Xiong J.,University of Arkansas for Medical Sciences |
Xiong J.,Central Arkansas Veterans Healthcare System |
Onal M.,University of Arkansas for Medical Sciences |
Onal M.,Central Arkansas Veterans Healthcare System |
And 8 more authors.
Nature Medicine | Year: 2011
Osteoclasts resorb the mineralized matrices formed by chondrocytes or osteoblasts. The cytokine receptor activator of nuclear factor-κB ligand (RANKL) is essential for osteoclast formation and thought to be supplied by osteoblasts or their precursors, thereby linking bone formation to resorption. However, RANKL is expressed by a variety of cell types, and it is unclear which of them are essential sources for osteoclast formation. Here we have used a mouse strain in which RANKL can be conditionally deleted and a series of Cre-deleter strains to demonstrate that hypertrophic chondrocytes and osteocytes, both of which are embedded in matrix, are essential sources of the RANKL that controls mineralized cartilage resorption and bone remodeling, respectively. Moreover, osteocyte RANKL is responsible for the bone loss associated with unloading. Contrary to the current paradigm, RANKL produced by osteoblasts or their progenitors does not contribute to adult bone remodeling. These results suggest that the rate-limiting step of matrix resorption is controlled by cells embedded within the matrix itself. © 2011 Nature America, Inc. All rights reserved.
Hart M.D.,Central Arkansas Veterans Healthcare System
CIN - Computers Informatics Nursing | Year: 2010
The objective of this research study was to produce a job-specific list of informatics competencies for generic nurse manager positions. In 2002, Staggers et al (Nurs Res. 2002;51(6):383-390) identified a list of core nursing informatics competencies at four levels of nursing practice but concluded that job-specific competencies still needed to be developed. An expert panel utilized the Master List of Nursing Informatics Competencies produced in the 2002 study by Staggers et al to define the job-specific informatics competencies appropriate for generic nurse manager positions. A three-round Delphi study was utilized to establish the core competencies appropriate for this job-specific position. Participants were expert informatics nurses in the US Veterans' Healthcare System. Based on the Four Levels of Practice defined in the 2002 study by Staggers et al, the panel identified the level 2 experienced nurse as most appropriate for generic nurse manager positions. For the purposes of review, each practice level was considered to include the competencies of the levels below it. Therefore, having selected level 2 experienced nurse, this necessitated the review of levels 1 and 2, which totaled 69 competencies. From the available 69 competencies, the panel selected a total of 49 core competencies appropriate for generic nurse manager positions. This Delphi research study chose to focus on a single job-specific position to take one small step toward the recommendation of Staggers et al to identify job-specific competencies. The generic nurse manager position was selected as it is a vital position in providing leadership and support within all institutions. While the study raises several questions about how the panel elected some competencies over others, it also begins to define which levels of competencies and categories are most appropriate. With this information at hand, the next logical step would be to establish associated tools for competency development and evaluation, which could then be used to properly prepare and review individuals for the associated nurse manager responsibilities. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins.
Deen T.L.,Central Arkansas Veterans Healthcare System |
Godleski L.,Veterans Health Administration National Telemental Health Center |
Fortney J.C.,Central Arkansas Veterans Healthcare System
Psychiatric Services | Year: 2012
Objective: This is the first large-scale study to describe the types of telemental health services provided by the Veterans Health Administration (VHA). Methods: The authors compiled national-level VHA administrative data for fiscal years 2006-2010 (October 1, 2005, to September 30, 2010). Telemental health encounters were identified by VHA and U.S. Department of Veterans Affairs stop codes and categorized as medication management, individual psychotherapy with or without medication management, group psychotherapy, and diagnostic assessment. Results: A total of 342,288 telemental health encounters were identified, and each type increased substantially across the five years. Telepsychotherapy with medication management was the fastest growing type of telemental health service. Conclusions: The use of videoconferencing technology has expanded beyond medication management alone to include telepsychotherapy services, including both individual and group psychotherapy, and diagnostic assessments. The increase in telemental health services is encouraging, given the large number of returning veterans living in rural areas.
