Incorporating Choice-Making Opportunities to Increase Engagement in Leisure Activities for Adults With Intellectual and Developmental Disabilities

A growing number of adults with intellectual and developmental disabilities (IDD) attend day programming. These programs are designed to give consumers the opportunity to explore the community, socialize with community members, and to engage in community activities. Unfortunately, activities offered may be selected by program staff without much input from the day program participants. Researchers examined the use of video-based paired stimulus preference assessments (VPA) to identify potentially preferred activities for three adults with IDD in a day program setting. Participant engagement levels during identified preferred activities were compared with staff-selected activities. Consistent with previous research, researchers were able to identify a hierarchy of preferred activities using the VPA. Researchers found preferred activities identified by the VPA maintained more engagement than staff-selected activities for all three participants. Our findings suggest VPA may be beneficial to incorporate into daily activity planning for adults with IDD in day programs

Chronic intermittent hypoxia disrupts cardiorespiratory homeostasis and gut microbiota composition in adult male guinea-pigs

Background: Carotid body (peripheral oxygen sensor) sensitisation is pivotal in the development of chronic intermittent hypoxia (CIH)-induced hypertension. We sought to determine if exposure to CIH, modelling human sleep apnoea, adversely affects cardiorespiratory control in guinea-pigs, a species with hypoxia-insensitive carotid bodies. We reasoned that CIH-induced disruption of gut microbiota would evoke cardiorespiratory morbidity. Methods: Adult male guinea-pigs were exposed to CIH (6.5% O2 at nadir, 6 cycles.hour−1) for 8 h.day−1 for 12 consecutive days. Findings: CIH-exposed animals established reduced faecal microbiota species richness, with increased relative abundance of Bacteroidetes and reduced relative abundance of Firmicutes bacteria. Urinary corticosterone and noradrenaline levels were unchanged in CIH-exposed animals, but brainstem noradrenaline concentrations were lower compared with sham. Baseline ventilation was equivalent in CIH-exposed and sham animals; however, respiratory timing variability, sigh frequency and ventilation during hypoxic breathing were all lower in CIH-exposed animals. Baseline arterial blood pressure was unaffected by exposure to CIH, but β-adrenoceptor-dependent tachycardia and blunted bradycardia during phenylephrine-induced pressor responses was evident compared with sham controls. Interpretation: Increased carotid body chemo-afferent signalling appears obligatory for the development of CIH-induced hypertension and elevated chemoreflex control of breathing commonly reported in mammals, with hypoxia-sensitive carotid bodies. However, we reveal that exposure to modest CIH alters gut microbiota richness and composition, brainstem neurochemistry, and autonomic control of heart rate, independent of carotid body sensitisation, suggesting modulation of breathing and autonomic homeostasis via the microbiota-gut-brainstem axis. The findings have relevance to human sleep-disordered breathing

MicroRNAs as biomarkers for major depression: A role for let-7b and let-7c

There is a growing emphasis in the field of psychiatry on the need to identify candidate biomarkers to aid in diagnosis and clinical management of depression, particularly with respect to predicting response to specific therapeutic strategies. MicroRNAs are small nucleotide sequences with the ability to regulate gene expression at the transcriptomic level and emerging evidence from a range of studies has highlighted their biomarker potential. Here we compared healthy controls (n=20) with patients diagnosed with major depression (n=40) and who were treatment-resistant to identify peripheral microRNA biomarkers, which could be used for diagnosis and to predict response to electroconvulsive therapy (ECT) and ketamine (KET) infusions, treatments that have previously shown to be effective in treatment-resistant depression (TRD). At baseline and after treatment, blood samples were taken and symptom severity scores rated using the Hamilton Depression Rating Scale (HDRS). Samples were analyzed for microRNA expression using microarray and validated using quantitative PCR. As expected, both treatments reduced HDRS scores. Compared with controls, the baseline expression of the microRNA let-7b was less by ~40% in TRD patients compared with controls. The baseline expression of let-7c was also lower by ~50% in TRD patients who received ECT. Bioinformatic analysis revealed that let-7b and let-7c regulates the expression of 27 genes in the PI3k-Akt-mTOR signaling pathway, which has previously been reported to be dysfunctional in depression. The expression of miR-16, miR-182, miR-451 and miR-223 were similar to that in controls. Baseline microRNA expression could not predict treatment response and microRNAs were unaffected by treatment. Taken together, we have identified let-7b and let-7c as candidate biomarkers of major depression

Qualitative Data from a Trial of Home Blood Pressure Telemonitoring and Pharmacist Management (Hyperlink)

Background/Aims: Hyperlink was a cluster-randomized intervention trial in HealthPartners clinics from 2009 to 2013 with nonintervention follow-up through 2015 (60 months). Participants had uncontrolled hypertension. Telemonitoring intervention patients had improved blood pressure control at 6 months compared with usual care patients (72% vs. 45%, P \u3c 0.001). Intervention effects narrowed at 12 (72% vs. 53%, P = 0.005) and 18 months (72% vs. 57%, P = 0.003); 60-month blood pressure data will be complete in October 2015. We conducted a mixed-methods analysis combining our quantitative results with patient, clinical and other organizational stakeholder perspectives to learn how to optimize the intervention for the most patients and implement this intervention in our care setting. Methods: We collected three sources of qualitative data: seven patient focus groups stratified by 6–18-month blood pressure outcomes, four structured interviews with intervention pharmacists, and interviews (currently being collected) with key organizational stakeholders. Focus group and structured interview data were analyzed by a team of five using grounded theory. Initial themes were identified and coded in NVivo10. Results: Qualitative data revealed several initial themes. First, patients valued trust in the patient-provider relationship and good communication between providers. Second, patients have varying goals with medications and successfully initiating/adhering to treatment is better when provider understands and respects the patient’s perspective on medications. Finally, intervention patients benefited from seeing their own blood pressure data (reinforcement) and a trusted provider seeing their data (accountability). Pharmacist interviews agreed with these themes, revealing key insights about intervention design including: length of intervention, addressing relapse, and meeting individual patient’s needs with effective use of data and lifestyle counseling. Results of 60-month blood pressure outcomes will be analyzed in the context of these initial findings, and qualitative findings will be further refined. Stakeholder interview results about implementation are forthcoming. Conclusion: Findings suggest the need for several adaptations to the intervention before implementation in practice: provision of blood pressure monitors for ongoing use, a shorter duration with ability to re-engage if blood pressure becomes uncontrolled, more tailoring of the intervention to individual needs, and better communication and handoffs between pharmacists and physicians