Whole Health coaching to rural Veterans through telehealth: Advantages, gaps, and opportunities

BackgroundThe Veterans Health Administration (VHA) is one of the largest providers of telehealth in the United States and continues to lead the way in transforming healthcare services. VHA has been implementing its Whole Health (WH) initiative since 2018, a proactive practice empowering patients to take charge of their health and well-being. A key facilitator of the WH initiative is the WH coach who partners with Veterans to achieve their health-related goals. A gap exists in the literature regarding the understanding of WH coaches’ use of telehealth to engage rural-residing Veterans. COVID-19 unexpectedly interrupted in-person VHA delivery of care, including WH coaching which primarily relied on in-person delivery and focused less on telehealth. During the pandemic, WH coaches had to adapt and integrate different modalities to engage their Veteran patients. We examined WH coaches’ approaches to extending coaching to rural Veterans via technology, emphasizing the advantages of telehealth, existing gaps in telehealth delivery, and opportunities for telehealth as a coaching modality.MethodsThis project was implemented as part of a larger mixed methods evaluation regarding WH coaching for rural Veterans; this manuscript presents the findings from the qualitative data from the larger study. The qualitative dataset is comprised of data collected using three different qualitative methods: four focus groups (n = 11; 3–4 participants per group), in-depth individual interviews (n = 9), and open-ended responses from a national web-based survey (n = 140). Focus group, in-depth interview, and open-ended survey data were collected sequentially and separately analyzed following each wave of data collection. Findings from the three analyses were then collaboratively merged, compared, reorganized, and refined by the evaluation team to create final themes.ResultsThree final themes that emerged from the merged data were: (1) Advantages of Telehealth; (2) Telehealth Gaps for Rural Veterans, and (3) Strategies for Bridging Telehealth Gaps. Themes explicate telehealth advantages, gaps, and opportunities for rural Veteran WH coaching.ConclusionFindings highlight that video telehealth alone is not sufficient for meeting the needs of rural Veterans. Digital technologies hold promise for equalizing health access gaps; however, both human factors and broadband infrastructure constraints continue to require WH coaches to use a mix of modalities in working with rural Veterans. To overcome challenges and bridge gaps, WH coaches should be ready to adopt a blended approach that integrates virtual, in-person, and lower-tech options

A dualistic model of primary anal canal adenocarcinoma with distinct cellular origins, etiologies, inflammatory microenvironments and mutational signatures: implications for personalised medicine.

Primary adenocarcinoma of the anal canal is a rare and aggressive gastrointestinal disease with unclear pathogenesis. Because of its rarity, no clear clinical practice guideline has been defined and a targeted therapeutic armamentarium has yet to be developed. The present article aimed at addressing this information gap by in-depth characterising the anal glandular neoplasms at the histologic, immunologic, genomic and epidemiologic levels. In this multi-institutional study, we first examined the histological features displayed by each collected tumour (n = 74) and analysed their etiological relationship with human papillomavirus (HPV) infection. The intratumoural immune cell subsets (CD4, CD8, Foxp3), the expression of immune checkpoints (PD-1, PD-L1), the defect in mismatch repair proteins and the mutation analysis of multiple clinically relevant genes in the gastrointestinal cancer setting were also determined. Finally, the prognostic significance of each clinicopathological variable was assessed. Phenotypic analysis revealed two region-specific subtypes of anal canal adenocarcinoma. The significant differences in the HPV status, density of tumour-infiltrating lymphocytes, expression of immune checkpoints and mutational profile of several targetable genes further supported the separation of these latter neoplasms into two distinct entities. Importantly, anal gland/transitional-type cancers, which poorly respond to standard treatments, displayed less mutations in downstream effectors of the EGFR signalling pathway (i.e., KRAS and NRAS) and demonstrated a significantly higher expression of the immune inhibitory ligand-receptor pair PD-1/PD-L1 compared to their counterparts arising from the colorectal mucosa. Taken together, the findings reported in the present article reveal, for the first time, that glandular neoplasms of the anal canal arise by HPV-dependent or independent pathways. These etiological differences leads to both individual immune profiles and mutational landscapes that can be targeted for therapeutic benefits

