Neuromodulation Using Primed Paired Associative Stimulation

University of Minnesota Ph.D. dissertation. October 2017. Major: Rehabilitation Science. Advisor: James Carey. 1 computer file (PDF); xi, 162 pages.Purpose: Neuroplasticity governs mechanisms of cortical reorganization, adaptation and recovery following neural injury. Paired associative stimulation (PAS) alters neuroplasticity by pairing peripheral nerve and cortical stimuli which induces spike-timing-dependent-like plasticity. Preceding a principal bout of PAS that intends to weight plasticity in one direction (e.g. facilitatory) with a priming bout of PAS that intends to weight plasticity in the opposite direction (e.g. suppressive) may deploy homeostatic synaptic mechanisms resulting in a greater change from baseline corticospinal excitability. Exploring principles of homeostatic synaptic plasticity using all combinations of priming and principal suppressive PAS (PASLTD), facilitatory PAS (PASLTP) and sham PAS (PASSHAM), this study explores the efficacy of primed PAS as a method of neuromodulation and investigates a relationship between individual characteristics and response to PAS. Methods: Thirty-one healthy individuals were randomized into and completed one of two experiments. Experiment 1 (n=15, age 23.60 ± 2.33 years) investigated priming of PASLTD using a cross-over of the following four interventions separated by at least one-week washouts: 1. PASSHAM→PASLTD; 2. PASLTP→PASLTD; 3. PASLTD→PASLTD; 4. PASSHAM→PASSHAM. Experiment 2 (n=16, age 22.25 ± 2.28 years) investigated priming of PASLTP using a similar four-intervention cross-over of 1. PASSHAM→PASLTP; 2. PASLTD→PASLTP; 3. PASLTP→PASLTP; 4. PASSHAM→PASSHAM. The primary outcome for both experiments was the average peak-to-peak amplitude of 20 motor evoked potentials (MEPs) recorded at baseline and 0, 10, 20, 30, 40, 50 and 60 minutes following intervention. Secondary outcomes included presence of the brain-derived neurotrophic factor (BDNF) Val66Met polymorphism and the latency of MEPs collected using an anterior-posterior current flow across the central sulcus. Results: In Experiment 1, the PASLTP→PASLTD intervention produced a significant increase from baseline corticospinal excitability. Nonresponders had a significantly higher presence of the BDNF Val66Met polymorphism. In Experiment 2, no intervention produced a significant change from baseline excitability. Priming did not convert individual nonresponders to responders for any PAS intervention. Discussion: Our results highlight the complexity of synaptic plasticity and the difficulty in harnessing mechanisms of plasticity to augment neuromodulation strategies. Individual characteristics may influence response to PASLTD and optimal protocols may need to be established for stratified groups

Neural parameter allocation search

https://arxiv.org/pdf/2006.10598.pdfFirst author draf

Health inequalities for older people from minority ethnic groups receiving palliative care and end of life care: a scoping review protocol

OBJECTIVE: The proposed scoping review aims to explore international literature on how older people from minority ethnic groups engage with and utilise palliative and end of life care, investigate the barriers and facilitators, and compare how this varies between ethnicities and health conditions. INTRODUCTION: Minority ethnic groups make up substantial parts of the populations of many countries around the world. Research has found that there are disparities in access to palliative care and end of life care among minority ethnic groups. Language barriers, cultural values, and socio-demographic factors have been cited as preventing access to quality palliative and end of life care. However, it is unclear how these barriers and inequalities differ across different minority ethnic groups in different countries, and across different health conditions within these groups. INCLUSION CRITERIA: The population will be older people of different minority ethnic groups who are receiving palliative or end of life care, family caregivers, and health and social care professionals. The sources of information will include quantitative, qualitative and mixed methods research, and sources that focus on minority ethnic groups’ interactions with palliative and end of life care. METHODS: A scoping review guided by the Joanna Briggs Institute Manual for Evidence Synthesis. Searches of MEDLINE, Embase, PsycInfo, CINAHL, Scopus, Web of Science, Assia, and the Cochrane Library will be conducted. Citation tracking, reference list checking and grey literature searches will be undertaken. Data will be extracted, charted and summarised descriptively. IMPLICATIONS: This review will highlight the health inequalities present in palliative and end of life care, the research gaps in understudied minority ethnic populations, locations where further study is required, and how barriers and facilitators differ across different ethnic groups and health conditions. The results of this review will be shared with stakeholders and will provide evidence-based recommendations for inclusive palliative and end of life care

Management of depression and referral of older people to psychological therapies:a systematic review of qualitative studies

BACKGROUND: Depressive symptoms are common in later life and increase both the risk of functional and cognitive decline and the use of healthcare services. Despite older people expressing preferences for talking therapies, they are less likely to be referred than younger adults, particularly when aged ≥80 years. AIM: To explore how healthcare professionals (HCPs) manage older people in relation to depression and referrals to psychological therapies. DESIGN AND SETTING: Systematic review and thematic synthesis of qualitative studies. METHOD: MEDLINE, Embase, PsycINFO, CINAHL, and the Social Sciences Citation Index (inception-March 2018) were searched for studies exploring HCPs' views regarding management of late-life depression across all settings. Studies of older people's views or depression management across all ages were excluded. RESULTS: In total, 27 studies, were included; these predominantly focused on the views of GPs and primary and community care nurses. Many HCPs felt that late-life depression was mainly attributable to social isolation and functional decline, but treatments appropriate for this were limited. Clinicians perceived depression to have associated stigma for older adults, which required time to negotiate. Limited time in consultations and the complexity of needs in later life meant physical health was often prioritised over mental health, particularly in people with frailty. Good management of late-life depression appeared to depend more on the skills and interest of individual GPs and nurses than on any structured approach. CONCLUSION: Mental ill health needs to be a more-prominent concern in the care of older adults, with greater provision of psychological services tailored to later life. This may facilitate future identification and management of depression

