Allied Health Student Clinical Placements in Residential Aged Care Facilities: Staff Opinions, Attitudes, and Support Needs

Purpose: As the population ages, the incidence and prevalence of chronic health issues requiring allied health management is increasing. Currently, there is an undersupply of appropriately skilled allied health professionals working in aged care. This has also been identified as a setting in which many beginning health practitioners are reluctant to seek employment. In order to address this workforce shortage, it is imperative that students are prepared for a possible future career within aged care facilities. Early clinical experience within this setting may increase student confidence, raise awareness of the need for services, and encourage students to consider working in aged care. At present, student clinical placements within aged care facilities are limited, potentially contributing to difficulties addressing workforce needs. The reasons for the lack of clinical placements and the relative contribution of the opinions, attitudes, training, and support needs of staff are unknown. The purpose of this study was to investigate the opinions, attitudes, support, and training needs of physiotherapists, dieticians, and managers working in residential aged care regarding allied health professional student clinical placements. Method: A written survey of allied health professionals (dieticians and physiotherapists, n=26) and managers (n=40) working in residential aged care was conducted. Responses were analysed using qualitative and quantitative methods. Results: Participants had generally positive attitudes towards student placements in residential aged care. Managers were significantly more positive regarding the scope for student clinical placements within their facilities than allied health professionals (p\u3c 0.05). The biggest barrier to student placements identified by both managers and allied health professionals was the nature of employment of allied health professionals in the sector. Participating allied health professionals also indicated that they required specific training in student supervision and the provision of clinical education. Conclusion: The attitudes and opinions of allied health professionals and managers did not appear to contribute to a lack of allied health professional student placements in aged care facilities. The main barriers to placement were the nature of allied health professional employment and a lack of staff experience in supervising students on clinical placement. Specific training and mentoring of allied health professionals may facilitate increased student placement capacity in the aged care setting

Current trends and practices in the use of imprisonment

This article charts the rapid rise in the use of imprisonment in recent decades before considering some of the most pressing issues of concern in the use of imprisonment today. First among these is prison overcrowding, which continues to blight the record of many countries in their treatment of prisoners. To illustrate the potentially dire consequences of overcrowding – a problem common to many other countries and regions – an account is given of a recent visit to a prison in El Salvador. The article then provides an overview of the relevant regional and international standards on the treatment of prisoners, referring also to the role of judicial bodies in ensuring implementation

Generation Z and Hospitality Careers

This article explores youth career decision-making at a time of ongoing concerns surrounding the supply of labour to the hospitality industry. This article is unique in its combination of attitudes of Generation Z with a pre-university-aged sample combined with employer views. A survey of 245 youth provided insights into work values and attitudes towards hospitality careers, which was complemented by interviews with nine hospitality employers. Findings indicate only a small percentage of youth consider hospitality employment an attractive option. However, this insight must be tempered by an acknowledgement of participants’ early, exploratory phase of career development, by the fact that other occupations were equally not regarded in particularly high esteem, and the important role capability considerations played in assessing career options. Beyond a focus on personal development, there was little indication of homogeneity regarding work values. Employer interviews supported the notion of an ‘ignorance barrier’ in relation to youth seeking hospitality employment. The UK hospitality sector is increasingly concerned with addressing the ‘image’ of the industry as an attractive career choice, and this research underlines the importance of industry working together with education partners to promote the opportunities and address negative perceptions

Development of an in vitro PIG-A gene mutation assay in human cells

Mutagens can be carcinogens, and traditionally, they have been identified in vitro using the Salmonella ‘Ames’ reverse mutation assay. However, prokaryotic DNA packaging, replication and repair systems are mechanistically very different to those in the humans we inevitably seek to protect. Therefore, for many years, mammalian cell line genotoxicity assays that can detect eukaryotic mutagens as well as clastogens and aneugens have been used. The apparent lack of specificity in these largely rodent systems, due partly to their mutant p53 status, has contributed to the use of animal studies to resolve data conflicts. Recently, silencing mutations at the PIG-A locus have been demonstrated to prevent glycophosphatidylinositol (GPI) anchor synthesis and consequentially result in loss of GPI-anchored proteins from the cell’s extracellular surface. The successful exploitation of this mutant phenotype in animal studies has triggered interest in the development of an analogous in vitro PIG-A mutation screeningassay. This article describes the development of a robust assay design using metabolically active human cells. The assay includes viability and cell membrane integrity assessment and conforms to the future ideas of the 21st-century toxicology testing

