Novel robotic assistive technologies: choosing appropriate training for healthcare professionals

One of the key challenges for the training of healthcare professionals (HCPs) is to maintain a good understanding and knowledge of new assistive technologies (ATs) that are currently on the market [1]. Indeed, at present, available training on ATs is limited and does not meet the practice-related needs of HCPs. It is in this context that the ADAPT European project aims to develop a new AT training programme for healthcare professionals, which will also introduce them to the project’s new AT developments - a smart powered wheelchair and a virtual reality wheelchair-driving simulator. The program consists of six multimodal units; five delivered via e-learning and one through a blended method of e-learning and face-to-face sessions. The development of the content is guided by findings from an earlier literature review and an online survey of AT training needs for HCP’s, both undertaken by the ADAPT cross-national research team, comprised of UK and French experts. The level of technical difficulty increases with successive units in order to train all HCPs to use innovative ATs more widely in their practice. A Learning Management System enables the dissemination of the e-learning AT program. Preliminary results from participant unit-specific evaluations available at this stage are overall positive and encouraging

Small urban centres as launching sites for plant invasions in natural areas : insights from South Africa

CITATION: McLean, P. et al. 2017. Small urban centres as launching sites for plant invasions in natural areas: insights from South Africa. Biological Invasions, 19(12):3541-3555. doi:10.1007/s10530-017-1600-4The original publication is available at https://www.springer.com/journal/10530Alien species are often first introduced to urban areas, so it is unsurprising that towns and cities are often hotspots for invasions. However, while large cities are usually the first sites of introduction, small towns are more numerous and have a greater chance of launching invasions into natural areas as they have proportionally larger interfaces with their surroundings. In this paper we develop a set of scenarios as hypotheses to explore the role of small towns in facilitating within-country dispersal of alien plants. In particular, we developed ten scenarios for how introductions to small towns, agricultural and natural areas can lead to landscape-scale invasions. We tested a part of these scenarios using a case study of a highly invaded region in South Africa (the Berg River catchment in the Western Cape). We specifically investigated the main plant invasion routes between 12 small towns and their surrounding agricultural and natural areas. This was accomplished by conducting urban-specific alien plant surveys in towns, then comparing these results to regional databases of naturalized and/or invasive plants. Many of the alien plants found in urban areas were listed as invasive or naturalized in the catchment (over 30% of the total alien species pool). Despite marked environmental gradients across the study area, we found no relationships between the alien plant species richness in towns and climatic variables or with levels of anthropogenic disturbances. All towns hosted large numbers of invasive plant species and nearly half of the alien species found in towns were naturalized or invasive in surrounding areas. The likelihood of alien plants being naturalized or invasive outside urban areas increased in proportion to their local abundance in towns and if they were tall and woody. Ornamental horticulture was the main reason for introduction of these alien species (69%). Small towns can and do harbour significant populations of plant taxa that are able to spread to surrounding natural areas to launch invasions. Comparing lists of species from urban alien plant surveys with those from naturalisation records for the region is a useful protocol for identifying species which may be moving along the introduction– naturalization–invasion continuum.https://link.springer.com/article/10.1007/s10530-017-1600-4Publisher’s versio

Characterization of Three Carbon- and Nitrogen-Rich Particles from Comet 81P/WILD

Comets may sample the early solar system s complement of volatile-forming elements - including C and N - more fully and reliably than do the terrestrial planets or asteroids. Until recently, all elemental analyses of unambiguously cometary material were carried out remotely. The return of the Stardust mission makes it possible to analyze documented material from P81/Wild 2 in the laboratory Wild 2 particles fragmented when they stopped in the aerogel collectors. We have studied three fragments thought to be rich in C and N by using several techniques: FTIR to characterize organic matter; synchrotron-induced x-ray fluorescence (SXRF) to determine Fe and certain element/Fe ratios; SEM to image sample morphology and to detect semiquantitatively Mg, Al, Si, Ca, and Fe; and nuclear reaction analysis (NRA) to measure C, N, O, and Si

