Creating an inclusive mall environment with the PRECEDE-PROCEED model: a living lab case study.

PURPOSE: Although public environments provide opportunities for participation and social inclusion, they are not always inclusive spaces and may not accommodate the wide diversity of people. The Rehabilitation Living Lab in the Mall is a unique, interdisciplinary, and multi-sectoral research project with an aim to transform a shopping complex in Montreal, Canada, into an inclusive environment optimizing the participation and social inclusion of all people. METHODS: The PRECEDE-PROCEDE Model (PPM), a community-oriented and participatory planning model, was applied as a framework. The PPM is comprised of nine steps divided between planning, implementation, and evaluation. RESULTS: The PPM is well suited as a framework for the development of an inclusive mall. Its ecological approach considers the environment, as well as the social and individual factors relating to mall users' needs and expectations. Transforming a mall to be more inclusive is a complex process involving many stakeholders. The PPM allows the synthesis of several sources of information, as well as the identification and prioritization of key issues to address. The PPM also helps to frame and drive the implementation and evaluate the components of the project. CONCLUSION: This knowledge can help others interested in using the PPM to create similar enabling and inclusive environments world-wide. Implication for rehabilitation While public environments provide opportunities for participation and social inclusion, they are not always inclusive spaces and may not accommodate the wide diversity of people. The PRECEDE PROCEDE Model (PPM) is well suited as a framework for the development, implementation, and evaluation of an inclusive mall. Environmental barriers can negatively impact the rehabilitation process by impeding the restoration and augmentation of function. Removing barriers to social participation and independent living by improving inclusivity in the mall and other environments positively impacts the lives of people with disabilities.

A paradigm change to inform fibromyalgia research priorities by engaging patients and health care professionals.

Background: Research objectives should be focused toward advancing knowledge that has meaningful impact on health. However, research agendas are mostly driven by the health care community, with limited input from patients. Aims: In this study, prioirities of uncertainties for the management of fibromyalgia (FM) that could propel future research were identified by a defined process using the James Lind Alliance Priority Setting Partnership (JLA-PSP) methodology. Methods: As a first step, a survey was distributed across Canada that engaged patients, caregivers, and health care professionals to provide narrative input to eight open-ended questions regarding FM care. Responses were thematically condensed and synthesized into an initial list of 43 uncertainties used to guide a comprehensive literature search. Questions already effectively addressed in the literature were excluded, leaving 25 uncertainties that were ranked during a one-day consensus workshop. Results: Three broad themes emerged: the value of personalized targeted treatment and subgrouping of patients; the efficacy of various self-management strategies and educational initiatives; and identification of the ideal health care setting to provide FM care. Opioids and cannabinoids were the only specific pharmacologic interventions ranked as needing further research. Conclusions: The prioritized questions highlight the importance of recognizing the heterogeneity of FM symptoms, the need for a personalized treatment approach, and a better understanding of the value of self-management strategies. This is the first study that uses an established and transparent methodology to engage all FM stakeholders to help inform researchers and funding bodies of clinically relevant research priorities.

