A literature review of the challenges encountered in the adoption of assistive technology (AT) and training of healthcare professionals

Background: Long-term disabilities often result in loss of autonomy and social interaction. Accordingly, there is a demand for Assistive Technology (AT) devices to enable individuals to live independently for as long as possible. However, many people experience difficulties in obtaining and using AT. This paper presents findings from a narrative literature review undertaken as part of the development of AT training for healthcare professionals, one of the work areas of the ADAPT project (Assistive Devices for Empowering Disabled People through Robotic Technologies), funded by EU INTERREG France (Channel) England. The results of the review informed the design of a survey of healthcare professionals regarding their views and experiences of AT and the development of AT training. Method: The review sought to understand challenges encountered in the adoption and use of AT as well as how training of healthcare professionals in AT takes place. A narrative approach was adopted as the most appropriate way to synthesise published literature on this topic and describe its current state-of-art. Narrative reviews are considered an important educational tool in continuing professional development. An initial search was conducted via databases in the UK and France, including CINAHL, Academic Search Index, Social Sciences Citation Index, BDSP (Base de données en Santé Publique), Documentation EHESP/MSSH (Ecole des Hautes Etudes en Santé Publique/Maison des Sciences Sociales et Handicap), Cairn, Google Scholar and Pubmed. Inclusion criteria for the review included: covering issues relating to AT provision and training, English or French language, and published from 1990 onwards. Application of these criteria elicited 79 sources, including journal papers (48), reports (11), online sources (11), books (6) and conference papers (3). Sources were thematically analysed to draw out key themes. Key results: The majority of papers were from USA and Canada (27), then UK (20) and France (19). Others were from Europe (7), Australia (3), country unknown (2), and one joint UK/France publication. The main source of literature was journal papers (48), of which the most common types were practice reports (18), evaluation surveys (10) and qualitative studies (9). The review uncovered a number of key challenges related to the adoption of devices, including: difficulty defining AT across disciplines, lack of knowledge of healthcare professionals and users, obtrusiveness and stigmatisation AT users can experience when using devices, and shortfalls in communication amongst professional groups and between professionals and users. These issues can lead to abandonment of AT devices. Furthermore, substantial barriers to healthcare professionals exist, including inconsistent provision and quality of training, lack of evaluation of training, lack of resources and funding, shortage of qualified professionals to teach, and the increasingly rapid development of the technologies. Conclusion: Support, training and education for prescribers, distributors, users, and their carers is vital in the adoption and use of AT. Evidence indicates a need for comprehensive education in the AT field, as well as ongoing assessment, updates and evaluation which is embedded in programmes

A survey of assistive technology (AT) knowledge and experiences of healthcare professionals in the UK and France: challenges and opportunities for workforce development

Background: Assistive Technologies (AT) in healthcare can increase independence and quality of life for users. Concurrently, new AT devices offer opportunities for individualised care solutions. Nonetheless, AT remains under-utilised and is poorly integrated in practice by healthcare professionals (HCPs). Although occupational therapists (OTs), physiotherapists and speech and language therapists (SLTs) consider that AT solutions can offer problem-solving approaches to personalised care, they have a lesser understanding of application of AT in their practice. In this paper, we report findings of a survey on AT knowledge and experiences of HCPs in UK and France. Training needs also explored in the survey are presented in a separate paper on development of online training for the ADAPT project. Method: A survey of 37 closed/open questions was developed in English and French by a team of healthcare researchers. Content was informed by published surveys and studies. Email invitations were circulated to contacts in Health Trusts in UK and France ADAPT regions and the survey was hosted on an online platform. Knowledge questions addressed AT understanding and views of impact on user’s lives. Experience questions focussed on current practices, prescription, follow-up, abandonment and practice standards. 429 HCPs completed the survey (UK=167; FR=262) between June and November 2018. Key results: Participants were mainly female (UK 89.2%; FR 82.8%) and qualified 10+ years (UK 66.5%; FR 62.2%). A key group in both countries were OTs (UK 34.1%; FR 46.6%), with more physiotherapists and SLTs in UK (16.8%, 16.8%; Vs. FR 6.5%, 2.3%), and more nurses in France (22.1% Vs. UK 10.8%). More HCPs were qualified to degree level in France (75.2%; UK 48.5%, p<0.001). In terms of knowledge, all HCPs agreed that AT helps people complete otherwise difficult or impossible tasks (UK 86.2%; FR 94.3%) and that successful AT adoption always depends on support from carers, family and professionals (UK 52.7%; FR 66.2%). There were some notable differences between countries that require further exploration. For example, more French HCPs thought that AT is provided by trial and error (84.7%, UK 45.5%, p<0.001), while more UK HCPs believed that AT promotes autonomous living (93.4%; FR 42.8%, p<0.001). Also, more French HCPs considered that AT refers exclusively to technologically-advanced electronic devices (71.8%, UK 28.8%, p<0.001). In both countries, top AT prescribers were OTs, physiotherapists and SLTs. Respondents had little/no knowledge in comparing/choosing AT (UK 86.8%; FR 76.7%) and stated they would benefit from interdisciplinary clinical standards (UK 80.8%; FR 77.1%). A third of HCPs did not know if AT users had access to adequate resources/support (UK 34.1%; FR 27.5%) and rated themselves as capable to monitor continued effective use of AT (UK 38.9%; FR 34.8%). Conclusion: Knowledge and application of AT was varied between the two countries due to differences in health care provision and support mechanisms. Survey findings suggest that HCPs recognised the value of AT for users’ improved care, but had low confidence in their ability to choose appropriate AT solutions and monitor continued use, and would welcome AT interdisciplinary clinical standards

