Managing Multiple Students on Clinical Placement via Peer Learning: The Hull Evaluation-Appraisal-Student-Integrated (EASI) Model

There is a national shortfall of student Allied Health Professional (AHP) clinical placement availability in the United Kingdom. Debate exists regarding ways to improve this situation against the backdrop of National Health Service (NHS) pressures. Historically, clinical educators have adopted a one clinical educator to one student (1:1) model. AHP clinicians perceive various barriers regarding the implementation of peer learning placement models where multiple students (two or more) are assigned to one clinical educator. A means to address the perceived barriers to adopting a peer learning placement model has been gained from unstructured interviews, conference feedback, questionnaires, and a literature review. Assimilation of this information has resulted in the development of a peer learning model named the Hull Evaluation-Appraisal-Student-Integrated (EASI) model. This combines tools developed from other peer learning models with bespoke tools that have been developed to address barriers perceived by clinical educators and students. The Hull EASI model emphasizes a team approach for enhancing students’ educational experience rather than it being the sole responsibility of the clinical educator. It was piloted within a physiotherapy musculoskeletal (MSK) outpatient setting. The Hull EASI model will undergo further development and evaluation, including in the inpatient setting and with other AHP professions. It will continue to evolve in response to local demands

Distraction Effects of Phone Use During a Crucial Driving Maneuver

Forty-two licensed drivers were tested in an experiment that required them to react to an invehicle phone at precisely the same time as they were faced with making a crucial driving decision. Using test track facilities, we extended a previous evaluation of this form to include examination of the influence of driver gender and driver age. Specifically, each driver was given task practice and then performed two blocks of twenty-four trials each, where one trial represented a circuit of the test track. Half of the trials were control conditions in which neither the stop-light was activated or the in-vehicle phone triggered. Four trials required only stopping and a further four only phone response. The remaining four trials required the driver to complete each task simultaneously. The order of presentation of specific trials was randomized. The invehicle phone response task also contained an embedded memory task that was evaluated at the end of each trial. Results confirmed previous observations of slower task response followed by increased braking and that these patterns varied by driver age and gender. Most importantly, we recorded a critical 15% increase in non-response to the stop-light in the presence of the phone distraction task which represents stop light violations on the open road. Further, results showed that age had a much large effect on response than gender, especially on task components that required speed of response. Since driving represents a highly complex and interactive environment, it is not possible to specify a simplistic relationship between these distraction effects and outcome accident patterns. However, we can conclude that such technologies erode performance safety margin and distract drivers from their critical primary task of vehicle control. As such there is expectedly a causal relation in accident outcome that is a crucial concern for invehicle device designers and for all others seeking to ameliorate the adverse impact of vehicle accidents

Improved quantification of HIV-1 infected CD4 + T cells using an optimised method of intracellular HIV-1 gag p24 antigen detection

The capacity of CD8+ T cells to inhibit HIV-1 replication in vitro strongly correlates with virus control in vivo. Post-hoc evaluations of HIV-1 vaccine candidates suggest that this immunological parameter is a promising benchmark of vaccine efficacy. Large-scale analysis of CD8+ T cell antiviral activity requires a rapid, robust and economical assay for accurate quantification of HIV-1 infection in primary CD4+ T cells. Detection of intracellular HIV-1 p24 antigen (p24 Ag) by flow cytometry is one such method but it is thought to be less sensitive and quantitative than p24 Ag ELISA. We report that fixation and permeabilisation of HIV-infected cells using paraformaldehyde/50% methanol/Nonidet P-40 instead of a conventional paraformaldehyde/saponin-based protocol improved their detection across multiplicities of infection (MOI) ranging from 10-2 to 8×10-5, and by nearly two-fold (p<0.001) at the optimal MOI tested (10-2). The frequency of infected cells was strongly correlated with p24 Ag release during culture, thus validating its use as a measure of productive infection. We were also able to quantify infection with a panel of HIV-1 isolates representing the major clades. The protocol described here is rapid and cost-effective compared with ELISA and thus could be a useful component of immune monitoring of HIV-1 vaccines and interventions to reduce viral reservoirs. © 2013 Elsevier B.V

Therapeutic vaccination following early antiretroviral therapy elicits highly functional T cell responses against conserved HIV-1 regions