Stochastic specification of primordial germ cells from mesoderm precursors in axolotl embryos

A common feature of development in most vertebrate models is the early segregation of the germ line from the soma. For example, in Xenopus and zebrafish embryos primordial germ cells (PGCs) are specified by germ plasm that is inherited from the egg; in mice, Blimp1 expression in the epiblast mediates the commitment of cells to the germ line. How these disparate mechanisms of PGC specification evolved is unknown. Here, in order to identify the ancestral mechanism of PGC specification in vertebrates, we studied PGC specification in embryos from the axolotl (Mexican salamander), a model for the tetrapod ancestor. In the axolotl, PGCs develop within mesoderm, and classic studies have reported their induction from primitive ectoderm (animal cap). We used an axolotl animal cap system to demonstrate that signalling through FGF and BMP4 induces PGCs. The role of FGF was then confirmed in vivo. We also showed PGC induction by Brachyury, in the presence of BMP4. These conditions induced pluripotent mesodermal precursors that give rise to a variety of somatic cell types, in addition to PGCs. Irreversible restriction of the germ line did not occur until the mid-tailbud stage, days after the somatic germ layers are established. Before this, germline potential was maintained by MAP kinase signalling. We propose that this stochastic mechanism of PGC specification, from mesodermal precursors, is conserved in vertebrates

Stochastic specification of primordial germ cells from mesoderm precursors in axolotl embryos

A common feature of development in most vertebrate models is the early segregation of the germ line from the soma. For example, in Xenopus and zebrafish embryos primordial germ cells (PGCs) are specified by germ plasm that is inherited from the egg; in mice, Blimp1 expression in the epiblast mediates the commitment of cells to the germ line. How these disparate mechanisms of PGC specification evolved is unknown. Here, in order to identify the ancestral mechanism of PGC specification in vertebrates, we studied PGC specification in embryos from the axolotl (Mexican salamander), a model for the tetrapod ancestor. In the axolotl, PGCs develop within mesoderm, and classic studies have reported their induction from primitive ectoderm (animal cap). We used an axolotl animal cap system to demonstrate that signalling through FGF and BMP4 induces PGCs. The role of FGF was then confirmed in vivo. We also showed PGC induction by Brachyury, in the presence of BMP4. These conditions induced pluripotent mesodermal precursors that give rise to a variety of somatic cell types, in addition to PGCs. Irreversible restriction of the germ line did not occur until the mid-tailbud stage, days after the somatic germ layers are established. Before this, germline potential was maintained by MAP kinase signalling. We propose that this stochastic mechanism of PGC specification, from mesodermal precursors, is conserved in vertebrates.</jats:p

Virologic Failure of Protease Inhibitor-Based Second-Line Antiretroviral Therapy without Resistance in a Large HIV Treatment Program in South Africa

Background: We investigated the prevalence of wild-type virus (no major drug resistance) and drug resistance mutations at second-line antiretroviral treatment (ART) failure in a large HIV treatment program in South Africa. Methodology/ Principal Findings HIV-infected patients $\geq$15 years of age who had failed protease inhibitor (PI)-based second-line ART (2 consecutive HIV RNA tests >1000 copies/ml on lopinavir/ritonavir, didanosine, and zidovudine) were identified retrospectively. Patients with virologic failure were continued on second-line ART. Genotypic testing for drug resistance was performed on frozen plasma samples obtained closest to and after the date of laboratory confirmed second-line ART failure. Of 322 HIV-infected patients on second-line ART, 43 were adults with confirmed virologic failure, and 33 had available plasma for viral sequencing. HIV-1 RNA subtype C predominated (n = 32, 97%). Mean duration on ART (SD) prior to initiation of second-line ART was 23 (17) months, and time from second-line ART initiation to failure was 10 (9) months. Plasma samples were obtained 7(9) months from confirmed failure. At second-line failure, 22 patients (67%) had wild-type virus. There was no major resistance to PIs found. Eleven of 33 patients had a second plasma sample taken 8 (5.5) months after the first. Median HIV-1 RNA and the genotypic resistance profile were unchanged. Conclusions/ Significance: Most patients who failed second-line ART had wild-type virus. We did not observe evolution of resistance despite continuation of PI-based ART after failure. Interventions that successfully improve adherence could allow patients to continue to benefit from second-line ART therapy even after initial failure