Evolution within a given virulence phenotype (pathotype) is driven by changes in aggressiveness: a case study of French wheat leaf rust populations

Plant pathogens are constantly evolving and adapting to their environment, including their host. Virulence alleles emerge, and then increase, and sometimes decrease in frequency within pathogen populations in response to the fluctuating selection pressures imposed by the deployment of resistance genes. In some cases, these strong selection pressures cannot fully explain the evolution observed in pathogen populations. A previous study on the French population of Puccinia triticina, the causal agent of wheat leaf rust, showed that two major pathotypes — groups of isolates with a particular combination of virulences — predominated but then declined over the 2005-2016 period. The relative dynamics and the domination of these two pathotypes — 166 317 0 and 106 314 0 —, relative to the other pathotypes present in the population at a low frequency although compatible, i.e. virulent on several varieties deployed, could not be explained solely by the frequency of Lr genes in the landscape. Within these two pathotypes, we identified two main genotypes that emerged in succession. We assessed three components of aggressiveness — infection efficiency, latency period and sporulation capacity — for 44 isolates representative of the four P. triticina pathotype-genotype combinations. We showed, for both pathotypes, that the more recent genotypes were more aggressive than the older ones. Our findings were highly consistent for the various components of aggressiveness for pathotype 166 317 0 grown on Michigan Amber — a ‘naive’ cultivar never grown in the landscape — or on Apache — a ‘neutral’ cultivar, which does not affect the pathotype frequency in the landscape and therefore was postulated to have no or minor selection effect on the population composition. For pathotype 106 314 0, the most recent genotype had a shorter latency period on several of the cultivars most frequently grown in the landscape, but not on ‘neutral’ and ‘naive’ cultivars. We conclude that the quantitative components of aggressiveness can be significant drivers of evolution in pathogen populations. A gain in aggressiveness stopped the decline in frequency of a pathotype, and subsequently allowed an increase in frequency of this pathotype in the pathogen population, providing evidence that adaptation to a changing varietal landscape not only affects virulence but can also lead to changes in aggressiveness

