Standard care and telecare services: comparing the effectiveness of two service systems with consumers with intellectual disabilities

BACKGROUND

Onsite standard care and remote telecare supports were provided to adults with intellectual disabilities living in integrated community settings and evaluated in terms of effectiveness as consumers completed a series of novel household activities.

METHODS

Using an alternating treatment design with baseline and follow-up conditions in this single-case study, investigators compared the prompting effectiveness provided by onsite standard care staff and a remote telecare provider.

RESULTS

While both types of supports resulted in consumers completing tasks, results indicated consumers achieved slightly more independence when prompted by the telecare support provider. Additionally, telecare supports resulted in greater duration for task completion per consumer.

CONCLUSIONS

Although consumers completed tasks with greater independence using telecare supports, caution should be used when interpreting results due to the small number of participants. The potential for this technology certainly exists in supporting consumers in their own homes thus, suggestions for future investigations are provided.

Noncovalent interactions within a synthetic receptor can reinforce guest binding

Structural and thermodynamic data are presented on the binding properties of anion receptors containing two covalently linked cyclopeptide subunits that bind sulfate and iodide anions with micromolar affinity in aqueous solution. A synchrotron X-ray crystal structure of the sulfate complex of one receptor revealed that the anion is bound between the peptide rings of the biscyclopeptide. Intimate intramolecular contacts between the nonpolar surfaces of the proline rings of the individual receptor moieties in the complex suggest that hydrophobic interactions within the receptor that do not directly involve the guest contribute to complex stability. This finding is supported by a microcalorimetric analysis of the solvent dependence of complex stability, which showed that increasing the water content of the solvent has only a weak influence on the Gibbs energy of binding. Hence, the increasing amount of energy required for desolvating the binding partners in solutions containing more water is almost compensated by the increasingly favorable hydrophobic interactions. Further observations that suggest that guest-induced intra-receptor interactions contribute to guest binding are (i) anion binding of a monomeric cyclopeptide lacking the covalent linkage between the two rings leads to the formation of 2:1 complexes; (ii) in the crystal structure of the 2:1 iodide complex of this monotopic receptor, a similar arrangement of the two cyclopeptide rings has been found as in the sulfate complex of the biscyclopeptide; (iii) complex formation of the monomeric cyclopeptide in aqueous solution is highly cooperative with a large stability constant corresponding to the formation of the 2:1 complexes from relatively instable 1:1 complexes; (iv) the monomeric cyclopeptide forms only 1:1 anion complexes in DMSO where hydrophobic interactions do not take place; and (v) introducing polar hydroxy groups on the proline rings of the monomeric cyclopeptide disrupts cooperativity causing the formation of only 1:1 complexes even in aqueous solution. Taken together these observations demonstrate that, in addition to direct receptor-substrate interactions, noncovalent interactions between the two subunits of such biscyclopeptides contribute significantly to anion complex stability. Reinforcement of molecular recognition through intra-receptor interactions should be an attractive new strategy to boost host-guest affinities.

Optimization of the binding properties of a synthetic anion receptor using rational and combinatorial strategies

The solution conformations of tetrameric and hexameric cyclopeptides containing alternating L-proline and 6-aminopicolinic acid subunits strongly depend on solvent polarity. Whereas in polar solvents, such as d6-DMSO, both peptides prefer on average symmetric conformations with converging NH groups, in less polar chloroform intramolecular hydrogen bonds to the peptide NH groups stabilize other, and in the case of the hexapeptide, non-symmetrical conformations. Independent of the solvent, both peptides interact with anions via their NH groups but whereas anion binding requires a cleavage of the intramolecular hydrogen bonds accompanied by a conformational reorganization in chloroform, in polar solvents the peptides are already well preorganized for anion complexation. Complex formation between anions and the cyclic hexapeptide was even detected in highly competitive D2O/CD3OD or H2O/CH3CN mixtures, which was attributed to the special sandwich-type structure of the complexes formed. Stabilizing these 2:1 aggregates by covalently linking two cyclopeptide rings together affords ditopic receptors with a high anion affinity in protic solvents. Complex stability depends on the structure of the linker with which the two receptor moieties are connected and even more potent anion receptors were obtained by a dynamic combinatorial optimization of this linking unit.