Dolutegravir efficacy at 48 weeks in key subgroups of treatment-naive HIV-infected individuals in three randomized trials

Objectives:Dolutegravir (DTG) has been studied in three trials in HIV treatment-naive participants, showing noninferiority compared with raltegravir (RAL), and superiority compared with efavirenz and ritonavir-boosted darunavir. We explored factors that predicted treatment success, the consistency of observed treatment differences across subgroups and the impact of NRTI backbone on treatment outcome.Design:Retrospective exploratory analyses of data from three large, randomized, international comparative trials: SPRING-2, SINGLE, and FLAMINGO.Methods:We examined the efficacy of DTG in HIV-infected participants with respect to relevant demographic and HIV-1-related baseline characteristics using the primary efficacy endpoint from the studies (FDA snapshot) and secondary endpoints that examine specific elements of treatment response. Regression models were used to analyze pooled data from all three studies.Results:Snapshot response was affected by age, hepatitis co-infection, HIV risk factor, baseline CD4+ cell count, and HIV-1 RNA and by third agent. Differences between DTG and other third agents were generally consistent across these subgroups. There was no evidence of a difference in snapshot response between abacavir/lamivudine (ABC/3TC) and tenofovir/emtricitabine (TDF/FTC) overall [ABC/3TC 86%, TDF/FTC 85%, difference 1.1%, confidence interval (CI) −1.8, 4.0 percentage points, P = 0.61] or at high viral loads (difference −2.5, 95% CI −8.9, 3.8 percentage points, P = 0.42).Conclusions:DTG is a once-daily, unboosted integrase inhibitor that is effective in combination with either ABC/3TC or TDF/FTC for first-line antiretroviral therapy in HIV-positive individuals with a variety of baseline characteristics

Oldest pathology in a tetrapod bone illuminates the origin of terrestrial vertebrates

The origin of terrestrial tetrapods was a key event in vertebrate evolution, yet how and when it occurred remains obscure, due to scarce fossil evidence. Here, we show that the study of palaeopathologies, such as broken and healed bones, can help elucidate poorly understood behavioural transitions such as this. Using high-resolution finite element analysis, we demonstrate that the oldest known broken tetrapod bone, a radius of the primitive stem tetrapod Ossinodus pueri from the mid-Viséan (333 million years ago) of Australia, fractured under a high-force, impact-type loading scenario. The nature of the fracture suggests that it most plausibly occurred during a fall on land. Augmenting this are new osteological observations, including a preferred directionality to the trabecular architecture of cancellous bone. Together, these results suggest that Ossinodus, one of the first large (&gt;2m length) tetrapods, spent a significant proportion of its life on land. Our findings have important implications for understanding the temporal, biogeographical and physiological contexts under which terrestriality in vertebrates evolved. They push the date for the origin of terrestrial tetrapods further back into the Carboniferous by at least two million years. Moreover, they raise the possibility that terrestriality in vertebrates first evolved in large tetrapods in Gondwana rather than in small European forms, warranting a re-evaluation of this important evolutionary event

Engaging with the politics of climate resilience towards clean water and sanitation for all

Climate resilient development has become the new paradigm for sustainable development influencing theory and practice acrossall sectors globally—gaining particular momentum in the water sector, since water security is intimately connected to climatechange. Climate resilience is increasingly recognised as being inherently political, yet efforts often do not sufficiently engage withcontext-specific socio-ecological, cultural and political processes, including structural inequalities underlying historically produced vulnerabilities. Depoliticised approaches have been shown to pose barriers to concerted and meaningful change. In this article,world-leading water specialists from academic and practitioner communities reflect on, and share examples of, the importance ofkeeping people and politics at the centre of work on climate resilient water security. We propose a roadmap to meaningfully engage with the complex politics of climate resilient water security. It is critical to re-politicise climate resilience to enable effortstowards sustainable development goal 6—clean water and sanitation for all