Fouilles à Marseille : la ville médiévale et moderne

Les fouilles archéologiques conduites dans le centre de Marseille depuis quelques décennies ont transformé notre connaissance de la ville. Longtemps focalisée sur la période grecque, première ville de France oblige, l'attention des archéologues s'est portée également sur des vestiges plus récents à partir du début des années 1990, alors que se multipliaient les opérations d'aménagement soit en limite de la ville antique et médiévale, soit au coeur même de celle-ci. Ainsi, de la place Villeneuve-Bargemon à la bibliothèque de l'Alcazar ou au tunnel de la Major, ce sont autant de lieux de découvertes qui retracent l'histoire de Marseille depuis le début du Moyen Age jusqu'à la Révolution française. Après dix ans de réflexion, alimentée par de nombreux articles, une exposition et des échanges croisés sur Marseille médiévale et moderne, les auteurs de ce volume ont souhaité restituer l'histoire de ce port majeur de la Méditerranée qu'est Marseille à un public aussi bien spécialisé que simplement désireux de mieux connaître cette ville. Le lecteur pourra ainsi comprendre comment des vestiges archéologiques, soigneusement sortis de leur gangue de terre par des archéologues professionnels, attestent des heurs et malheurs d'une cité qui croît au rythme du développement de l'activité portuaire. A côté des archéologues, la contribution des historiens et des archivistes à cette redécouverte de Marseille est importante. Elle témoigne de la nécessité de multiplier les regards sur des périodes que l'on croit connaître parce que plus proches de nous. L'ancrage que donne la matérialité des vestiges permet de mieux comprendre les références topographiques des textes d'archives écrits à une époque où l'évidence des lieux pour leurs contemporains fait ressortir notre propre ignorance. Abondamment illustré, ce volume met en valeur également le développement d'une archéologie des Temps modernes à côté de celle, déjà acceptée, du Moyen Age. C'est le développement de l'archéologie dite "de sauvetage" puis "préventive" qui a incité à traiter de façon égale tous les vestiges, quelle que soit leur période. Et là encore la confrontation avec les textes, en particulier dans le domaine de la construction, montre tout l'intérêt de cette approche pour la connaissance de nos racines

Unfolding Of Physical Spectra By Sequential Bayes Methods Part I: Linear Spline Models

Spline models are developed to correct smearing effects (unfolding) due to instrument resolution in measured spectra of neutron or X-ray scattering. Sequential algorithms are studied; the a-priori information has been included applying Bayes methods. © 1975 North-Holland Publishing Co.1273405411Mendès, de Polignac, (1973) Acta Cryst., 29 A, p. 1Mendès, Delestre, (1972) First Intern. Conf. on Spectral lines, , Knoxville, TennesseeSage, Melsa, (1971) Estimation theory with applications to communications and control, , McGraw-Hill, New YorkFreund, (1973) Ph. D. Dissertation, , Technische Universität, MünchenM. Roth, private communication (1973

Chromogranin A in the early steps of the neurosecretory pathway

International audienceChromogranin A (CgA) is a soluble glycoprotein stored with hormones andneuropeptides in secretory granules (SG) of most (neuro)endocrine cells andneurons. Since its discovery in 1967, many studies have reported its structuralcharacteristics, biological roles, and mechanisms of action. Indeed, CgA is botha precursor of various biologically active peptides and a granulogenic proteinregulating the storage and secretion of hormones and neuropeptides. Thisreview emphasizes the findings and theoretical concepts around the CgAlinkedmolecular machinery controlling hormone/neuropeptide aggregationand the interaction of CgA-hormone/neuropeptide aggregates with the trans-Golgi membrane to allow hormone/neuropeptide targeting and SG biogenesis.We will also discuss the intriguing alteration of CgA expression and secretionin various neurological disorders, which could provide insights to elucidate themolecular mechanisms underlying these pathophysiological conditions

Patients' perspectives on bronchiectasis:findings from a social media listening study

Although it is of great importance for healthcare professionals to ensure that patients’ needs and concerns are valued and that they feel confident in the quality of the care they receive, there have been few studies specifically addressing the opinions, experiences and needs of patients with bronchiectasis, and more importantly the emotional impact of the disease, diagnosis and treatment.  Using enterprise grade social listening tools, a comprehensive search around bronchiectasis was performed in five languages, on different social media platforms between January 2018 and December 2019 to obtain the perspectives of patients and caregivers from nine countries on symptoms, treatments and burden of the disease.  Over 27 000 mentions of bronchiectasis were identified on social media channels, 38.8% of which were posted by patients and caregivers. Approximately 1600 posts were found on bronchiectasis symptoms, out of which persistent cough, shortness of breath and mucus production (22%, 20% and 18%, respectively) were the most commonly discussed. The research revealed that existing diagnostic tests often delay diagnosis or provide inaccurate results, leading to multiple rounds of consults and substantial delays in treatment initiation and management of the disease. Misdiagnosis was common across different age groups, especially among patients without severe symptoms, and this was associated with an emotional burden of anger, confusion, frustration and anxiety.  Analysis of social media presents a new approach to derive insights on patients’ experiences and emotions with bronchiectasis and has the potential to complement more traditional approaches to drive more patient-focused drug development