Contexte: Les objectifs en matière de recherche devraient se concentrer sur l'avancement des connaissances qui ont des effets significatifs sur la santé. Toutefois, les programmes de recherche sont surtout définis par le milieu des soins de santé, tandis que la contribution des patients demeure limitée.Objectifs: Dans cette étude, les incertitudes prioritaires pour la prise en charge de la fibromylagie, qui pourraient donner lieu à de futures études, ont été déterminées selon un processus fondé sur la méthodologie du Partenariat d'établissement des priorités de la James Lind Alliance.Méthodes: Comme première étape, une enquête a été distribuée partout au Canada auprès de patients, de prestataires de soins et de professionnels de la santé afin d'obtenir leurs réponses sous forme narrative à huit questions ouvertes concernant les soins relatifs à la fibromyalgie. Les réponses ont été regroupées par thèmes et résumées dans une liste initiale de 43 incertitudes qui a été utilisée pour orienter une recherche exhaustive de la littérature. Les questions déjà abordées de manière efficace dans la littérature ont été exclues, tandis que les 25 incertitudes restantes ont été classées dans le cadre d'un atelier de recherche de consensus d'une journée.Résultats: Trois grands thèmes se sont démarqués : l'utilité des traitements ciblés personnalisés et de la division des patients en sous-groupes; l'efficacité de diverses stratégies d'auto-prises en charge et initiatives éducatives; et la détermination du cadre de soins de santé idéal pour dispenser les soins relatifs à la fibromyalgie.Conclusions: Les questions priorisées soulignent l'importance de reconnaître l'hétérogénéité des symptômes de la fibromyalgie, la nécessité d'une approche de traitement personnalisé et une meilleure compréhension de l'utilité des stratégies d'auto-prise en charge. Il s'agit de la première étude à utiliser une méthodologie établie et transparente pour impliquer toutes les parties concernées par la fibromyalgie pour aider à faire connaître aux chercheurs et aux agences de financement les priorités pertinentes sur le plan clinique.

Evidence of lasting dysregulation of neuroendocrine and HPA axis function following global cerebral ischemia in male rats and the effect of Antalarmin on plasma corticosterone level.

Abnormal function of the neuroendocrine stress system has been implicated in the behavioral impairments observed following brain ischemia. The current study examined long-term changes in stress signal regulation 30days following global cerebral ischemia. Experiment 1 investigated changes in the expression of corticotropin releasing hormone (CRH) and its subtype 1 receptor (CRHR1), glucocorticoid receptors (GR) in the paraventricular nucleus of the hypothalamus (PVN), the central nucleus of the amygdala (CeA), and the CA1 subfield of the hippocampus. Tyrosine hydroxylase (TH) was determined at the locus coeruleus (LC). Experiment 2 investigated the role of central CRHR1 activation on corticosterone (CORT) secretion at multiple time intervals following global ischemia after exposure to an acute stressor. Findings from Experiment 1 demonstrated a persistent increase in GR, CRH and CRHR1 immunoreactivity (ir) at the PVN, reduced GR and CRHR1 expression in pyramidal CA1 neurons, and increased LC TH expression in ischemic rats displaying working memory errors in the radial arm Maze. Findings from Experiment 2 revealed increased CORT secretion up to 7 days, but no longer present 14 and 21 days post ischemia. However upon an acute restraint stress induced 27 days following reperfusion, ischemic rats had increased plasma CORT secretions compared to sham-operated animals, suggesting HPA axis hypersensitivity. Antalarmin (2 µg/2 µl) pretreatment significantly attenuated post ischemic elevation of basal and stress-induced CORT secretion. These findings support persistent neuroendocrine dysfunctions following brain ischemia likely to contribute to emotional and cognitive impairments observed in survivors of cardiac arrest and stroke.

A refined blood collection method for quantifying corticosterone.

In many rodent laboratories, blood samples are collected from rats using the tail vein nick procedure and analyzed to quantify blood corticosterone levels as an indicator of stress. The standard method of corticosterone quantification often requires the collection of a relatively large volume of blood, followed by the extraction of the blood plasma. An alternative blood sampling method requires the collection of only a drop of blood on paper (the 'drop' method), minimizing handling of the animals, and does not require plasma extraction. The authors aimed to validate the drop method of blood sampling for use in corticosterone quantification. They induced stress in rats by cerebral ischemia, collected blood samples at various intervals using both the drop method and the plasma extraction method and then quantified corticosterone by radioimmunoassay. Corticosterone levels of the ischemic rats were compared with those of sham-operated rats and those of ischemic rats that had been given metyrapone, a glucocorticoid synthesis inhibitor, prior to vessel occlusion. Blood corticosterone levels in the samples obtained from the same animal using the two different methods were highly correlated for all rats. The authors further provide a regression model that can be used to predict plasma corticosterone values from those obtained from the drop blood samples. Quantification of corticosterone from only a small drop of blood has many practical and ethical advantages and should be considered as an alternative to standard methods.

