Sex and Relationships: The Role of Learning Disability Support Staff

Sex and relationships with regards to people with learning disabilities is an important area of research for two overarching reasons; the promotion of social equality for people with learning disabilities, and to promote safety. Many people with learning disabilities have the support of paid staff to enable them to live independent lives. Support-staff’s attitudes and opinions towards sex and relationships can have an impact on the type of support they provide. This study sought to explore what informs support-staff understanding of their role with regards to provision of support around sex and relationships, how learning disability support-staff conceptualise their role with regards to providing this support, and what conflicts arise as a result of their adopted role. The study employed a qualitative design, using semi-structured interviews with a sample of 11 support-staff from across South East England. A critical realist epistemology was adopted and a thematic analysis used to analyse the data. Three overarching themes emerged; ‘Definition of support work’, ‘Moral and value judgement’, and ‘Enablement and empowerment’. Support-staff discussed the changing nature of the support-staff role and how understanding of the overall support-staff role impacts on the type of provision towards sex and relationships. Support-staff identified the personal and value laden nature of decisions around sex and relationships, drawing on societal norms, family values and legislation to inform their role. Support-staff demonstrated a willingness to support people with learning disabilities with regards to sex and relationships and identified ways in which they could be enabled and empowered to do so such as organisational changes, clear guidance and support from external professionals. The findings have implications for clinical change in organisations and cross professional working in this area. Further research could take a more action focused approach to enable and empower support-staff in the arena of sex and relationships

Cannabinoids in the treatment of epilepsy: current status and future prospects

Cannabidiol (CBD) is one of the prominent phytocannabinoids found in Cannabis sativa, differentiating from Δ9-tetrahydrocannabinol (THC) for its non-intoxicating profile and its antianxiety/antipsychotic effects. CBD is a multi-target drug whose anti-convulsant properties are supposed to be independent of endocannabinoid receptor CB1 and might be related to several underlying mechanisms, such as antagonism on the orphan GPR55 receptor, regulation of adenosine tone, activation of 5HT1A receptors and modulation of calcium intracellular levels. CBD is a lipophilic compound with low oral bioavailability (6%) due to poor intestinal absorption and high first-pass metabolism. Its exposure parameters are greatly influenced by feeding status (ie, high fatcontaining meals). It is mainly metabolized by cytochrome P 450 (CYP) 3A4 and 2C19, which it strongly inhibits. A proprietary formulation of highly purified, plant-derived CBD has been recently licensed as an adjunctive treatment for Dravet syndrome (DS) and Lennox-Gastaut syndrome (LGS), while it is being currently investigated in tuberous sclerosis complex. The regulatory agencies’ approval was granted based on four pivotal double-blind, placebocontrolled, randomized clinical trials (RCTs) on overall 154 DS patients and 396 LGS ones, receiving CBD 10 or 20 mg/kg/day BID as active treatment. The primary endpoint (reduction in monthly seizure frequency) was met by both CBD doses. Most patients reported adverse events (AEs), generally from mild to moderate and transient, which mainly consisted of somnolence, sedation, decreased appetite, diarrhea and elevation in aminotransferase levels, the last being documented only in subjects on concomitant valproate therapy. The interaction between CBD and clobazam, likely due to CYP2C19 inhibition, might contribute to some AEs, especially somnolence, but also to CBD clinical effectiveness. Cannabidivarin (CBDV), the propyl analogue of CBD, showed anti-convulsant properties in pre-clinical studies, but a plant-derived, purified proprietary formulation of CBDV recently failed the Phase II RCT in patients with uncontrolled focal seizures

The role of working memory and verbal fluency in autobiographical memory in early Alzheimer’s disease and matched controls