Zimniak P.,University of Arkansas for Medical Sciences |
Zimniak P.,Central Arkansas Veterans Healthcare System
Free Radical Biology and Medicine | Year: 2011
This review begins with the premise that an organism's life span is determined by the balance between two countervailing forces: (i) the sum of destabilizing effects and (ii) the sum of protective longevity-assurance processes. Against this backdrop, the role of electrophiles is discussed, both as destabilizing factors and as signals that induce protective responses. Because most biological macromolecules contain nucleophilic centers, electrophiles are particularly reactive and toxic in a biological context. The majority of cellular electrophiles are generated from polyunsaturated fatty acids by a peroxidation chain reaction that is readily triggered by oxygen-centered radicals, but propagates without further input of reactive oxygen species(ROS). Thus, the formation of lipid-derived electrophiles such as 4-hydroxynon-2-enal (4-HNE) is proposed to be relatively insensitive to the level of initiating ROS, but to depend mainly on the availability of peroxidation-susceptible fatty acids. This is consistent with numerous observations that life span is inversely correlated to membrane peroxidizability, and with the hypothesis that 4-HNE may constitute the mechanistic link between high susceptibility of membrane lipids to peroxidation and shortened life span. Experimental interventions that directly alter membrane composition (and thus their peroxidizability) or modulate 4-HNE levels have the expected effects on life span, establishing that the connection is not only correlative but causal. Specific molecular mechanisms are considered, by which 4-HNE could (i) destabilize biological systems via nontargeted reactions with cellular macromolecules and (ii) modulate signaling pathways that control longevity-assurance mechanisms. © 2011 Federation of European Biochemical Societies. Published by Elsevier B.V. All rights reserved.
Kaushal G.P.,Central Arkansas Veterans Healthcare System |
Kaushal G.P.,University of Arkansas for Medical Sciences
Kidney International | Year: 2012
Autophagy is upregulated during ischemia-reperfusion (IR)-induced and cisplatin-induced acute kidney injury (AKI). Proximal tubule-specific Atg7 knockout mice exhibited increased renal injury compared with wild-type mice following cisplatin- and IR-induced AKI. Inhibition of autophagy by chloroquine aggravated AKI, whereas upregulation of autophagy by rapamycin recovered lost renal function and histology, further indicating a protective role of autophagy in AKI. These findings reported by Jiang et al. will provide stimulus to further examine the role and mechanism of the enhancement of autophagy in AKI. © 2012 International Society of Nephrology.
Xiong J.,University of Arkansas for Medical Sciences |
Xiong J.,Central Arkansas Veterans Healthcare System |
O'Brien C.A.,University of Arkansas for Medical Sciences |
O'Brien C.A.,Central Arkansas Veterans Healthcare System
Journal of Bone and Mineral Research | Year: 2012
The idea that osteoblasts, or their progenitors, support osteoclast formation by expressing the cytokine receptor activator of NFkB ligand (RANKL) is a widely held tenet of skeletal biology. Two recent studies provide evidence that osteocytes, and not osteoblasts or their progenitors, are the major source of RANKL driving osteoclast formation in cancellous bone. The goal of this review is to highlight the results of these new studies and discuss their implications for our understanding of bone remodeling. Copyright © 2012 American Society for Bone and Mineral Research.
Wellen M.,Central Arkansas Veterans Healthcare System
Current Psychiatry Reports | Year: 2010
Demoralization is a phenomenon in which a patient reaches a state of subjective incompetence, hopelessness, and helplessness that can lead to that devastating moment in which he or she feels the only recourse left is to give up. This article reviews the medical literature regarding the current understanding, importance, and impact of demoralization. In addition, using the key characteristics of demoralization, this article attempts to compare and contrast demoralization with anhedonia and grief. © Springer Science+Business Media, LLC 2010.
Sanyal A.J.,Virginia Commonwealth University |
Abdelmalek M.F.,Duke University |
Suzuki A.,University of Arkansas for Medical Sciences |
Suzuki A.,Central Arkansas Veterans Healthcare System |
And 2 more authors.
Gastroenterology | Year: 2014
Background & Aims n-3 polyunsaturated fatty acids reduce insulin resistance, lipogenesis, and inflammation, which are features of nonalcoholic steatohepatitis (NASH). Ethyl-eicosapentanoic acid (EPA-E) is a synthetic polyunsaturated fatty acid that reduces hypertriglyceridemia. We report the final results of a phase 2b multicenter, prospective, double-blind, randomized, placebo-controlled trial of EPA-E for NASH. Methods Our study, performed at 37 sites in North America, included subjects with NASH and nonalcoholic fatty liver disease (NAFLD) activity scores ≥4, with minimum scores of 1 for steatosis and inflammation, along with either ballooning or at least stage 1a fibrosis. A total of 243 subjects were randomly assigned to groups given placebo (n = 75), low-dosage EPA-E (1800 mg/d; n = 82), or high-dosage EPA-E (2700 mg/d; n = 86) for 12 months. Subjects were examined at 4-week intervals for 3 months, 6-week intervals for the next 3 months, and every 3 months thereafter, until 1 month after the last dose was taken. Liver biopsies were collected 2 weeks after the last dose of EPA-E or placebo. The primary efficacy end point was NAFLD activity score ≤3, without worsening of fibrosis; or a decrease in NAFLD activity score by ≥2 with contribution from >1 parameter, without worsening of fibrosis, 1 year after the last dose of EPA-E or placebo was given. Results Similar proportions of subjects in each group met the primary end point (40%, 37%, and 35.9% for placebo, low-dosage, and high-dosage EPA-E, respectively). EPA-E had no significant effects on steatosis, inflammation, ballooning, or fibrosis scores. There were no significant effects on levels of liver enzymes, insulin resistance, adiponectin, keratin 18, high-sensitivity C-reactive protein, or hyaluronic acid. High-dosage EPA-E reduced levels of triglyceride (-6.5 mg/dL vs an increase of 12 mg/dL in the placebo group; P =.03). There were no treatment-related serious adverse events. Conclusions In a phase 2 trial, EPA-E had no significant effect on the histologic features of NASH. EPA-E reduced subjects' levels of triglyceride compared with placebo, without any increase in serious adverse events. Clinicaltrials.gov Number: 01154985. © 2014 by the AGA Institute.