Needs of caregivers in heart failure management: A qualitative study

This is a freely-available open access publication. The final version of this paper has been published in Chronic Illness, March 2015 by SAGE Publications Ltd, All rights reserved. It is available via the DOI in this record.Objectives: To identify the needs of caregivers supporting a person with heart failure and to inform the development of a caregiver resource to be used as part of a home-based selfmanagement programme. Methods: A qualitative study informed by thematic analysis involving 26 caregivers in individual interviews or a focus group. Results: Three distinct aspects of caregiver support in heart failure management were identified. Firstly, caregivers identified needs about supporting management of heart failure including: coping with the variability of heart failure symptoms, what to do in an emergency, understanding and managing medicines, providing emotional support, promoting exercise and physical activity, providing personal care, living with a cardiac device and supporting depression management. Secondly, as they make the transition to becoming a caregiver, they need to develop skills to undertake difficult discussions about the role; communicate with health professionals; manage their own mental health, well-being and sleep; and manage home and work. Thirdly, caregivers require skills to engage social support, and voluntary and formal services while recognising that the longterm future is uncertain. Discussion: The identification of the needs of caregiver has been used to inform the development of a home-based heart failure intervention facilitated by a trained health care practitioner.NIHR (Programme Grants for Applied Research

NIHR Nottingham Biomedical Research Centre (BRC) Musculoskeletal theme: virtual conference proceedings 24 th & 25 th February 2022

This paper gives summaries of the keynote lectures given and the research abstracts presented at the NIHR Nottingham Biomedical Research Centre Musculoskeletal theme virtual conference held on 24th and 25th February 2022. The purpose of the conference was to stimulate collaboration within the broad field of musculoskeletal research, by having presentations showing different techniques and topics, given by our experts and our PhD students. Collaboration was encouraged by inviting colleagues to contact each other by email to start a conversation - an invitation that we extend through this paper, and extend to interested colleagues anywhere in the world. This conference was funded by the NIHR Nottingham Biomedical Research Centre. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care

Mapping post-diagnostic dementia care in England: an e-survey

Purpose: Post-diagnostic dementia care is often fragmented in the United Kingdom, with great variation in provision. Recent policies suggest moving towards better community-based care for dementia; however, little is known on how this care is delivered. This study aimed to map the post-diagnostic dementia support provided in England a decade after the introduction of a National Dementia Strategy. Design/methodology/approach: A mixed-methods e-survey (open Nov 2018–Mar 2019) of dementia commissioners in England recruited through mailing lists of relevant organisations was conducted. The authors descriptively summarised quantitative data and carried out thematic analysis of open-ended survey responses. Findings: 52 completed responses were received, which covered 82 commissioning bodies, with representation from each region in England. Respondents reported great variation in the types of services provided. Information, caregiver assessments and dementia navigation were commonly reported and usually delivered by the voluntary sector or local authorities. Integrated pathways of care were seen as important to avoid overlap or gaps in service coverage. Despite an increasingly diverse population, few areas reported providing dementia health services specifically for BME populations. Over half of providers planned to change services further within five years. Practical implications: There is a need for greater availability of and consistency in services in post-diagnostic dementia care across England. Originality/value: Post-diagnostic dementia care remains fragmented and provided by a wide range of providers in England

Transitions and challenges for people with Parkinson’s and their family members: A qualitative study

OBJECTIVE: To explore the experiences and challenges of people with Parkinson’s and their family members living in the community through the lens of their transitions to better understand the phases and changes in their lives. DESIGN: Qualitative study using semi-structured interviews and analysed using codebook thematic analysis. SETTING/PARTICIPANTS: Purposive sampling was used in primary and secondary healthcare services across Southern England in 2019 to recruit 21 people with Parkinson’s (aged between 45–89 years) and 17 family members (13 spouses and 4 adult children, aged between 26–79 years). RESULTS: Participants’ descriptions were classified in three main phases of transition from a place of health towards greater dependency on others: 1) ‘Being told you are a person with Parkinson’s’ (early), 2) ‘Living with Parkinson’s’ (mid), and 3) ‘Increasing dependency’ (decline). Seven sub-themes were identified to describe the transitions within these three phases: phase 1: receiving and accepting a diagnosis; navigating reactions; phase 2: changing social interactions and maintaining sense of self; information: wanting to know but not wanting to know; finding a place within the healthcare system; and 3: changes in roles and relationships; and increasingly dependent. CONCLUSION: This study has identified points of change and means of supporting key transitions such as diagnosis, changes in social connections, and increased use of secondary healthcare services so that comprehensive, holistic, individualised and well-timed support can be put in place to maintain well-being