Adapting Sexual Configurations Theory to Nursing

Lesbian, gay, bisexual, transgender, and queer/questioning people in the United States experience multiple health disparities related to sexual and reproductive health. Attempts to address these disparities have focused on sexual orientation and gender identity rather than on the specific aspects of sexuality that may be more relevant to an individual’s health outcomes. This focus is also incongruent with a holistic approach to health and wellness interventions. We propose an adaptation of sexual configurations theory, a psychological theory with which to accurately describe different aspects of sexuality, to better position nurses to address these important disparity issues. We position sexual configurations theory within a contextual framework that incorporates aspects of trauma theory as a new way to evaluate individual sexuality in a holistic nursing context.     

Life activity choices by people with aphasia: repeated interviews and proxy agreement

Background: Person-centered rehabilitation requires that meaningful life activities are identified on a case-by-case basis, but the discovery process can be inaccessible for clients with aphasia. Card-sorting methodology addresses core barriers and help clients communicate their preferences.

Aims: To characterize life activities that people with aphasia want to do, to estimate consistency in selections over time, and to replicate previous findings about the ability of family members and friends to identify their loved ones’ activity preferences.

Methods & Procedures: We administered the Life Interests and Values (LIV) Cards to 26 people with aphasia, asking them which of 95 depicted life activities they wanted to do more in their lives. Half the activity cards were presented again one to ten weeks later. Twenty family members or friends responded as proxies by selecting from a questionnaire with the same items.

Outcomes & Results: Participants with aphasia selected diverse activities, though as a group they identified significantly more activities from the “social” activity category than from the “home and community”, “creative and relaxing”, or “physical” categories. Across the repeated interviews, they selected identical activities on average 78% of the time. Item-to-item agreement between people with aphasia and their proxy responders was significantly lower at 69%.

Conclusions: People with aphasia have diverse activity interests and are reliable informants about their preferences. Because significant others have limited ability to predict these choices, their impressions are inadequate substitutes for direct interviews.     

Two forms of short-interval intracortical inhibition in human motor cortex

BackgroundPulses of transcranial magnetic stimulation (TMS) with a predominantly anterior-posterior (AP) or posterior-anterior (PA) current direction over the primary motor cortex appear to activate distinct excitatory inputs to corticospinal neurons. In contrast, very few reports have examined whether the inhibitory neurons responsible for short-interval intracortical inhibition (SICI) are sensitive to TMS current direction.ObjectivesTo investigate whether SICI evaluated with AP and PA conditioning stimuli (CS_PA and CS_AP) activate different inhibitory pathways. SICI was always assessed using a PA-oriented test stimulus (TS_PA).MethodsUsing two superimposed TMS coils, CS_PA and CS_AP were applied at interstimulus intervals (ISI) of 1–5 ms before a TS_PA, and at a range of different intensities. Using a triple stimulation design, we then tested whether SICI at ISI of 3 ms using opposite directions of CS (SICI_CSPA3 and SICI_CSAP3) interacted differently with three other forms of inhibition, including SICI at ISI of 2 ms (SICI_CSPA2), cerebellum-motor cortex inhibition (CBI 5 ms) and short-latency afferent inhibition (SAI 22 ms). Finally, we compared the effect of tonic and phasic voluntary contraction on SICI_CSPA3 and SICI_CSAP3.ResultsCS_AP produced little SICI at ISIs = 1 and 2 ms. However, at ISI = 3 ms, both CS_AP and CS_PA were equally effective at the same percent of maximum stimulator output. Despite this apparent similarity, combining SICI_CSPA3 or SICI_CSAP3 with other forms of inhibition led to quite different results: SICI_CSPA3 interacted in complex ways with CBI, SAI and SICI_CSPA2, whereas the effect of SICI_CSAP3 appeared to be quite independent of them. Although SICI_CSPA and SICI_CSAP were both reduced by the same amount during voluntary tonic contraction compared with rest, in a simple reaction time task SICI_CSAP was disinhibited much earlier following the imperative signal than SICI_CSPA.ConclusionsSICI_CSPA appears to activate a different inhibitory pathway to that activated by SICI_CSAP. The difference is behaviourally relevant since the pathways are controlled differently during volitional contraction. The results may explain some previous pathological data and open the possibility of testing whether these pathways are differentially recruited in a range of tasks.     

Advanced diffusion magnetic resonance imaging in patients with Alzheimer’s and Parkinson’s diseases

The prevalence of neurodegenerative diseases is increasing as human longevity increases. The objective biomarkers that enable the staging and early diagnosis of neurodegenerative diseases are eagerly anticipated. It has recently become possible to determine pathological changes in the brain without autopsy with the advancement of diffusion magnetic resonance imaging techniques. Diffusion magnetic resonance imaging is a robust tool used to evaluate brain microstructural complexity and integrity, axonal order, density, and myelination via the micron-scale displacement of water molecules diffusing in tissues. Diffusion tensor imaging, a type of diffusion magnetic resonance imaging technique is widely utilized in clinical and research settings;however, it has several limitations. To overcome these limitations, cutting-edge diffusion magnetic resonance imaging techniques, such as diffusional kurtosis imaging, neurite orientation dispersion and density imaging, and free water imaging, have been recently proposed and applied to evaluate the pathology of neurodegenerative diseases. This review focused on the main applications, findings, and future directions of advanced diffusion magnetic resonance imaging techniques in patients with Alzheimer's and Parkinson's diseases, the first and second most common neurodegenerative diseases, respectively.