News Article | February 28, 2017
LEWISVILLE, Texas--(BUSINESS WIRE)--CareView Communications, Inc. ("CareView" or the "Company") (OTCQB: CRVW), an information technology provider to the healthcare industry, today announced the execution of a products and services agreement with the Central Arkansas Veterans Healthcare System for installation of its CareView System® in its primary hospital, John L. McClellan Memorial Veterans Hospital in Little Rock. CareView has already begun installation of its video monitoring, archival and patient care documentation systems and patient entertainment systems in 100 beds. The installation at John L. McClellan Memorial Veterans Hospital is pursuant to the Company's approval from the U.S. General Services Administration ("GSA") under which CareView's products and services are included on its Multiple Award Schedule program. The approval allows the Company to sell the CareView System at a negotiated rate to the approximate 169 VA facilities with over 39,000 licensed beds and the approximate 42 DOD hospitals with over 2,600 licensed beds. The GSA's Multiple Award Schedule is one of the most widely accepted government contract vehicles available to agency procurement officers. GSA's application process requires potential vendors to be recognized as highly credible and well established. As a GSA contract holder, CareView's products and services are listed and available on the GSA Schedule Contract #GS-07F-020AA. Steven Johnson, CareView's President and Chief Executive Officer, stated, "We are excited to be installing the CareView System at this important VA hospital. We are hopeful that once installation and training is complete, the other VA hospitals will also want to participate. Our products and services represent an enormous opportunity to improve the health and safety of our Nation’s veterans." CareView's mission is to be the leading provider of products and on-demand application services for the healthcare industry by specializing in bedside video monitoring, archiving and patient care documentation systems and patient entertainment services. Through the use of telecommunications technology and the Internet, our products and on-demand services will greatly increase the access to quality medical care and education for both consumers and healthcare professionals. We offer the next generation of patient care through our unique data and patient monitoring system that connects patients, families and healthcare professionals (the "CareView System®"). Our proprietary, high-speed data network system may be deployed throughout a healthcare facility to provide the facility with recurring revenue and infrastructure for future applications. Real-time bedside and point-of-care video monitoring and recording improve efficiency while limiting liability, and entertainment packages and patient education enhance the patient's quality of stay. Through continued investment in patient care technology, we are helping hospitals and assisted living facilities build a safe, high quality healthcare delivery system that best serves the patient, while striving for the highest level of patient satisfaction and comfort. CareView is dedicated to working with all types of hospitals, nursing homes, adult living centers and selected outpatient care facilities domestically and internationally. Corporate offices are located at 405 State Highway 121 Bypass, Suite B-240, Lewisville, TX 75067. More information about the Company and its products and services is available on the Company’s website at www.care-view.com. Statements made in this release that are not statements of historical or current facts are “forward-looking statements” within the meaning of the Private Securities Litigation Reform Act of 1995. Forward-looking statements may involve known and unknown risks, uncertainties and other factors that may cause the actual results, performance or achievements of CareView Communications, Inc. to be materially different from historical results or from any future results or projections expressed or implied by such forward-looking statements. Accordingly, readers should not place undue reliance on any forward looking statements. In addition to statements that explicitly describe such risks and uncertainties, readers are urged to consider statements in the conditional or future tenses or that includes terms such as “believes,” “belief,” “expects,” “estimates,” “intends,” “anticipates” or “plans” to be uncertain and forward-looking. Forward-looking statements may include comments as to the beliefs and expectations of the company's management as to future events and trends affecting its business and are necessarily subject to uncertainties, many of which are outside of the company's control. Examples of such statements include that CareView is hopeful that other VA Hospitals will want to participate. Important factors that could cause actual results to differ materially from those indicated by such forward-looking statements are described in the sections titled "Risk Factors" in the company's filings with the Securities and Exchange Commission, including its most recent Annual Report on Form 10-K and Quarterly Reports on Form 10-Q, as well as reports on Form 8-K, including, but not limited to the following: including market acceptance of the Company’s services and projects and the Company’s continued access to capital and other risks and uncertainties. The actual results the Company achieves may differ materially from any forward-looking statements due to such risks and uncertainties. These statements are based on our current expectations and speak only as of the date of such statements. The Company undertakes no obligation to publicly update or revise any forward-looking statement, whether as a result of future events, new information or otherwise. More information is available on CareView's website at www.care-view.com.
