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Background & Aims Regular screening with colonoscopy lowers colorectal cancer incidence and mortality. We aimed to determine patterns of repeat and surveillance colonoscopy and identify factors associated with over- and underuse of colonoscopy. Methods We analyzed data from participants in a previous Veterans Health Administration (VHA) study who underwent outpatient colonoscopy at 25 VHA facilities between October 2007 and September 2008 (n=1455). The proportion of patients who received a follow-up colonoscopy was calculated for 3 risk groups, defined based on the index colonoscopy: no adenoma, low-risk adenoma, or high-risk adenoma. Results Colonoscopy was overused (used more frequently than intervals recommended by guidelines) by 16% of patients with no adenomas, 26% with low-risk adenomas, and 29% with high-risk adenomas. Most patients with high-risk adenomas (54%) underwent colonoscopy after the recommended interval or did not undergo colonoscopy. Patients who received a follow-up recommendation that was discordant with guidelines were more likely to undergo colonoscopy too early (no adenoma odds ratio [OR], 3.80; 95% CI, 2.31–6.25 and low-risk adenoma OR, 5.28; 95% CI, 1.88–14.83). Receipt of colonoscopy at non-academic facilities was associated with overuse among patients without adenomas (OR, 5.26; 95% CI, 1.96–14.29) or with low-risk adenomas (OR, 3.45; 95% CI, 1.52–7.69). Performance of colonoscopies by general surgeons vs gastroenterologists (OR, 2.08; 95% CI, 1.02–4.23) and female sex of the patient (OR, 3.28; 95% CI, 1.06–10.16) were associated with overuse of colonoscopy for patients with low-risk adenomas. No factors examined were associated with underuse of colonoscopy among patients with high-risk adenomas. Conclusions In an analysis of patients in the VHA system, more than a quarter of patients with low-risk adenomas received a follow-up colonoscopies too early, whereas more than half of those with high-risk adenomas did not undergo surveillance colonoscopy as recommended. Our findings highlight the need for system-level improvements to facilitate the appropriate delivery of colonoscopy based on individual risk.

Microphysics parameterization becomes increasingly important as the model grid spacing increases toward convection-resolving scales. The performance of several partially or fully two-moment (2M) schemes within the Weather Research and Forecasting (WRF) Model, version 3.5.1, chosen because of their well-documented advantages over one-moment (1M) schemes, is evaluated with respect to their ability in producing the well-known polarimetric radar signatures found within supercell storms. Such signatures include the ZDR and KDP columns, the ZDR arc, the midlevel ZDR and ρHV rings, the hail signature in the forward-flank downdraft, and the KDP foot. Polarimetric variables are computed from WRF Model output using a polarimetric radar simulator. It is found that microphysics schemes with a 1M rimed-ice category are unable to simulate the ZDR arc, despite containing a 2M rain category. It is also found that a hail-like rimed-ice category (in addition to graupel) may be necessary to reproduce the observed hail signature. For the microphysics schemes that only contain a graupel-like rimed-ice category, only very wet graupel particles are able to reach the lowest model level, which did not adequately reduce ZDR in this signature. The most realistic signatures overall are found with microphysics schemes that are fully 2M with a separate hail category.

Objective: The 1990-1991 Gulf War employed more women servicemembers than any prior conflict. Gender-based differences among veterans of this era have yet to be explored. This study is among the first and most recent to stratify Gulf War veteran demographics, lifestyle factors, and self-reported diagnoses by gender. Methods: Data from the cross-sectional Gulf War Era Cohort and Biorepository pilot study (n ¼ 1,318; collected between 2014 and 2016), including users and nonusers of the Veterans Health Administration, were used to calculate demographics and adjusted odds ratios. Results: Women veterans were oversampled and comprised approximately 23% of the sample. Women reported similar rates of Veterans Health Administration use (44%) and deployment (67%) as men (46% and 72%, respectively). Women were less likely than men to report frequent alcohol use (adjusted odds ratio [aOR], 0.59; 95% confidence interval [CI], 0.43-0.81; p ¼ .0009) or have a history of smoking (aOR, 0.65; 95% CI, 0.49-0.84; p ¼ .0014). Among common health conditions, women were more likely than men to report a diagnosis of osteoporosis (