Changes in HPA reactivity and noradrenergic functions regulate spatial memory impairments at delayed time intervals following cerebral ischemia.

This study investigates the association of ischemia-induced spatial memory impairment to alterations of the HPA axis and noradrenergic activation post insult. Experiment 1 characterized the effects of 10 min forebrain ischemia on corticosterone (CORT) secretion following ischemia and in response to spatial memory assessment in the Barnes maze, as well as the impact of pre-ischemia treatment with the glucocorticoid inhibitor metyrapone (175 mg/kg; s.c.). The results showed that cerebral ischemia represents a significant physiological stressor that upregulated CORT secretion 1, 24 and 72 h post-ischemia but not at 7 days. In response to testing in the Barnes maze ischemic animals showed elevated CORT secretion simultaneously with spatial memory deficits. The single dose of metyrapone attenuated the ischemia-induced adrenocortical hyper-responsiveness and subsequent memory deficits despite not providing neuroprotection in the hippocampal CA1 pyramidal cells. To complement these findings, we examined whether norepinephrine which provides positive feedback to the HPA axis and is upregulated following brain ischemia could influence memory performance at delayed intervals after ischemia. Experiment 2 demonstrated that pre-testing administration of the alpha2-adrenoceptor agonist clonidine (.04 mg/kg, s.c.) attenuated ischemia-induced working memory impairments in a radial maze while opposite effects were obtained with the antagonist yohimbine (.3 mg/kg, s.c.). Post-testing administration of clonidine produced spatial reference memory impairments in ischemic rats. The findings from the current study demonstrate increased sensitization and responsiveness of systems regulating stress hormones at long intervals post ischemia. Importantly, we demonstrate that these effects contribute to post ischemic cognitive impairments which can be attenuated pharmacologically even in the presence of hippocampal degeneration at time of testing.

How right is the righting reflex? The risk of false positives in neuroprotection studies using behavioral measures to certify forebrain ischemia.

The righting reflex (RR) as a behavioral index of incomplete ischemia during four-vessel occlusion (4VO) remains a common exclusion criterion. In the present study different drugs (aniracetam, ondansetron, and metyrapone) were administered to Wistar rats at a variety of doses prior to unanesthetized forebrain ischemia lasting 10 minutes forebrain ischemia in. Using the RR as an exclusion criterion, their effects on neuronal survival and functional recovery were investigated. Our observations revealed dose-related suppression of RR expression leading to a higher proportion of drug-treated rats categorized as having experienced successful ischemia compared to the vehicle-treated groups. If uncontrolled, this effect led to assessments of increased neuronal survival (in CA1 hippocampal subfield) or improved cognitive behavioral recovery in treated rats. These observations appeared to be related to failure in identifying rats subjected to incomplete forebrain ischemia producing minimal neuronal damage rather than protective effects associated to drug administration. These findings highlight the risk of falsely reporting treatment-related neuronal protection with the unanesthetized 4VO model in rodents.

Time-dependent effects of global cerebral ischemia on anxiety, locomotion, and habituation in rats.

Although changes in emotionality represent common features of post-ischemic recovery in humans, little is known about the effects of global cerebral ischemia on standard behavioral measures of emotionality in rodents. The present study investigated anxiety, locomotor activity, and habituation in test-naïve ischemic (subjected to 10 min global ischemia) and sham-operated rats tested 1, 5, 15, and 30 days post-reperfusion in the elevated plus-maze and the open-field. Although rats tested on day 1 post-reperfusion showed increased anxiety relative to sham-operated controls, they demonstrated decreased anxiety on day 5. Anxiety levels were normal on days 15 and 30 following ischemia. Similarly, time-dependent changes in locomotor activity were observed with ischemic rats showing increased activity level on days 1, 5, and 30 post-reperfusion. Surprisingly, locomotor activity was suppressed at day 15. Habituation deficits in the open-field were apparent only on day 1 despite the lack of CA1 neuronal degeneration at this time interval. These findings suggest that both the nature and extent of the effects of global ischemia on behavioral measures of emotionality, locomotion, and habituation in rats are time-dependent.

