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.