Abstract-To identify the prevalence of traumatic brain injury (TBI), posttraumatic stress disorder (PTSD), and pain in Veterans from Operation Iraqi Freedom/Operation Enduring Freedom/Operation New Dawn (OIF/OEF/OND), Veterans who received any inpatient or outpatient care from Veterans Health Administration (VHA) facilities from 2009 to 2011 were studied. A subset of Veterans was identified who were diagnosed with TBI, PTSD, and/or pain (head, neck, or back) as determined by their International Classification of Diseases-9th Revision-Clinical Modification codes. Between fiscal years 2009 and 2011, 613,391 Veterans accessed VHA services at least once (age: 31.9 +/-9.6 yr). TBI diagnosis in any 1 year was slightly less than 7%. When data from 3 years were pooled, 9.6% were diagnosed with TBI, 29.3% were diagnosed with PTSD, and 40.2% were diagnosed with pain. The full polytrauma triad expression (TBI, PTSD, and pain) was diagnosed in 6.0%. Results show that increasing numbers of Veterans from OIF/ OEF/OND accessed VHA over a 3 year period. Among those with a TBI diagnosis, the majority also had a mental health disorder, with approximately half having both PTSD and pain. While the absolute number of Veterans increased by over 40% from 2009 to 2011, the proportion of Veterans diagnosed with TBI and the high rate of comorbid PTSD and pain in this population remained relatively stable.

A distributive justice framework is used to examine how individuals make judgments about what is fair when making different types of health‐care allocation decisions. The effects of 4 patient characteristics are assessed: (a) prognosis, (b) degree of responsibility for illness, (c) employment status, and (d) race. Results reveal that when the patient was defined as being more versus less responsible for his illness, respondents gave him a significantly lower priority score for obtaining health‐care services, and they felt that he should be more responsible for paying for or soliciting funds to cover the costs of his health needs. Respondents also reacted with more negative emotion to the responsible patient and described him in more negative trait terms. Although patient's race produced no main effects, race did interact with employment status on several key variables. When the patient was described as being unemployed, the White patient compared to the Black patient was given a higher health‐care priority score, he was resented less, and respondents were more willing to contribute money to pay for his health‐care costs; but when the patient was described as being employed, the direction of differences between the races on these variables was reversed.

AIMTo reduce readmissions and improve patient outcomes in cirrhotic patients through better understanding of readmission predictors.METHODSWe performed a single-center retrospective study of patients admitted with decompensated cirrhosis from January 1, 2011 to December 31, 2013 (n = 222). Primary outcomes were time to first readmission and 30-d readmission rate due to complications of cirrhosis. Clinical and demographic data were collected to help describe predictors of readmission, along with care coordination measures such as post-discharge status and outpatient follow-up. Univariate and multivariate analyses were performed to describe variables associated with readmission.RESULTSOne hundred thirty-two patients (59.4%) were readmitted at least once during the study period. Median time to first and second readmissions were 54 and 93 d, respectively. Thirty and 90-d readmission rates were 20.7 and 30.1 percent, respectively. Predictors of 30-d readmission included education level, hepatic encephalopathy at index, ALT more than upper normal limit and Medicare coverage. There were no statistically significant differences in readmission rates when stratified by discharge disposition, outpatient follow-up provider or time to first outpatient visit.CONCLUSIONReadmissions are challenging aspect of care for cirrhotic patients and risk continues beyond 30 d. More initiatives are needed to develop enhanced, longitudinal post-discharge systems.

Background and aim Deploy and evaluate a gastroenterology (GI) electronic consultation (e-consult) program. E-consults are a promising approach to enhance provider communication, facilitate timely specialty advice and may replace some outpatient visits. Study As part of our health system's efforts to provide more cost-effective care under risk-based contracts, we implemented an e-consult program where referring providers submit patient-specific clinical questions electronically via an electronic referral system. A GI consultant then reviews the patient's record and provides a written recommendation back to the referring physician. For our program evaluation, we conducted chart reviews of each e-consult to understand how the program was being used and surveyed the participating providers and consultants. Results From September 2015 to March 2016, we received 144 e-consults, with most questions concerning GI symptoms or abnormal hepatology labs. Only 36% of e-consults recommended an in-person GI consult or procedure. In our survey of participating providers, referring providers strongly agreed that the GI e-consults promoted good patient care (88%) and were satisfied with the program (84%). The majority of GI consultants felt strongly that e-consults were useful for referring providers and their patients, but that current reimbursement and time allotted were not adequate. Conclusions We report on the implementation of a GI e-consult program within an ACO, showing that many clinical questions could be answered using this mechanism. E-consults in gastroenterology have the potential to reduce unnecessary visits and/or procedures for patients who can be managed by their primary provider, potentially increasing access for other patients.

Background: Factors associated with interval colorectal cancer (CRC) development in the inflammatory bowel disease (IBD) population remain unclear.

This study examined morphological processing of inflected and derived words by children in Grades 4, 6, and 8. Participants were shown root forms and inflected, derived, and orthographic control items (e.g., harm, harmed, harmful, or harmony), followed by a fragment completion task (e.g., completing h a_ _). Participants were equally likely to complete the fragment with the target root (e.g., harm for h a_ _) following priming with inflected or derived forms. This reflected a morphological effect; priming scores were higher for the inflected and derived forms than for orthographic counterparts. These effects were consistent across the grades studied, suggesting that morphological processing of inflected and derived words has a similar time course across Grades 4, 6, and 8.One lively area of research on the mental lexicon in both adults and children concerns the processing of words that contain several morphemes, or the smallest meaningful units of language. For developmental research, there is a particularly active line of investigation examining development in two key types of morphologically complex words: inflected and derived words. Inflected words contain an affix that specifies features such as case, tense, gender, or number but does not affect the syntactic category of the word (e.g., the addition of the suffix -s to the root read to mark the present tense in reads). In contrast, derived words have an affix that generally changes the syntactic category of the word (e.g., the addition of the suffix -er to the root verb read to form the noun reader). As we will see in the literature review that follows, there is a long history of research in the domain of oral language suggesting that there is particular growth in knowledge of derived forms in late childhood and into adolescence. The present study investigated this question through the use of a priming paradigm tapping awareness of the common root within inflected and derived words.

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