Matched/Mismatched Interaction of a Cyclic Hexapeptide with Ion Pairs Containing Chiral Cations and Chiral Anions

The binding of a chiral quaternary ammonium ion to a cyclopeptide containing aromatic amino acid subunits is affected not only by the configuration of the cation but also by the configuration of the chiral counterion. Analysis of the binding equilibria shows that complex formation involves interaction of the whole ion pair with the host indicating that steric requirements of the anion influence complex geometry and stability.

Dynamic combinatorial optimization of a neutral receptor that binds inorganic anions in aqueous solution

A dynamic combinatorial library of potential anion receptors was generated from a cyclic peptide disulfide dimer and a series of dithiol spacers. Exposing the library to KI or K2SO4 led to the amplification of two new neutral receptors that bind anions through hydrogen bonding with up to micromolar affinity in aqueous solution. Thermodynamic studies suggest that these second-generation receptors outclass the previously described first-generation receptor, largely as a result of a more favorable enthalpy of binding. These results demonstrate that dynamic combinatorial optimization of designed hosts can be a powerful strategy, bringing synthetic receptors that approach the efficiencies of proteins one step closer.

Enantioselective recognition of a chiral quaternary ammonium ion by C3 symmetric cyclic hexapeptides

C3 Symmetric cyclic hexapeptides containing alternating L-proline and 3-aminobenzoic acid derivatives as subunits possess different affinities towards the two enantiomers of the N,N,N-trimethyl-1-phenylethyl ammonium cation.

A molecular oyster: a neutral anion receptor containing two cyclopeptide subunits with a remarkable sulfate affinity in aqueous solution

An artificial anion receptor is presented, in which two cyclohexapeptide subunits containing l-proline and 6-aminopicolinic acid subunits in an alternating sequence are connected via an adipinic acid spacer. This compound was devised to stabilize the 2:1 sandwich-type anion complexes that are observed when the two cyclopeptide moieties are not covalently connected and to obtain a 1:1 stoichiometry for these aggregates. Electrospray ionization mass spectrometry and NMR spectroscopic investigations showed that the bridged bis(cyclopeptide) does indeed form defined 1:1 complexes with halides, sulfate, and nitrate. ROESY NMR spectroscopy and molecular modeling allowed a structural assignment of the sulfate complex in solution. The stabilities of various anion complexes were determined by means of NMR titrations and isothermal titration microcalorimetry in 50% water/methanol. Both methods gave essentially the same quantitative results, namely stability constants that varied in the range 105-102 M-1 and decreased in the order SO42- > I- > Br- > Cl- > NO3-. This order was rationalized in terms of the size of the anions with the larger anions forming the more stable complexes because they better fit into the cavity of the host. The ability of sulfate to form stronger hydrogen bonds to the NH groups of the receptor, in addition to its slightly larger ionic radius with respect to iodide, causes the higher stability of the sulfate complex. No significant effect of the countercation on complex stability was observed. Furthermore, complex stability is enthalpically as well as entropically favored. A comparison of the iodide and sulfate complex stabilities of the ditopic receptor with those of a cyclopeptide that forms 1:1 anion complexes in solution showed that the presence of a second binding site increases complex stability by a factor of 100-350.