Ischemia-induced hyperactivity: effects of dim versus bright illumination on open-field exploration and habituation following global ischemia in rats.

The current study reports the impact of different illumination conditions on exploratory activity following global ischemia in rats. Exploratory activity was tested at different post-ischemic intervals under bright (450 lux) or dim (40 lux) light exposure. A 30 min testing period performed 5 days post-reperfusion examined within-session open-field habituation in ischemic and sham-operated animals. Additional animals were tested in the open-field under the two illumination conditions for shorter 10 min tests on days 3, 6, and 9 following reperfusion. Our findings demonstrated illumination-related activity profile in the open-field in ischemic animals. While ischemic rats showed increased activity when tested under bright open-field illumination, reduced activity was observed under dim illumination as compared to sham-operated controls. Further, habituation deficits were not apparent in animals subjected to global ischemia under any illumination condition. Similar behavioral profiles and habituation were observed in ischemic animals when exposed to repetitive open-field tests at days 3, 6, and 9 following reperfusion. CA1 neuronal injury (approximately 75% as compared to sham rats) was comparable in all ischemic groups at day 12 following reperfusion. The present findings suggest that differences in initial behavioral reactivity of sham and ischemic rats to bright versus dimly lighted environments may contribute to differences in open-field exploration reported between these groups. They also challenge the notion that deficits in exploration in ischemic animals are mainly attributable to processes related to habituation, or that hyperactivity represents a reliable predictor of CA1 neuronal injury. These observations may help explain discrepant ischemia-induced behavioral effects reported in the open field.

Time-dependent changes in CRH concentrations and release in discrete brain regions following global ischemia: effects of MK-801 pretreatment.

The excitatory actions of corticotropin-releasing hormone (CRH) in the brain and the neuroprotective effects of CRH antagonists in models of ischemia suggest a role for this peptide in the cascade of events leading to cellular damage. The present study aimed to characterize endogenous activation of CRH in discrete brain regions following global ischemia. Time-dependent changes in CRH concentrations were assessed in 10 brain regions including hippocampal, parahippocampal, and hypothalamic regions as well as the amygdala and the frontal cortex at three post-ischemic intervals: 4, 24, and 72 h (Experiment 1). The impact of pretreatment with a neuroprotective dose of the NMDA antagonist (5R,10S)-(+)-5-Methyl-10,11-dihydro-5H-dibenzo[a,d]cyclohepten-5,10-imine hydrogen maleate (MK-801; hydrogen maleate) on 24-h ischemia-induced CRH concentrations in the 10 brain regions was also determined (Experiment 2). In vivo microdialysis was used to assess dynamic fluctuations in CRH release at the dorsal hippocampus (CA1 pyramidal layer) and central nucleus of the amygdala (CeA; Experiment 3). Our findings revealed a rapid elevation of CRH concentrations at the piriform cortex (Pir) and hypothalamic nuclei following global ischemia. This was followed by decreased CRH concentrations at the amygdala, the frontal cortex (FC), the CA3, and the hypothalamus 24-h post-ischemia. MK-801 reversed the decreases in the hypothalamic nuclei but not in the other brain regions. Seventy-two hours post-ischemia, CRH levels returned to control values in all regions except the dentate gyrus (DG) where elevated CRH levels were observed. In vivo, a significant increase in CRH release in response to global ischemia was found at the CeA with no alterations at the CA1. These findings support brain region-specific ischemia-induced CRH alterations and suggest that CRH actions to mediate neuronal damage at the hippocampal CA1 layer may be indirect.