Exploring the Barriers and Facilitators Experienced by Palliative Health Care Providers Working with Patients Experiencing Homelessness during the COVID-19 Pandemic.

Background: Patients experiencing homelessness not only have higher rates of medical complexity, comorbidity, and mortality, but also face barriers to accessing palliative care services. In structurally vulnerable populations with palliative care needs, these barriers are compounded, creating significant challenges for both patients and providers that have important health equity implications. Objective: The aim is to explore the experiences of palliative care providers working with patients experiencing homelessness during the COVID-19 pandemic and understand the barriers they faced in providing care, as well as facilitators that aided in the success of their teams. Methods: Seven health care providers from two Canadian palliative outreach teams involved in delivering palliative care services to patients experiencing homelessness during the COVID-19 pandemic participated in audio-recorded and transcribed videoconferencing interviews. Analysis was completed using generic descriptive thematic analysis. Results: Five key themes were identified: (1) factors negatively impacting patient health, (2) use of technology, (3) care provider emotions, (4) care provider education and advocacy, and (5) outreach team factors. Conclusion: Identified barriers during the pandemic included worsening of existing patient vulnerabilities, as well as challenges incorporating technology into care. Providers faced increased emotional burden, with a rise in workload, stress, fear, and grief. However, several facilitators allowed teams to provide high-quality care to this vulnerable population, including team support, interprofessional collaboration, and advocacy and education initiatives. The outreach model also proved to be a highly flexible, resilient, and adaptable model for providing care during the COVID-19 pandemic.

Pathways of the inferior frontal occipital fasciculus in overt speech and reading.

In this study, we examined the relationship between tractography-based measures of white matter integrity (ex. fractional anisotropy [FA]) from diffusion tensor imaging (DTI) and five reading-related tasks, including rapid automatized naming (RAN) of letters, digits, and objects, and reading of real words and nonwords. Twenty university students with no reported history of reading difficulties were tested on all five tasks and their performance was correlated with diffusion measures extracted through DTI tractography. A secondary analysis using whole-brain Tract-Based Spatial Statistics (TBSS) was also used to find clusters showing significant negative correlations between reaction time and FA. Results showed a significant relationship between the left inferior fronto-occipital fasciculus FA and performance on the RAN of objects task, as well as a strong relationship to nonword reading, which suggests a role for this tract in slower, non-automatic and/or resource-demanding speech tasks. There were no significant relationships between FA and the faster, more automatic speech tasks (RAN of letters and digits, and real word reading). These findings provide evidence for the role of the inferior fronto-occipital fasciculus in tasks that are highly demanding of orthography-phonology translation (e.g., nonword reading) and semantic processing (e.g., RAN object). This demonstrates the importance of the inferior fronto-occipital fasciculus in basic naming and suggests that this tract may be a sensitive predictor of rapid naming performance within the typical population. We discuss the findings in the context of current models of reading and speech production to further characterize the white matter pathways associated with basic reading processes.

Investigating the ventral-lexical, dorsal-sublexical model of basic reading processes using diffusion tensor imaging.

Recent results from diffusion tensor imaging (DTI) studies provide evidence of a ventral-lexical stream and a dorsal-sublexical stream associated with reading processing. We investigated the relationship between behavioural reading speed for stimuli thought to rely on either the ventral-lexical, dorsal-sublexical, or both streams and white matter via fractional anisotropy (FA) and mean diffusivity (MD) using DTI tractography. Participants (N = 32) overtly named exception words (e.g., 'one', ventral-lexical), regular words (e.g., 'won', both streams), nonwords ('wum', dorsal-sublexical) and pseudohomophones ('wun', dorsal-sublexical) in a behavioural lab. Each participant then underwent a brain scan that included a 30-directional DTI sequence. Tractography was used to extract FA and MD values from four tracts of interest: inferior longitudinal fasciculus, uncinate fasciculus, arcuate fasciculus, and inferior fronto-occipital fasciculus. Median reaction times (RTs) for reading exception words and regular words both showed a significant correlation with the FA of the uncinate fasciculus thought to underlie the ventral processing stream, such that response time decreased as FA increased. In addition, RT for exception and regular words showed a relationship with MD of the uncinate fasciculus, such that response time increased as MD increased. Multiple regression analyses revealed that exception word RT accounted for unique variability in FA of the uncinate over and above regular words. There were no robust relationships found between pseudohomophones, or nonwords, and tracts thought to underlie the dorsal processing stream. These results support the notion that word recognition, in general, and exception word reading in particular, rely on ventral-lexical brain regions.