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IntroductionMeaningful activities (MA) have a positive impact on identity, well-being, participation and inclusion. Although people with intellectual disabilities (PID) depend on their direct support professionals (DSPs) to engage in MA, the DSPs need support which could enable them to offer more qualitative care and support.Methods and analysisTo identify DSPs’ needs, and to develop a tool/service, an innovative and iterative approach is developed, based on the human-centred design (HCD) process, combined with traditional qualitative and quantitative research methods. In the inspiration phase (needs analysis), in-depth interviews will be conducted in two day care centres in Flanders using an interpretative phenomenological analyses, one with a supply-driven approach and the other with a demand-driven approach, followed by a survey sent to all Flemish day care centres. In the ideation phase, the insights of phase 1 will guide a cocreation process (comprising a World Cafe, brainstorm and prototype sessions) with the DSPs, PID and other stakeholders. In the implementation phase, the solution will be tested in the two day care centres from phase 1 by means of living labs and a realist evaluation. By adopting this protocol, the functionality, quality, usability and acceptance are expected to increase. This protocol adopts all phases of the HCD process and shows the complementarity of HCD with traditional research methods. PID and the DSPs will benefit as the end result is truly grounded in their specific needs and wishes.Ethics and disseminationEthical approval by the Ethics Committee of the University Hospital Ghent, Belgium (reference numbers: B670202042983 and PA2021-091). All participants will sign informed consent forms. Results of this study will be submitted for publication in relevant peer-reviewed journals and will be presented at relevant conferences.

Person-centered planning is a well known and widely used approach to individual program planning in the field of intellectual and developmental disabilities. Its purpose is to develop collaborative supports focused on community presence, community participation, positive relationships, respect, and competence. Because there is little research on its effectiveness, our purpose here was to (a) review the current status of effectiveness research; (b) describe its effectiveness in terms of outcomes or results; and (c) discuss the effectiveness of person-centered planning in relation to evidence-based practices. Analyzed studies suggest that, overall, this planning has a positive, but moderate, impact on personal outcomes for this population. The body of evidence provided in this review is weak with regard to criteria for evidence-based research.

This article describes a systematic approach to enhancing the personal well-being of children and adolescents with intellectual or closely related developmental disabilities. The article incorporates international trends in disability-related policies and practices and proposes a quality of life framework for implementing the approach, which consists of input, throughput, output, and outcome components. Guidelines for implementing the approach are presented, along with an example of its use.

As the concept of quality of life (QOL) has evolved from a theoretical concept to both a measurable construct and an action-oriented change agent in the field of intellectual disabilities, there has emerged a corresponding need to develop, implement, and use a systematic approach to the assessment of domain-referenced quality of life outcomes. The purpose of this article is to suggest eight principles based on published literature and the authors' experiences that should underlie the assessment of QOL-related personal outcomes in the field of intellectual disabilities. Data from the development of the personal outcomes scale are used to exemplify each principle. The article's premise is that model development and test construction should work in tandem, and that a ‘quality of life assessment instrument' should be based on an empirically derived QOL conceptual and measurement framework/model.

La mejora de la calidad de vida de los usuarios es la principal tarea de las organizaciones que prestan servicios de apoyo a las personas con discapacidad intelectual. Los planes individuales de apoyo (PIA) deben diseñarse teniendo en cuenta este objetivo. Por tanto, las cuestiones más importantes a las que debe prestarse atención cuando se redacta un PIA son: 1) ¿Qué quiere el usuario? y 2) ¿Qué apoyos necesita? Obviamente, lo que se busca es que el usuario goce de una buena calidad de vida.Además, en este trabajo hacemos hincapié en la importancia de las prácticas basadas en la evidencia; y, sobre la base de estos dos puntos de partida, proponemos las siguientes directrices para la elaboración del PIA. En el PIA se debe:– Analizar los objetivos y perspectivas del usuario (¿qué quiere conseguir en la vida?).– Analizar qué apoyos el usuario quiere y necesita (¿qué apoyos son importantes desde su punto de vista y cuáles realmente necesita?).– Formular estrategias de apoyo en función de los objetivos personales, los deseos y las necesidades del usuario.– Hacer un seguimiento de los procesos de apoyo en permanente diálogo y colaboración con el usuario.– Medir los resultados personales que se han conseguido.– Disponer de un sistema permanente para llevar a cabo los ajustes y adaptaciones que sean necesarios.– Recurrir a las prácticas basadas en la evidencia.– Ser claro y comprensible para el usuario.Con estas directrices hemos desarrollado un PIA en Internet, en el cual las ocho dimensiones de calidad de vida conforman el marco teórico a partir del cual se elaboran las estrategias de apoyo. El diálogo con el usuario se integra en el sistema de apoyo y los instrumentos basados en la evidencia se utilizan para medir las necesidades de apoyo y los resultados personales obtenidos.

In this article, the authors relate the life of Chris through narrative snapshots. Chris asked the authors to tell her story. They decided that it could be used to provide an insight into the different ways people with labels are confronted with professional practices and rituals. Although Chris lived a “tough life,” her story is full of resilience and resistance. Chris will be kept in the authors' memory as a strong woman, a teacher, and a friend.

