Crawling, climbing, perching, and flying by FiBa soft robots.

This paper introduces an approach to fabricating lightweight, untethered soft robots capable of diverse biomimetic locomotion. Untethering soft robotics from electrical or pneumatic power remains one of the prominent challenges within the field. The development of functional untethered soft robotic systems hinges heavily on mitigating their weight; however, the conventional weight of pneumatic network actuators (pneu-nets) in soft robots has hindered untethered operations. To address this challenge, we developed film-balloon (FiBa) modules that drastically reduced the weight of soft actuators. FiBa modules combine transversely curved polymer thin films and three-dimensionally printed pneumatic balloons to achieve varied locomotion modes. These lightweight FiBa modules serve as building blocks to create untethered soft robots mimicking natural movement strategies. These modules substantially reduce overall robot weight, allowing the integration of components such as pumps, valves, batteries, and control boards, thereby enabling untethered operation. FiBa modules integrated with electronic components demonstrated four bioinspired modes of locomotion, including turtle-inspired crawling, inchworm-inspired climbing, bat-inspired perching, and ladybug-inspired flying. Overall, our study offers an alternative tool for designing and customizing lightweight, untethered soft robots with advanced functionalities. The reduction of the weight of soft robots enabled by our approach opens doors to a wide range of applications, including disaster relief, space exploration, remote sensing, and search and rescue operations, where lightweight, untethered soft robotic systems are essential.

Central Venous Stenosis, Access Outcome and Survival in Patients undergoing Maintenance Hemodialysis.

BACKGROUND AND OBJECTIVES: Central venous catheters have traditionally provided access for urgent hemodialysis, but are also sometimes advocated as an option for older or more comorbid patients. Adverse effects of this type of dialysis access include central venous stenosis, for which the risk factors and consequences are incompletely understood. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: We conducted two studies within the same population cohort, comprising all patients starting hemodialysis in a single center from January 2006 to December 2013. First, patients were retrospectively analyzed for the presence of central venous stenosis; their access outcomes are described and survival compared with matched controls drawn from the same population. Second, a subset of patients with a history of catheter access within this cohort was analyzed to determine risk factors for central venous stenosis. RESULTS: Among 2811 patients, central venous stenosis was diagnosed in 120 (4.3%), at a median dialysis vintage of 2.9 (interquartile range, 1.8-4.6) years. Compared with matched controls, patients with central venous stenosis had similar survival (median 5.1 versus 5.2 years; P=0.54). Among a subset of 500 patients, all with a history of catheter use, 34 (6.8%) developed central venous stenosis, at a rate of 2.2 per 100 patient-years. The incidence of central venous stenosis was higher with larger number of previous catheters (relative risk [RR], 2.2; 95% confidence interval [95% CI]. 1.6 to 2.9), pacemaker insertion (RR, 3.9; 95% CI, 1.7 to 8.9), and was lower with older age (RR, 0.7 per decade; 95% CI, 0.6 to 0.8). In a Cox proportional hazards model, the catheter number, pacemaker, and younger age at dialysis initiation were all significant independent risk factors for central venous stenosis. CONCLUSIONS: Central venous stenosis occurred in a minority of patients on hemodialysis, and was associated with compromised future access, but unchanged survival. Among patients with a history of catheter use, risk related to both the number of catheters and the total catheter duration, although nondialysis factors such as pacemakers were also important. Central venous stenosis risk was lower in older patients, supporting the selective use of tunneled catheters in this group.

Texture-Based Differences in Eating Rate Reduce the Impact of Increased Energy Density and Large Portions on Meal Size in Adults.