Conformation and anion binding properties of cyclic hexapeptides containing L-4-hydroxyproline and 6-aminopicolinic acid subunits

Two cyclic hexapeptides containing alternating all R and all S configured Ll-(4R/S)-hydroxyproline and 6-aminopicolinic acid subunits are presented, and the influence of the hydroxyl groups on the solubility, conformation, and receptor properties is investigated. Cyclopeptide 2, containing the natural 4R configured hydroxyproline, adopts a conformation similar to that of the unsubstituted peptide 1, which is able to bind anions such as halides and sulfate in aqueous solution. 2 also interacts with these anions, but whereas 1 forms sandwich type 2:1 complexes, in which the anion is bound by two cyclopeptide moieties, 2 forms 1:1 complexes. The stabilities of the halide and sulfate complexes of 2 range between 10(0) and 10(2) M(-1) in 80% D(2)O/CD(3)OD. Complex formation is detectable even in water, but with slightly smaller stability constants. Using this information a quantitative evaluation of the stability of the 2:1 complexes of 1, for which overall stability constants in the order 10(4) to 10(5) M(-2) in 80% D(2)O/CD(3)OD were observed, was made. In contrast to 2, the conformation of 3, containing the non-natural 4S configured hydroxyproline, is strongly affected by the presence of the hydroxyl groups. In d(6)-DMSO and methanol/water mixtures a slow conformational equilibrium between two C(3)-symmetrical conformers is observed, and 3 is thus much less preorganized for anion binding than either 1 or 2.

Cyclic hexapeptides with free carboxylate groups as new receptors for monosaccharides

[structure: see text]. Cyclic hexapeptides composed of alternating L-proline and 3-aminobenzoic acid subunits with substituents on the aromatic subunits that contain free carboxylate groups are able to bind monosaccharides in 4% CD3OD/CDCl3. The binding selectivity of these peptides depends on the structure of the substituents on the aromatic subunits.

A Cyclic Hexapeptide Containing L-Proline and 6-Aminopicolinic Acid Subunits Binds Anions in Water

A neutral receptor that binds anions by hydrogen bonds even in water is the cyclopeptide reported in this article. This property results from the particular structure of the complex in which the anions are effectively shielded from the surrounding solvent, as can be seen in the iodide complex shown.

Understanding hippocampal activity by using purposeful behavior: Place navigation induces place cell discharge in both task-relevant and task-irrelevant spatial reference frames

Continuous rotation of an arena in a cue-rich room dissociates the stationary room-bound information from the rotating arena-bound information. This disrupted spatial discharge in the majority of place cells from rats trained to collect randomly scattered food. In contrast, most place cell firing patterns recorded from rats trained to solve a navigation task on the rotating arena were preserved during the rotation. Spatial discharge was preserved in both the task-relevant stationary and the task-irrelevant rotating reference frames, but firing was more organized in the task-relevant frame. It is concluded that, (i) the effects of environmental manipulations can be understood with confidence only when the rat's purposeful behavior is used to formulate interpretations of the data, and (ii) hippocampal place cell activity is organized in multiple overlapping spatial reference frames.

Brain cooling in humans--anatomical considerations

Vascular arrangements allowing a bulky transfer of venous blood from the skin of the head and from nasal and paranasal mucous membranes to the dura matter provide an excellent anatomical basis for the convection process of cooling, caused by evaporation of sweat or mucus. The dura mater, with its extraordinarily high vascularization controlled by a potent vasomotor apparatus, may transmit temperature changes to the cerebrospinal fluid (CSF) compartment. Temperature gradients of the CSF may in turn influence the temperature of brain parenchyma (1) directly, along the extensive contact area between the cerebrocortical surface and the CSF-compartment, or (2) indirectly, via brain arteries that extend over long distances and arborize within the subarachnoid space before entering the pial vascular network and brain parenchyma. Numerous subarachnoid and pial arterial branches exposed to the CSF have diameters in the range of the vessels of the retia mirabilia of animals in which selective brain cooling has been clearly established experimentally. It is also shown that the arrangements of venous plexuses within the vertebral canal provide anatomical preconditions for a cooling of the spinal cord via the CSF. The possibility of spinal cord and spinal ganglia cooling by temperature convection via venous blood--cooled in the venous networks of the skin of the back--flowing through numerous anastomoses to the external and internal vertebral plexuses and, finally, into the vascular bed of the spinal dura is discussed on the basis of anatomical facts.