Retrieval of autobiographical memories (AMs) is important for “sense of self”. Previous research and theoretical accounts suggest that working memory (WM) and semantic and phonemic fluency abilities facilitate the hierarchical search for, and reliving of past, personal events in the mind’s eye. However, there remains a lack of consensus as to the nature of the relationships between these cognitive functions and the truly episodic aspects of AM. The present study therefore aimed to explore the associations between these variables in a sample with a wide range of cognitive abilities. The study incorporated a between-groups component, and a correlational component with multiple regression. Participants with Alzheimer’s disease (n = 10) and matched healthy controls (n = 10) were assessed on measures of semantic and episodic AM search and retrieval, auditory and spatial WM, and semantic and phonemic fluency. The AD group produced less episodic AM content compared to controls. Semantic fluency predicted episodic AM retrieval independent of age effects but there were no significant relationships between measures of phonemic fluency, WM and episodic AM. The results suggest that the ability to maintain hierarchical search of the semantic knowledge-base is important for truly episodic reliving, and interventions for people with AM impairment might therefore benefit from incorporating structured, individualised external memory-aids to facilitate AM search and retrieval

The twist-bend nematic phase: translational self-diffusion and biaxiality studied by 1H nuclear magnetic resonance diffusometry

Recently, there has been a surge of interest in mesogens exhibiting the twist-bend nematic (NTB) phase that is shown to be chiral even though formed by effectively achiral molecules. Although it now seems to be clear that the NTB phase in the bulk is formed by degenerate domains having opposite handedness, the presence of a supramolecular heliconical structure proposed in the Dozov model has been contradicted by the Hoffmann et al. model in which the heliconical arrangement is replaced by a polar nematic phase. The evidence in support of this is that the quadrupolar splitting tensor measured in various experiments is uniaxial and not biaxial as expected for the twist-bend nematic structure. In this debate, among other evidence, the molecular translational diffusion, and its magnitude with respect to that in the nematic phase above the NTB phase, has also been invoked to eliminate or to confirm one model or the other. We attempt to resolve this issue by reporting the first measurements of the translational self-diffusion coefficients in the nematic and twist-bend nematic phases formed 1″,7″-bis-4-(4′-cyanobiphenyl-4′-yl) heptane (CB7CB). Such measurements certainly appear to resolve the differences between the two models in favour of that for the classic twist-bend nematic phase

Membranes and synaptosomes used to investigate synaptic GABAergic currents in epileptic patients

Among the most prevalent neurological disorders, epilepsy affects about 1% of the population worldwide. We previously found, using human epileptic tissues, that GABAergic neurotransmission impairment is a key mechanism that drives the pathological phenomena that ultimately lead to generation and recurrence of seizures. Using both a "microtransplantation technique" and synaptosomes preparations from drug-resistant temporal lobe epilepsies (TLEs), we used the technique of two-electrode voltage clamp to record GABA-evoked currents, focusing selectively on the synaptic "fast inhibition" mediated by low-affinity GABA(A) receptors. Here, we report that the use-dependent GABA current desensitization (i.e., GABA rundown, which is evoked by applying to the cells consecutive pulses of GABA, at high concentration), which is a distinguishing mark of TLE, is mainly dependent on a dysfunction that affects synaptic GABA(A) receptors. In addition, using the same approaches, we recorded a depolarized GABA reversal potential in synaptosomes samples from the human epileptic subicula of TLE patients. These results, which confirm previous experiments using total membranes, suggest an altered chloride homeostasis in the synaptic area. Finally, the lack of a Zn2+ block of GABA-evoked currents using the synaptosomes supports the enrichment of "synaptic fast inhibitory" GABA(A) receptors in this preparation. Altogether, our findings suggest a pathophysiological role of low-affinity GABA(A) receptors at the synapse, especially during the fast and repetitive GABA release underlying recurrent seizures

Agnosia for accents in primary progressive aphasia.