For organizations providing supports to persons with intellectual disability it is their main task to enhance the quality of life of their clients. Individual Support Plans should be designed with this goal in mind. Consequently, important questions in writing an ISP are: 1) What does the person want?, and 2) Which support does the person need? The outcome should obviously be a good quality of life.Furthermore we emphasize in our work the importance of evidence-based practices. Based on these starting points we propose the following guideliness for an ISP. An ISP should:–     Explore goals and personal perspectives: what does a person want in his life.–     Explore what support a person needs and wants: which supports are important for and which are important to the person.–     Formulate support strategies in answer to the personal goals, wants and needs.–     Monitor in dialogue with the person the process of support.–     Measure personal outcomes.–     Comprise an ongoing system of finetuning and adjusting.–     Use evidence based practices in doing so.–     Be transparant and comprehensible for the person.Following these guideliness we developed an internet based ISP in which the eight QOL dimensions provide the framework for developing support strategies, the dialogue with the client is build into the system of supports, and evidence based instruments are used to measure support needs and personal outcomes. 

Systemic resistance induced in plants by nonpathogenic rhizobacteria is typically effective against multiple pathogens. Here, we show that root-colonizing Pseudomonas fluorescens strain SS101 (Pf.SS101) enhanced resistance in Arabidopsis (Arabidopsis thaliana) against several bacterial pathogens, including Pseudomonas syringae pv tomato (Pst) and the insect pest Spodoptera exigua. Transcriptomic analysis and bioassays with specific Arabidopsis mutants revealed that, unlike many other rhizobacteria, the Pf.SS101-induced resistance response to Pst is dependent on salicylic acid signaling and not on jasmonic acid and ethylene signaling. Genome-wide transcriptomic and untargeted metabolomic analyses showed that in roots and leaves of Arabidopsis plants treated with Pf.SS101, approximately 1,910 genes and 50 metabolites were differentially regulated relative to untreated plants. Integration of both sets of \"omics\" data pointed to a prominent role of camalexin and glucosinolates in the Pf.SS101-induced resistance response. Subsequent bioassays with seven Arabidopsis mutants (myb51, cyp79B2cyp79B3, cyp81F2, pen2, cyp71A12, cyp71A13, and myb28myb29) disrupted in the biosynthesis pathways for these plant secondary metabolites showed that camalexin and glucosinolates are indeed required for the induction of Pst resistance by Pf.SS101. Also for the insect S. exigua, the indolic glucosinolates appeared to play a role in the Pf.SS101-induced resistance response. This study provides, to our knowledge for the first time, insight into the substantial biochemical and temporal transcriptional changes in Arabidopsis associated with the salicylic acid-dependent resistance response induced by specific rhizobacteria.

BackgroundChest CT displays chest pathology better than chest X-ray (CXR). We evaluated the effects on health outcomes of replacing CXR by ultra-low-dose chest-CT (ULDCT) in the diagnostic work-up of patients suspected of non-traumatic pulmonary disease at the emergency department.MethodsPragmatic, multicentre, non-inferiority randomised clinical trial in patients suspected of non-traumatic pulmonary disease at the emergency department. Between 31 January 2017 and 31 May 2018, every month, participating centres were randomly allocated to using ULDCT or CXR. Primary outcome was functional health at 28 days, measured by the Short Form (SF)-12 physical component summary scale score (PCS score), non-inferiority margin was set at 1 point. Secondary outcomes included hospital admission, hospital length of stay (LOS) and patients in follow-up because of incidental findings.Results2418 consecutive patients (ULDCT: 1208 and CXR: 1210) were included. Mean SF-12 PCS score at 28 days was 37.0 for ULDCT and 35.9 for CXR (difference 1.1; 95% lower CI: 0.003). After ULDCT, 638/1208 (52.7%) patients were admitted (median LOS of 4.8 days; IQR 2.1–8.8) compared with 659/1210 (54.5%) patients after CXR (median LOS 4.6 days; IQR 2.1–8.8). More ULDCT patients were in follow-up because of incidental findings: 26 (2.2%) versus 4 (0.3%).ConclusionsShort-term functional health was comparable between ULDCT and CXR, as were hospital admissions and LOS, but more incidental findings were found in the ULDCT group. Our trial does not support routine use of ULDCT in the work-up of patients suspected of non-traumatic pulmonary disease at the emergency department.Trial registration numberNTR6163.

PURPOSE: Maintenance of cognitive abilities is important for elderly to stay independent. With the aging of the population, the call for modifiable factors is emerging. Dietary protein might improve cognitive performance; however, this has hardly been studied. Therefore, we studied the impact of 24-week dietary protein supplementation on cognitive performance in pre-frail and frail elderly people. METHODS: Pre-frail and frail elderly subjects, according to the Fried criteria, randomly received a protein drink containing 15 g protein or a placebo drink twice a day. Cognitive performance was measured at baseline and after 24 weeks by means of a sensitive neuropsychological test battery. In addition, reaction time was assessed after both 12 and 24 weeks of intervention. Domain scores were calculated for the domains episodic memory, attention and working memory, information processing speed, and executive functioning. Analyses of covariance were used to determine differences between groups. Linear mixed models were used to determine differences in reaction time over time and per treatment. RESULTS: In total, 65 subjects (79 ± 8 years) with a median Mini-Mental State Examination score of 28 (interquartile range 26–30) were included. Reaction time improved more in the protein group (68 ms) than in the placebo group (18 ms, P = 0.03). Dietary protein had no significant effect on any of the cognitive domain scores. CONCLUSIONS: Protein supplementation might improve reaction time performance in pre-frail and frail elderly, but did not improve other cognitive functions.