Synthesis and coupling reactions of alpha,alpha-dialkylated amino acids with nucleobase side chains

Several di- and tripeptides containing protected purine (adenine) and pyrimidine (thymine) residues on their side chains were synthesized. The parent amino acids alpha, alpha-dialkylated in a symmetrical manner. An effective coupling procedure was developed for these sterically hindered amino acids: the fluoren-9-ylmethyloxycarbonyl-protected amino acid was dehydrated to its oxazolinone form, which was coupled in good yields with amino esters in hot tetrachloroethane.

[Topography of the hypophysis and its neighboring structures]

The first part of the article informs about four points: the skeletal structures of the middle cranial fossa, the basic divisions of the gland and their connections with the hypothalamus, its blood supply, and its development. The topographic part deals with the incorporation of the pituitary gland in the sella turcica, its relationship to the meninges, the subarachnoid cavity and other neighbouring structures, especially the sphenoidal sinus, the posterior ethmoidal cells as well as the chiasma opticum. With respect to the latter, the position of the fibres in the optic nerve, chiasma and optic tract and the consequences of lesions in characteristic areas are described. Finally, the variant structures of the cavernous sinus and the topography of its contents are discussed. Detailed data can be found about the course of the oculomotor nerves and the possible locations of their lesions.

Anatomic relationships along the low-middle convexity: Part I--Normal specimens and magnetic resonance imaging

Sagittal sections of anatomic specimens and magnetic resonance images well display the individual gyri and sulci along the low-middle convexity. Those familiar with the typical pattern and with the common normal variations will be able to use sagittal magnetic resonance imaging to correctly localize lesions by identifying: (a) the five major rami of the sylvian fissure; (b) the subdivision of the triangular inferior frontal gyrus into the M-shaped partes orbitalis, triangularis, and opercularis by the anterior horizontal and anterior ascending rami of the sylvian fissure; (c) the zig-zag shape of the middle frontal gyrus, which characteristically angles sharply and inferiorly to fuse with the anterior surface of the precentral gyrus; (d) T-shaped bifurcation of the posterior end of the inferior frontal sulcus to form the inferior precentral sulcus; (e) separation of the central sulcus from the sylvian fissure by union of the opercular ends of the precentral and postcentral gyri to form the subcentral gyrus inferior to the central sulcus; (f) narrower sagittal dimension of the postcentral gyrus than the precentral gyrus; (g) horseshoe shape of the supramarginal gyrus perched atop the posterior ascending ramus of the sylvian fissure; (h) similar horseshoe shape of the angular gyrus perched atop the posterior end of the superior temporal sulcus; (i) commonly intercalated accessory presupramarginal and preangular gyri; and (j) the arcuate course of the intraparietal sulcus, which separates the superior from the inferior parietal lobules. The anatomic relationships described are more nearly constant anteriorly than posteriorly. When used as described, they prove helpful in correctly localizing pathology and in planning a surgical approach to lesions that may be difficult to localize on the basis of axial or coronal plane magnetic resonance images.

Topographic relationship of the ventromedial lymphatic bundle and the superficial inguinal nodes to the subcutaneous veins

The relationships between lymph vessels and veins are of clinical importance for the prevention of injury to collectors and resulting edema after removal of veins. Injection preparations of the lymph vessels and veins showed that on the dorsum of the foot the collectors overcross the veins; however, in all remaining areas they undercross them. Only the great saphenous vein is overcrossed by lymph collectors. It also has accompanying lymph vessels but its vascular sheath, however, does not contain any lymph vessels. The position of the collectors depends on the thickness of the subcutaneous adipose tissue. On the dorsum of the foot the lymphatics are often closely bound up with the corium; on the lower leg, however, they are embedded in the adipose tissue. Some collectors are closely related to perforator veins. In the knee region the lymph bundle ascends dorsomedially to the medial condylus of the femur. On the thigh, where the subcutaneous fatty tissue is thick, the collectors from three layers. The superficial inguinal lymph nodes draining the leg and the external genitalia are situated around the saphenous opening and are closely related to the subinguinal venous star, so that in surgical intervention the collectors of this region are more exposed to danger than in other regions.