To understand existing care practices and policies, and potential enhancements, to improve the effectiveness of the US Department of Veterans Affairs (VA) Supportive Services for Veteran Families ...(SSVF) Health Care Navigators (HCN) in linking Veterans experiencing housing instability in rural areas with health care services.
We used primary data collected during semistructured interviews with HCNs (n = 21) serving rural areas across the United States during Spring 2022.
We applied the Consolidated Framework for Implementation Research (CFIR) 2009 and the Social Ecological Model (SEM) to the collection and analysis of qualitative data to understand how HCNs administer services within SSVF and the larger community.
We used rapid qualitative methods to summarize and analyze data. Templated matrix summaries identified facilitators and barriers to linking Veterans with health care services and policy and practice implications.
Using CFIR 2009, we identified contextual factors affecting successful implementation of HCN services within SSVF; we offer a crosswalk between CFIR 2009 and the version updated in 2022. Framing facilitators and barriers within the SEM provided insight into whether implementation strategies should be addressed at a community, interpersonal, or intrapersonal level within the SEM. Facilitators included sufficient knowledge, training, and mentorship opportunities for HCNs and their capacity to collaborate within their organization and with other community-based organizations. Barriers included lack of local technology and housing resources, inadequate understanding of Veterans' service eligibilities and pathways to access those services, and deficient collaboration with the VA.
Understanding facilitators and barriers experienced by HCN when linking unstably housed Veterans in rural areas with health care services can inform future strategies, including policy changes such as increased training to support HCNs' understanding of eligibility, benefits, and entitlements as well as improving communication and collaboration between VA and community partners.
Suicide prevention is a top clinical priority within the Department of Veterans Affairs (VA). While research consistently shows that suicide risk is associated with adverse social determinants of ...health (SDH, e.g., housing instability, unemployment, justice involvement), less is known about the extent to which suicide prevention staff are aware of and able to address these risk factors. This study aimed to understand the experiences of VA Suicide Prevention Coordinators (SPCs) with referring Veterans at risk of suicide to services that address SDH.
In January–February 2022, 171 VA SPCs completed a questionnaire about their experiences connecting Veterans with SDH-focused services. Descriptive statistics summarized closed-response items and a thematic analysis was conducted for open-ended responses.
The majority of SPCs agreed that adverse SDH contribute to suicide risk and that services to address SDH could reduce suicide risk for Veterans. While most SPCs were aware of on-site SDH services, many reported barriers to connecting Veterans with those services including insufficient resources, lack of staff time, and eligibility criteria.
Changes at the organizational and policy levels are needed to provide comprehensive suicide prevention services that connect at-risk Veteran with services to address adverse SDH.
Veterans in rural areas of the United States face barriers to accessing healthcare and other services, which are intensified for those experiencing housing instability. Recent legislative acts have ...the potential to address obstacles faced by rural patients in the U.S. This study explores how infrastructure—including features related to the physical and digital environment—impacts the ability of rural Veterans experiencing housing instability to access healthcare and related services from the perspective of homeless service providers within the Veterans Health Administration (VHA). We conducted semi‐structured telephone interviews (n = 22) with providers in high/low performing and/or resourced communities across the U.S. in May and June 2021 and analysed transcripts using template analysis. Themes described by providers highlight how infrastructure limitations in rural areas can exacerbate health disparities for Veterans experiencing housing instability, the impact of COVID‐19 on service access, and recommendations to enhance service delivery. Providers suggested that VHA reconfigure where and how staff work, identify additional resources for transportation and/or alternative transportation models, and increase Veterans' access to technology and broadband Internet. Federal infrastructure investments should address challenges faced by Veterans experiencing housing instability in rural areas and the concerns of providers connecting them with care.
Objective
To characterize ocular motor function in patients with Niemann‐Pick disease type C (NPC).
Methods
In a multicontinental, cross‐sectional study we characterized ocular‐motor function in 72 ...patients from 12 countries by video‐oculography. Interlinking with disease severity, we also searched for ocular motor biomarkers. Our study protocol comprised reflexive and self‐paced saccades, smooth pursuit, and gaze‐holding in horizontal and vertical planes. Data were compared with those of 158 healthy controls (HC).
Results
Some 98.2% of patients generated vertical saccades below the 95% CI of the controls’ peak velocity. Only 46.9% of patients had smooth pursuit gain lower than that of 95% CI of HC. The involvement in both downward and upward directions was similar (51°/s (68.9, 32.7–69.3) downward versus 78.8°/s (65.9, 60.8–96.8) upward). Horizontal saccadic peak velocity and latency, vertical saccadic duration and amplitude, and horizontal position smooth pursuit correlated best to disease severity. Compensating strategies such as blinks to elicit saccades, and head and upper body movements to overcome the gaze palsy, were observed. Vertical reflexive saccades were more impaired and slower than self‐paced ones. Gaze‐holding was normal. Ocular‐motor performance depended on the age of onset and disease duration.
Conclusions
This is the largest cohort of NPC patients investigated for ocular‐motor function. Vertical supranuclear saccade palsy is the hallmark of NPC. Vertical upward and downward saccades are equally impaired. Horizontal saccadic peak velocity and latency, vertical saccadic duration and amplitude, and horizontal position smooth pursuit can be used as surrogate parameters for clinical trials. Compensating strategies can contribute to establishing a diagnosis.
In this largest cohort of patients with Niemann‐Pick type C disease examined so far, we found that vertical supranuclear saccade (VSSP), and not gaze palsy (VSGP), is the hallmark of this disease. We also identify the surrogate biomarkers that can be used in clinical trials to track the disease progress and treatment effect.
We previously demonstrated that boiling of hop essential oil in water transforms sesquiterpene hydrocarbons into oxidation products (oxygenated sesquiterpenoids), which impart typical spicy/woody ...scents associated with "kettle hop" aroma when added to beer. In this study, boiling experiments in water as well as in wort with increasing hop oil (cv. Saaz) concentrations and subsequent headspace solid-phase microextraction GC-MS analysis revealed a positive correlation between the initial added hop oil concentration and formation of oxygenated sesquiterpenoids. Intervarietal differences were investigated by comprehensive GC-MS fingerprinting of hop-derived volatiles in unboiled and boiled hop essential oils (cv. Hallertau Magnum, Hallertau Tradition, Hallertau Perle, and Saaz) in wort. Unboiled essential oils of European aroma hops were shown to contain significantly higher levels of α-humulene, β-caryophyllene, and sesquiterpene oxidation products compared with cv. Hallertau Magnum. However, changes in the volatile profile upon boiling in wort appeared largely variety independent (i.e., chemically identical α-humulene and β-caryophyllene derivatives were formed). GC-olfactometry further showed that some of these derivatives formed upon boiling (i.e., 6(5→4)-abeo-caryophyll-8(13)-en-5-al, caryophyllene oxide, humulene epoxide III, humulenol II, caryophylla-4(12),8(13)-diene-5α/β-ol, 3Z-caryophylla3,8(13)-diene-5α/β-ol, and 14-hydroxy-β-caryophyllene) eluted in flavoractive zones.
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