As an example of complex auditory signal processing, the analysis of accented speech is potentially vulnerable in the progressive aphasias. However, the brain basis of accent processing and the effects of neurodegenerative disease on this processing are not well understood. Here we undertook a detailed neuropsychological study of a patient, AA with progressive nonfluent aphasia, in whom agnosia for accents was a prominent clinical feature. We designed a battery to assess AA's ability to process accents in relation to other complex auditory signals. AA's performance was compared with a cohort of 12 healthy age and gender matched control participants and with a second patient, PA, who had semantic dementia with phonagnosia and prosopagnosia but no reported difficulties with accent processing. Relative to healthy controls, the patients showed distinct profiles of accent agnosia. AA showed markedly impaired ability to distinguish change in an individual's accent despite being able to discriminate phonemes and voices (apperceptive accent agnosia); and in addition, a severe deficit of accent identification. In contrast, PA was able to perceive changes in accents, phonemes and voices normally, but showed a relatively mild deficit of accent identification (associative accent agnosia). Both patients showed deficits of voice and environmental sound identification, however PA showed an additional deficit of face identification whereas AA was able to identify (though not name) faces normally. These profiles suggest that AA has conjoint (or interacting) deficits involving both apperceptive and semantic processing of accents, while PA has a primary semantic (associative) deficit affecting accents along with other kinds of auditory objects and extending beyond the auditory modality. Brain MRI revealed left peri-Sylvian atrophy in case AA and relatively focal asymmetric (predominantly right sided) temporal lobe atrophy in case PA. These cases provide further evidence for the fractionation of brain mechanisms for complex sound analysis, and for the stratification of progressive aphasia syndromes according to the signature of nonverbal auditory deficits they produce

Geologic map, volcanic stratigraphy and structure of the Cabo de Gata volcanic zone, Betic-Rif orogen, SE Spain

The geologic map of the Neogene Cabo de Gata volcanic zone is presented together with a comprehensive volcanic stratigraphy and structure based on logging, correlation and mapping. Volcanic rocks are interbedded with sedimentary rocks throughout the Cabo de Gata volcanic zone. The volcano-sedimentary succession of Cabo de Gata has been divided into formations according to lithology, age, composition and stratigraphic position. The contacts between sedimentary units and volcanic units and between formations are unconformities. Sedimentary units were deposited during periods of volcanic repose. The depositional environment of volcanism in Cabo de Gata is characterized as shallow-water submarine to emergent based on lithofacies of volcanic rocks and on fossil content and sedimentary structures of sedimentary rocks. The eruptive style in Cabo de Gata is dominantly effusive, although small-volume explosive eruptions due to magma-water interaction processes and to explosions of lava flow and domes complexes occurred.Peer Reviewe

An integrated structural and magnetic fabric study to constrain the progressive extensional tectonics of the Rio do Peixe Basin, Brazil

We constrained the tectonic evolution of the intracratonic Cretaceous Rio do Peixe Basin (RPB) in NE Brazil, combining structural and Anisotropy of Magnetic Susceptibility (AMS) data. We analyzed the structural features of four sites along two major faults bordering the basin, the NE-striking Portalegre Fault and the E-W-striking Malta Fault. AMS data from 42 sites in the syn-rift sandstone suggest two stretching directions driving the opening of the RPB. The early syn-rift phase I resulted from N-S to NNE-SSW stretching direction with vertical sigma 1, producing normal fault displacement along the E-W-striking Malta Fault and right-lateral transtension along the NE-striking Portalegre Fault, Sitio Sagui and Lagoa do Forno faults. The syn-rift phase II resulted from NW-SE stretching direction with vertical sigma 1, causing normal displacement on NE-striking major faults and left-lateral transtension on E-W-striking major faults. Additionally, the NW-SE extension was responsible for forming NE-striking extensional faults and deformation bands in sedimentary units. The RPB developed due to the intraplate deformation of the Borborema Province during the early stage of the Pangea Breakup and recorded two stretching directions that gradually shifted from NNE-SSW to NW-SE as a consequence of the South America clockwise rotation. The extensional stress orthogonal to the main E-W-striking and NE-striking Precambrian shear zones facilitated the opening and evolution of the RPB