally (1-3 days/week), and 6% did not use their OS. Associations were found between use and all measured aspects of usability (p-values varied from <0.001 to 0.028). Patients who used their OS more often had a more positive opinion regarding all the aspects of usability. We conclude that all aspects of the usability of OS are relevant in relation to their use and should be taken into account when prescribing and evaluating OS.

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This study investigated long-term use of custom-made orthopedic shoes (OS) at 1.5 years follow-up. In addition, the association between short-term outcomes and long-term use was studied. Patients from a previously published study who did use their first-ever pair of OS 3 months after delivery received another questionnaire after 1.5 years. Patients with different pathologies were included in the study (n = 269, response = 86%). Mean age was 63 ± 14 years, and 38% were male. After 1.5 years, 87% of the patients still used their OS (78% frequently [4-7 days/week] and 90% occasionally [1-3 days/week]) and 13% of the patients had ceased using their OS. Patients who were using their OS frequently after 1.5 years had significantly higher scores for 8 of 10 short-term usability outcomes (p-values ranged from <0.001 to 0.046). The largest differences between users and nonusers were found for scores on the short-term outcomes of OS fit and communication with the medical specialist and shoe technician (effect size range = 0.16 to 0.46). We conclude that patients with worse short-term usability outcomes for their OS are more likely to use their OS only occasionally or not at all at long-term follow-up.

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Over a decade ago, in August 1977, the First Marine Mammal Stranding Workshop was convened in Athens, Georgia. That workshop, organized by j.R. Geraci and D.J. St. Aubin, not only considered biology and pathology of stranded marine mammals, but it also served as a springboard for the formation of regional marine mammal stranding networks in the United States. The ramifications have been extremely important to the field of marine mammalogy since, for some species, examination or rehabilitation of stranded specimens serves as virtually the only source of information on distribution, anatomy, physiology, reproduction, and pathology. The First Marine Mammal Stranding Workshop led to increased awareness of the marine mammals themselves, as well as the logistic and legal factors associated with effective handling of the animals. A number of individuals indicated that they felt that a Second Marine Mammal Stranding Workshop held prior to the Seventh Biennial Conference on the Biology of Marine Mammals (Miami, Florida; December 1987) would be both timely and productive. Accordingly, we organized the workshop and scheduled it to occur on 3-5 December. Our goals for the workshop were several, including 1) providing descriptions of some research, especially new techniques, regarding stranded marine mammals; 2) providing a forum where scientists could interact and possibly initiate cooperative research activities; 3) presenting information regarding procedures used effectively to handle stranded animals; 4) assessing ways to standardize data and specimen collection, archiving, and retrieval; and 5) providing a forum for assessing accomplishments and status of regional stranding networks to date, as well as for making recommendations regarding future activities of the networks. Nearly 100 individuals representing Federal and State governments, academic institutions, the oceanarium industry, consulting groups, conservation organizations, and the private sector attended the workshop (see Workshop Participants, this volume). (PDF file contains 166 pages.)

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Night sharks, Carcharhinus signatus, are an oceanic species generally occurring in outer continental shelf waters in the western North Atlantic Ocean including the Caribbean Sea and Gulf of Mexico. Although not targeted, night sharks make up a segment of the shark bycatch in the pelagic longline fishery. Historically, night sharks comprised a significant proportion of the artisanal Cuban shark fishery but today they are rarely caught. Although information from some fisheries has shown a decline in catches of night sharks, it is unclear whether this decline is due to changes in fishing tactics, market, or species identification. Despite the uncertainty in the decline, the night shark is currently listed as a species of concern due to alleged declines in abundance resulting from fishing effort, i.e. overutilization. To assess their relevance to the species of concern list, we collated available information on the night shark to provide an analysis of its status. Night shark landings were likely both over- and under-reported and thus probably did not reflect all commercial and recreational catches, and overall they have limited relevance to the current status of the species. Average size information has not changed considerably since the 1980’s based on information from the pelagic longline fishery when corrected for gear bias. Analysis of biological information indicates night sharks have intrinsic rates of increase (r) about 10% yr–1 and have moderate rebound potential and an intermediate generation time compared to other sharks. An analysis of trends in relative abundance from four data sources gave conflicting results, with one series in decline, two series increasing, and one series relatively flat. Based on the analysis of all currently available information, we believe the night shark does not qualify as a species of concern but should be retained on the prohibited species list as a precautionary approach to management until a more comprehensive stock assessment can be conducted.

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BACKGROUND: Many patients with diabetes have poor blood pressure (BP) control. Pharmacological therapy is the cornerstone of effective BP treatment, yet there are high rates both of poor medication adherence and failure to intensify medications. Successful medication management requires an effective partnership between providers who initiate and increase doses of effective medications and patients who adhere to the regimen. METHODS: In this cluster-randomized controlled effectiveness study, primary care teams within sites were randomized to a program led by a clinical pharmacist trained in motivational interviewing-based behavioral counseling approaches and authorized to make BP medication changes or to usual care. This study involved the collection of data during a 14-month intervention period in three Department of Veterans Affairs facilities and two Kaiser Permanente Northern California facilities. The clinical pharmacist was supported by clinical information systems that enabled proactive identification of, and outreach to, eligible patients identified on the basis of poor BP control and either medication refill gaps or lack of recent medication intensification. The primary outcome is the relative change in systolic blood pressure (SBP) measurements over time. Secondary outcomes are changes in Hemoglobin A1c, low-density lipoprotein cholesterol (LDL), medication adherence determined from pharmacy refill data, and medication intensification rates. DISCUSSION: Integration of the three intervention elements--proactive identification, adherence counseling and medication intensification--is essential to achieve optimal levels of control for high-risk patients. Testing the effectiveness of this intervention at the team level allows us to study the program as it would typically be implemented within a clinic setting, including how it integrates with other elements of care. TRIAL REGISTRATION: The ClinicalTrials.gov registration number is NCT00495794.