'Kick and kill' cure strategies aim to induce HIV protein expression in latently infected cells (kick), and thus trigger their elimination by cytolytic T cells (kill). In the Research in Viral Eradication of HIV Reservoirs trial (NCT02336074), people diagnosed with primary HIV infection received immediate antiretroviral therapy (ART) and were randomised 24 weeks later to either a latency-reversing agent, vorinostat, together with ChAdV63.HIVconsv and MVA.HIVconsv vaccines, or ART alone. This intervention conferred no reduction in HIV-1 reservoir size over ART alone, despite boosting virus-specific CD4+ and CD8+ T cells. The effects of the intervention were examined at the cellular level in the two trial arms using unbiased computational analysis of polyfunctional scores. This showed that the frequency and polyfunctionality of virus-specific CD4+ and CD8+ T cell populations were significantly increased over 12 weeks post-vaccination, compared to the ART-only arm. HIV-specific IL-2-secreting CD8+ T cells also expanded significantly in the intervention arm and were correlated with antiviral activity against heterologous HIV in vitro. Therapeutic vaccination during ART commenced in primary infection can induce functional T cell responses that are phenotypically similar to those of HIV controllers. Analytical therapy interruption may help determine their ability to control HIV in vivo

Identification of effective subdominant anti-HIV-1 CD8+ T cells within entire post-infection and post-vaccination immune responses

Ajuts: R01/R56 NIH Grant AI-52779 (GDT), NIH F31 Fellowship (1F31AI106519-01)(TLP), Center for AIDS Research (P30 AI 64518) i Center for HIV/AIDS Vaccine Immunology and Immunogen Discovery, grant number UM1-AI100645-01 (AM)Abstract.Defining the components of an HIV immunogen that could induce effective CD8+ T cell responses is critical to vaccine development. We addressed this question by investigating the viral targets of CD8+ T cells that potently inhibit HIV replication in vitro, as this is highly predictive of virus control in vivo. We observed broad and potent ex vivo CD8+ T cell-mediated viral inhibitory activity against a panel of HIV isolates among viremic controllers (VC, viral loads <5000 copies/ml), in contrast to unselected HIV-infected HIV Vaccine trials Network (HVTN) participants. Viral inhibition of clade-matched HIV isolates was strongly correlated with the frequency of CD8+ T cells targeting vulnerable regions within Gag, Pol, Nef and Vif that had been identified in an independent study of nearly 1000 chronically infected individuals. These vulnerable and so-called "beneficial" regions were of low entropy overall, yet several were not predicted by stringent conservation algorithms. Consistent with this, stronger inhibition of clade-matched than mismatched viruses was observed in the majority of subjects, indicating better targeting of clade-specific than conserved epitopes. The magnitude of CD8+ T cell responses to beneficial regions, together with viral entropy and HLA class I genotype, explained up to 59% of the variation in viral inhibitory activity, with magnitude of the T cell response making the strongest unique contribution. However, beneficial regions were infrequently targeted by CD8+ T cells elicited by vaccines encoding full-length HIV proteins, when the latter were administered to healthy volunteers and HIV-positive ART-treated subjects, suggesting that immunodominance hierarchies undermine effective anti-HIV CD8+ T cell responses. Taken together, our data support HIV immunogen design that is based on systematic selection of empirically defined vulnerable regions within the viral proteome, with exclusion of immunodominant decoy epitopes that are irrelevant for HIV control

Healthy Hearts – A community-based primary prevention programme to reduce coronary heart disease

