Experiences of dialectical behaviour therapy in a community setting for individuals with intellectual disabilities.

Background There is growing interest in the application of dialectical behaviour therapy (DBT) for individuals with intellectual disability (ID) and recent qualitative studies have explored their experiences of DBT in inpatient and forensic settings. This article aimed to explore experiences of DBT in a community setting for people with ID. Method Eleven individuals recruited from two NHS Trusts were interviewed about their experiences of DBT. Interview data was analysed using interpretative phenomenological analysis (IPA). Results Four superordinate themes and eight subordinate themes emerged from the data. The first superordinate theme 'experience of power' captured participants experience of power within DBT. The second theme 'differences in therapy contexts' highlighted how participants had made sense of different therapeutic contexts. The third theme 'the experience of a positive therapeutic relationship' focused on the qualities and attitudes of the therapist. The fourth theme 'a new way of being' described the impact DBT had on participants' everyday lives and the shift in their sense of self. Discussion This study provides insight into the lived experiences of people with ID receiving DBT. Therapeutic processes including the interplay between factors unique to DBT and features common across therapies are discussed.

Successful Cochlear Implantation in the Face of Persistent Stapedial Artery: Surgical Technique and Imaging Features.

The stapedial artery is an embryologic structure that very rarely persists into adulthood. Termed the persistent stapedial artery (PSA), it is most often asymptomatic, identified retrospectively, and can complicate middle ear surgery. A 70-year-old woman presented with profound bilateral sensorineural hearing loss and elected to undergo cochlear implantation. During surgery, a pulsatile, cord-like structure was found obscuring the round window niche. A high-resolution computed tomography (HRCT) imaging review confirmed PSA diagnosis. A cochleostomy was made using a cochleostomy burr and gentle vessel compression. Complete insertion of the cochlear implant was achieved and its placement confirmed. The patient went on to develop open-set discrimination. We report the first successful case of cochlear implantation in the face of a PSA. Inverted HRCT imaging was found to enhance PSA visualization and may aid preoperative diagnosis. A cochleostomy technique is recommended for electrode insertion to minimize the risk of bleeding.

Across-Experiment Transcriptomics of Sheep Rumen Identifies Expression of Lipid/Oxo-Acid Metabolism and Muscle Cell Junction Genes Associated With Variation in Methane-Related Phenotypes.

Ruminants are significant contributors to the livestock generated component of the greenhouse gas, methane (CH4). The CH4 is primarily produced by the rumen microbes. Although the composition of the diet and animal intake amount have the largest effect on CH4 production and yield (CH4 production/dry matter intake, DMI), the host also influences CH4 yield. Shorter rumen feed mean retention time (MRT) is associated with higher dry matter intake and lower CH4 yield, but the molecular mechanism(s) by which the host affects CH4 production remain unclear. We integrated rumen wall transcriptome data and CH4 phenotypes from two independent experiments conducted with sheep in Australia (AUS, n = 62) and New Zealand (NZ, n = 24). The inclusion of the AUS data validated the previously identified clusters and gene sets representing rumen epithelial, metabolic and muscular functions. In addition, the expression of the cell cycle genes as a group was consistently positively correlated with acetate and butyrate concentrations (p < 0.05, based on AUS and NZ data together). The expression of a group of metabolic genes showed positive correlations in both AUS and NZ datasets with CH4 production (p < 0.05) and yield (p < 0.01). These genes encode key enzymes in the ketone body synthesis pathway and included members of the poorly characterized aldo-keto reductase 1C (AKR1C) family. Several AKR1C family genes appear to have ruminant specific evolution patterns, supporting their specialized roles in the ruminants. Combining differential gene expression in the rumen wall muscle of the shortest and longest MRT AUS animals (no data available for the NZ animals) with correlation and network analysis, we identified a set of rumen muscle genes involved in cell junctions as potential regulators of MRT, presumably by influencing contraction rates of the smooth muscle component of the rumen wall. Higher rumen expression of these genes, including SYNPO (synaptopodin, p < 0.01) and NEXN (nexilin, p < 0.05), was associated with lower CH4 yield in both AUS and NZ datasets. Unlike the metabolic genes, the variations in the expression of which may reflect the availability of rumen metabolites, the muscle genes are currently our best candidates for causal genes that influence CH4 yield.

What do we know about cognitive functioning in adult congenital heart disease?

With the advent of improved medical and surgical care in congenital heart disease, there has been an increase in the number of patients who survive into adulthood, giving rise to a new patient population 'Adults with congenital heart disease'. In the past, morbidity and mortality were the primary concerns for this group. However, with improvements in outcome attention has shifted to other factors such as psychosocial and cognitive functioning. This paper reviews the literature on the cognitive functioning in adult congenital heart disease patients. A total of five relevant articles were retrieved via electronic searches of six databases, including MEDLINE, EMBASE, CINAHL, AMED, PsychINFO, and PubMed. The results displayed a consensus on the presence of some cognitive difficulties in adult congenital heart disease patients. The aetiology of cognitive dysfunctions appears to be multifactorial. The literature is limited by the very small number of studies looking at adults with congenital heart disease, with the majority focusing on cognitive functioning among children with congenital heart disease. However, the presence of cognitive dysfunctions and the resulting impact on the patient's day to day lives warrant for a more detailed and prospective research to enhance the understanding of its aetiology and impact.