Clinical use of HIV integrase inhibitors : a systematic review and meta-analysis

Background: Optimal regimen choice of antiretroviral therapy is essential to achieve long-term clinical success. Integrase inhibitors have swiftly been adopted as part of current antiretroviral regimens. The purpose of this study was to review the evidence for integrase inhibitor use in clinical settings. Methods: MEDLINE and Web-of-Science were screened from April 2006 until November 2012, as were hand-searched scientific meeting proceedings. Multiple reviewers independently screened 1323 citations in duplicate to identify randomized controlled trials, nonrandomized controlled trials and cohort studies on integrase inhibitor use in clinical practice. Independent, duplicate data extraction and quality assessment were conducted. Results: 48 unique studies were included on the use of integrase inhibitors in antiretroviral therapy-naive patients and treatment-experienced patients with either virological failure or switching to integrase inhibitors while virologically suppressed. On the selected studies with comparable outcome measures and indication (n = 16), a meta-analysis was performed based on modified intention-to-treat (mITT), on-treatment (OT) and as-treated (AT) virological outcome data. In therapy-naive patients, favorable odds ratios (OR) for integrase inhibitor-based regimens were observed, (mITT OR 0.71, 95% CI 0.59-0.86). However, integrase inhibitors combined with protease inhibitors only did not result in a significant better virological outcome. Evidence further supported integrase inhibitor use following virological failure (mITT OR 0.27; 95% CI 0.11-0.66), but switching to integrase inhibitors from a high genetic barrier drug during successful treatment was not supported (mITT OR 1.43; 95% CI 0.89-2.31). Integrase inhibitor-based regimens result in similar immunological responses compared to other regimens. A low genetic barrier to drug-resistance development was observed for raltegravir and elvitegravir, but not for dolutegravir. Conclusion: In first-line therapy, integrase inhibitors are superior to other regimens. Integrase inhibitor use after virological failure is supported as well by the meta-analysis. Careful use is however warranted when replacing a high genetic barrier drug in treatment-experienced patients switching successful treatment

Impact of Low-Level-Viremia on HIV-1 Drug-Resistance Evolution among Antiretroviral Treated-Patients

to determine the emergence and evolution of DRAM during LLV in HIV-1-infected patients while receiving antiretroviral therapy (ART).Retrospective analysis of patients presenting a LLV episode defined as pVL between 40 and 500 c/mL on at least 3 occasions during a 6-month period or longer while on the same ART. Resistance genotypic testing was performed at the onset and at the end of LLV period. Emerging DRAM was defined during LLV if never detected on baseline genotype or before.48 patients including 4 naive and 44 pretreated (median 9 years) presented a LLV episode with a median duration of 11 months. Current ART included 2NRTI (94%), ritonavir-boosted PI (94%), NNRTI (23%), and/or raltegravir (19%). Median pVL during LLV was 134 c/mL. Successful resistance testing at both onset and end of the LLV episode were obtained for 37 patients (77%), among who 11 (30%) acquired at least 1 DRAM during the LLV period: for NRTI in 6, for NNRTI in 1, for PI in 4, and for raltegravir in 2. During the LLV period, number of drugs with genotypic resistance increased from a median of 4.5 to 6 drugs. Duration and pVL level of LLV episode, duration of previous ART, current and nadir CD4 count, number of baseline DRAM and GSS were not identified as predictive factors of resistance acquisition during LLV, probably due to limited number of patients.Persistent LLV episodes below 500 c/ml while receiving ART is associated with emerging DRAM for all drug classes and a decreasing in further therapeutic options, suggesting to earlier consider resistance monitoring and ART optimization in this setting

Antiretroviral Drug Resistance in HIV-1–Infected Patients Experiencing Persistent Low-Level Viremia During First-Line Therapy

Population sequencing was performed for persons identified with persistent low-level viremia in 2 clinical trials. Persistent low-level viremia (defined as plasma HIV-1 RNA level >50 and <1000 copies/mL in at least 2 determinations over a 24-week period, after at least 24 weeks of antiretroviral therapy) was observed in 65 (5.6%) of 1158 patients at risk. New resistance mutations were detected during persistent low-level viremia in 37% of the 54 evaluable cases. The most common mutations were M184I/V (14 cases), K103N (9), and M230L (3). Detection of new mutations was associated with higher HIV-1 RNA levels during persistent low-level viremia