News Article | November 18, 2016
UC Riverside-led researcher proposes that peer-led services are an ideal way to connect student veterans to resources and healthcare services RIVERSIDE, Calif. - About two-thirds of veterans using Veterans Affairs Department education benefits earn a degree or complete a certificate or training program. The remaining third drop out, however, overcome by challenges in transitioning from service member to student. Now a study led by a health services researcher at the University of California, Riverside offers a solution: peer-led services, which, the researcher says, are ideal for connecting student veterans to resources and healthcare services. "Peer-led supportive services offer veterans a sense of community and have the potential to increase retention rates and help ensure academic success," said Ann Cheney, an assistant professor in the Center for Healthy Communities in the School of Medicine and the lead author of the study that appears in the fall 2016 issue of Progress in Community Health Partnerships: Research, Education, and Action. She explained that many university campuses already have supportive services for students. "But these most often are neither veteran-initiated nor veteran-led," she said. "Some veterans are deterred from accessing these services because of values and attitudes promulgated within the military, such as self-reliance and pride." The research paper stresses that veteran-led programs connect students with fellow veterans and veteran faculty members who share military experience. "Such faculty members can help veteran students transition from the military's rigid structure to that of a student, which tends to be more self-directed," Cheney said. "By seeking help from VA and community providers and researchers, campus communities can play a vital role in improving veterans' overall health and well-being and academic success." The study was conducted at six campuses in rural Arkansas to describe challenges and lessons learned in the first year of a VA/Student Partnership for Rural Veterans project. To develop veteran-to-veteran services, Cheney and her colleagues leveraged established community advisory boards. They also collaborated with student services, faculty with vested interest in veteran health, and leaders of student veteran organizations. "Engaging veterans, campus leaders, and community stakeholders in grass-roots efforts to develop peer-led services and resources that are locally tailored to the needs of veterans can result in long-term collaborations and sustainable programs," Cheney said. "Supportive services can help veterans transition into higher education and potentially set them up for academic success, but the evidence base still needs to be established. This study leads us one step closer to understanding the value of peer-led services for our most recent generation of veterans." Cheney sees the process of engagement described in the paper as an ideal way to engage members of at-risk student groups and the community to build partnerships to develop peer-led services for students in need of supportive services. She was joined in the research by co-lead Justin Hunt and several researchers in Arkansas: Tracy H. Abraham, Angie Waliski, Shane Russell, and Cliff Hudson, at the Central Arkansas Veterans Healthcare System, North Little Rock; Steve Sullivan, Dianne Swaim, and Caleb Lewis at the Central Arkansas Veterans Healthcare System Chaplain Services, North Little Rock; and Brian Candler and Sonya Hall at the VA/Student Partnership for Rural Veterans Community Partner. The study, initiated in 2013, was supported by the VA Office of Rural Health and the South Central VA Mental Illness Research Education and Clinical Center. A medical anthropologist with research experience in mental health and substance use health services, Cheney researches health disparities in underserved, primarily rural, populations, including women, veterans, ethnic and racial minorities, and immigrants. At the time of the study, she was an assistant professor of psychiatry in the Division of Health Services Research at the University of Arkansas for Medical Sciences, and a research health scientist in Health Services Research and Development at the Central Arkansas Veterans Healthcare System. The University of California, Riverside is a doctoral research university, a living laboratory for groundbreaking exploration of issues critical to Inland Southern California, the state and communities around the world. Reflecting California's diverse culture, UCR's enrollment is now nearly 23,000 students. The campus opened a medical school in 2013 and has reached the heart of the Coachella Valley by way of the UCR Palm Desert Center. The campus has an annual statewide economic impact of more than $1 billion. A broadcast studio with fiber cable to the AT&T Hollywood hub is available for live or taped interviews. UCR also has ISDN for radio interviews. To learn more, call (951) UCR-NEWS.