Background: Large portions and high dietary energy density promote overconsumption at meal times. This could be reduced by eating slowly.Objective: Two studies investigated whether texture-based reductions in eating rate and oral processing moderate consumption at breakfast in combination with variations in energy density and portion size.Methods: Adults attended 4 breakfast sessions (2 × 2 repeated-measures design) to consume rice porridge, combining a 45% reduction in eating rate [thin porridge (140 g/min) compared with thick porridge (77 g/min)] with a 77% increase in energy density (0.57 compared with 1.01 kcal/g) in study 1 [n = 61; aged 21-48 y; body mass index (BMI; in kg/m2): 16-29] and a 50% increase in portion size (100% compared with 150%) in study 2 (n = 53; aged 21-42 y; BMI: 16-29). Oral processing behaviors were coded by using webcams. Porridge intake was measured alongside changes in rated appetite.Results: Increases in energy density and portion size led to increases of 80% and 13% in energy intake at breakfast, respectively (P < 0.001), but only portion size increased the weight of food consumed (13%). The thicker porridges were consumed at a slower rate and led to 11-13% reductions in food weight and energy intake compared with the thin versions (P < 0.001). Combined, the least energy was consumed when the thick "slow" porridge was served with a lower energy density or smaller portion (P < 0.05). Although intake was reduced for the thick porridges, they were expected to be more filling than the thin versions and experienced as equally satiating postconsumption.Conclusions: Adults eat in response to external features of the food environment. An opportunity exists to use a combination of energy-density dilution, smaller portions, and natural variations in food texture to design meals that promote reductions in energy intake while maintaining satiety.

Comparison of efavirenz and protease inhibitor based combination antiretroviral therapy regimens in treatment-naïve people living with HIV with baseline resistance.

A retrospective cohort analysis comparing the efficacy of boosted protease inhibitor-based and efavirenz-based combination antiretroviral therapy in treatment-naïve people living with HIV with baseline resistance found that efavirenz-based treatment led to a shorter mean time to undetectable viral load. A higher proportion of patients with nonnucleoside reverse transcriptase inhibitor related baseline resistance mutations in the efavirenz-treatment group achieved an undetectable viral load at both 6 and 12 months post-treatment initiation, compared with the boosted protease-inhibitor-treatment group.Supplementary content: http://links.lww.com/QAD/A930.

Transmitted antiretroviral drug resistance in treatment naïve HIV-infected persons in London in 2011 to 2013.

INTRODUCTION: Previously published UK data on HIV transmitted drug resistance (TDR) shows that it ranges between 3 and 9.4% [1,2]. However, there are no recent data from populations where HIV transmission rates are increasing. The aim of this study was to assess the prevalence of TDR in untreated HIV-infected individuals attending three HIV specialist clinics under the HIV Directorate, Chelsea and Westminster Hospital and based throughout London - the Kobler Clinic, 56 Dean Street and West London Centre for Sexual Health. METHODS: We included all patients with a HIV diagnosis, no history of antiretroviral therapy (ART) intake, attending one of the three clinics (Kobler (K), 56 Dean Street (DS) and West London (WL)), between 2011 and 2013 who started antiretrovirals. Reverse transcriptase (RT) and protease region sequencing was performed using Vircotype virtual phenotype resistance analysis. Drug resistance mutations were identified according to Stanford University HIV Drug Resistance Database (http://hivdb.stanford.edu/). RESULTS: Among 1705 HIV-1-infected patients enrolled in the study, 1252 were males (919 were MSM), 107 were females and 346 had no gender recorded. Ethnicity was 51.1% white British/Irish/other, 6.1% African, 2.1% Caribbean, 2.8% Asian, 1.3% Indian/Pakistani/Bangladeshi, 4.2%, other, 3.2% not stated, and 29.2% unknown. 547 were from K (84.3% males, 48.3% MSM), 826 were from DS (84.3% males, 71.9% MSM), and 109 from WL (87.2% males, 56.0% MSM), 223 from other sites not specified. 77.5% (1321 of 1705) of patients had baseline viral resistance testing performed. Prevalence of primary resistance in those with a baseline viral resistance test was 13.5% overall: 19.3% in K, 14.9% in DS, and 14.7% in WL. The most common mutations detected were: NRTI: 184V, 215F, 41L; NNRTI 103N, 179D, 90I; PI 90M, 46I, and 82A. Among patients who tested with TDR, 79.1% had one single mutation, 18.7% and 2.2% exhibited dual or triple class-resistant viruses, respectively. CONCLUSIONS: This study across a large HIV Medicine Directorate reported an overall TDR prevalence which is higher than that previously published and with significant rates of NNRTI resistance at baseline.