Direct mass spectrometry analysis for the understanding of polymers degradation

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Direct characterization of polyurethanes and additives by atmospheric solid analysis probe with time-of-flight mass spectrometry (ASAP-TOF-MS)

International audienceBecause of the wide range of formulations, polyurethanes (PURs) are among the most used copolymers. According to their applications, the nature and concentration of the monomers, as well as the additives, are adjusted. As copolymer, this material is difficult to characterize directly by mass spectrometry without sample pretreatment. In this work, atmospheric solid analysis probe mass spectrometry (ASAP-MS) is used to characterize model and commercial PURs with different formulations. Application of a temperature gradient over the ASAP probe allows a soft vaporization of all sample components: additives are detected at lower gas temperature, whereas the polymer is detected at higher gas temperature. Thus, a temporal separation of the molecules as a function of their volatilization and/or degradation temperature is observed. The vaporized products are identified by ASAP thanks to pyrolysis, but also by low energy source fragmentation observed during the analysis. Thus, complete analysis of PURs with only a single time-of-flight (TOF) mass analyzer is realized. The ability of ASAP-MS for differentiation of different chemical structures of PURs (polyester and polyether based PURs) is demonstrated; the main advantage of this technique being that the analysis is performed in one step, directly on the crude polymer

Modification chimique par introduction sélective de charge Tag pour la quantification des protéines par désorption MALDI en spectrométrie de masse à temps de vol

Une nouvelle méthode de quantification de protéines cibles par spectrométrie de masse MALDI/TOF a été mise au point.Le but est de quantifier une protéine isolée sur une puce à protéines. Cinq dérivés d esters de N-hydroxysucinimides appelés Charge Tag ont été synthétisés. Des expériences PSD-MALDI-TOF/TOF montrent que ceux-ci modifient la fonction N-terminale des protéines et la fonction amine primaire de la chaîne latérale des résidus lysines. Lors de leur dissociation le site préchargé préserve sa charge, donnant la série y ou b selon que le Charge Tag est localisé du côté N ou C-terminal. Dans un deuxième temps, l impact de la modification chimique sur la structure tridimensionnelle de la protéine a été étudié. Celle-ci ne modifie que les sites les plus accessibles, sans accéder au cœur de la protéine. Ainsi la reconnaissance des protéines modifiées par leur anticorps sur la puce à protéines est possible. Enfin, la quantification relative et absolue de protéines entières isolées ou incluses dans un protéome complexe, le sérum humain a été montrée.PARIS-BIUSJ-Thèses (751052125) / SudocPARIS-BIUSJ-Physique recherche (751052113) / SudocSudocFranceF

Direct analysis of ethylenediaminetetraacetic acid (EDTA) on concrete by reactive-desorption electrospray ionization mass spectrometry

International audienceAnalysis of organic ligands such as ethylene diamine tetraacetic acid (EDTA) is today an important challenge due to their ability to increase the mobility of radionuclides and metals. Reactive desorption electrospray ionization mass spectrometry (reactive-DESI-MS) was used for direct analysis of EDTA on concrete samples. EDTA forms complexes and those with FeIII ions are among the most thermodynamically favored. This complexing capacity was used to improve the specific detection of EDTA directly on a concrete matrix by doping the solvent spray of DESI with a solution of FeCl3 to selectively create the complex between EDTA and FeIII. Thus, EDTA sensitivity was largely improved by two orders of magnitude with reactive-DESI-MS experiments thanks to the specific detection of EDTA as a [EDTA-4HþFeIII] complex. The proof of principle that reactive DESI can be applied to concrete samples to detect EDTA has been demonstrated. Its capacity for semi-quantitative determination and localization of EDTA under ambient conditions and with very little sample preparation, minimizing sample manipulations and solvent volumes, two important conditions for the development of new methodologies in the field of analytical chemistry, has been shown