Background The ten year probability of cardiovascular events can be calculated, but many people are unaware of their risk and unclear how to reduce it. The aim of this study was to assess whether a community based intervention, for men and women aged between 45 and 64 years without pre-existing coronary heart disease, would reduce their Framingham scores when reassessed one year later. Methods Individuals in the relevant age group from a defined geographical area were sent an invitation to attend for an assessment of their cardiovascular risk. Individuals with pre-existing cardiovascular disease or terminal illness were excluded. The invitation was in the form of a "Many Happy Returns" card with a number of self-screening questions including the question, "If you put the enclosed string around your waist, is it too short?" The card contained a red 80 cm piece of string in the case of women, or a green 90 cm piece of string in the case of men. At the assessment appointment, Framingham scores were calculated and a printout was given to each individual. Advice was provided for relevant risk factors identified using agreed guidelines. If appropriate, onward referral was also made to a GP, dietician, an exercise referral scheme, or to smoking cessation services, using a set of guidelines. Individuals were sent a second invitation one year later to return for re-assessment. Results and discussion 2031 individuals were asked to self-assess their eligibility to participate, 596 individuals attended for assessment and 313 of these attended for follow-up one year later. The mean reduction in the Framingham risk score, was significantly lower at one year (0.876, 95% CI 0.211 to 1.541, p = 0.01). The mean 10-year risk of CHD at baseline was 13.14% (SD 9.18) and had fallen at follow-up to 12.34% (SD 8.71), a mean reduction of 6.7% of the initial 10-year Framingham risk. If sustained, the estimated NNT to prevent each year of CHD would be 1141 (95% CI 4739 to 649) individual appointments. Conclusion This community intervention for primary prevention of CHD reduces Framingham risk scores at one year in those who engage with the programme

Asthma exacerbation and steroid burden in Australian primary care

Peer reviewedPostprin

Gems of the Galaxy Zoos—A Wide-ranging Hubble Space Telescope Gap-filler Program*

We describe the Gems of the Galaxy Zoos (Zoo Gems) project, a gap-filler project using short windows in the Hubble Space Telescope's schedule. As with previous snapshot programs, targets are taken from a pool based on position; we combine objects selected by volunteers in both the Galaxy Zoo and Radio Galaxy Zoo citizen-science projects. Zoo Gems uses exposures with the Advanced Camera for Surveys to address a broad range of topics in galaxy morphology, interstellar-medium content, host galaxies of active galactic nuclei, and galaxy evolution. Science cases include studying galaxy interactions, backlit dust in galaxies, post-starburst systems, rings and peculiar spiral patterns, outliers from the usual color–morphology relation, Green Pea compact starburst systems, double radio sources with spiral host galaxies, and extended emission-line regions around active galactic nuclei. For many of these science categories, final selection of targets from a larger list used public input via a voting process. Highlights to date include the prevalence of tightly wound spiral structure in blue, apparently early-type galaxies, a nearly complete Einstein ring from a group lens, redder components at lower surface brightness surrounding compact Green Pea starbursts, and high-probability examples of spiral galaxies hosting large double radio sources

Identification of Effective Subdominant Anti-HIV-1 CD8+ T Cells Within Entire Post-infection and Post-vaccination Immune Responses

Defining the components of an HIV immunogen that could induce effective CD8+ T cell responses is critical to vaccine development. We addressed this question by investigating the viral targets of CD8+ T cells that potently inhibit HIV replication in vitro, as this is highly predictive of virus control in vivo. We observed broad and potent ex vivo CD8+ T cell-mediated viral inhibitory activity against a panel of HIV isolates among viremic controllers (VC, viral loads <5000 copies/ml), in contrast to unselected HIV-infected HIV Vaccine trials Network (HVTN) participants. Viral inhibition of clade-matched HIV isolates was strongly correlated with the frequency of CD8+ T cells targeting vulnerable regions within Gag, Pol, Nef and Vif that had been identified in an independent study of nearly 1000 chronically infected individuals. These vulnerable and so-called “beneficial” regions were of low entropy overall, yet several were not predicted by stringent conservation algorithms. Consistent with this, stronger inhibition of clade-matched than mismatched viruses was observed in the majority of subjects, indicating better targeting of clade-specific than conserved epitopes. The magnitude of CD8+ T cell responses to beneficial regions, together with viral entropy and HLA class I genotype, explained up to 59% of the variation in viral inhibitory activity, with magnitude of the T cell response making the strongest unique contribution. However, beneficial regions were infrequently targeted by CD8+ T cells elicited by vaccines encoding full-length HIV proteins, when the latter were administered to healthy volunteers and HIV-positive ART-treated subjects, suggesting that immunodominance hierarchies undermine effective anti-HIV CD8+ T cell responses. Taken together, our data support HIV immunogen design that is based on systematic selection of empirically defined vulnerable regions within the viral proteome, with exclusion of immunodominant decoy epitopes that are irrelevant for HIV control