The aging of the population in developed and developing countries, together with the degree of maturity reached by certain technologies, means that the design of care environments for the elderly with a high degree of technological innovation is now being seriously considered. Assistive environments for daily living (Ambient Assisted Living, AAL) include the deployment of sensors and certain actuators in the home or residence where the person to be cared for lives so that, with the help of the necessary computational management and decision-making mechanisms, the person can live a more autonomous life. Although the cost of implementing such technologies in the home is still high, they are becoming more affordable, and their use is, therefore, becoming more popular. At a time when some countries are finding it difficult to provide adequate care for their elderly, this option is seen as a help for carers and to avoid collapsing health care services. However, despite the undoubted potential of the services offered by these AAL systems, there are serious problems of acceptance today. In part, these problems arise from the design phase, which often does not sufficiently take into account the end users—older people but also carers. On the other hand, it is complex for these older people to interact with interfaces that are sometimes not very natural or intuitive. The use of a socially assistive robot (SAR) that serves as an interface to the AAL system and takes responsibility for the interaction with the person is a possible solution. The robot is a physical entity that can operate with a certain degree of autonomy and be able to bring features to the interaction with the person that, obviously, a tablet or smartphone will not be able to do. The robot can benefit from the recent popularization of artificial intelligence-based solutions to personalize its attention to the person and to provide services that were unimaginable just a few years ago. Their inclusion in an AAL ecosystem should, however, also be carefully assessed. The robot’s mission should not be to replace the person but to be a tool to facilitate the elderly person’s daily life. Its design should consider the AAL system in which it is integrated, the needs and preferences of the people with whom it will interact, and the services that, in conjunction with this system, the robot can offer. The aim of this article is to review the current state of the art in the integration of SARs into the AAL ecosystem and to determine whether an initial phase of high expectations but very limited results have been overcome.

Socially assistive robots are receiving a growing interest in the health and social care sectors. They are considered a promising technology to add value to the work of caregivers, and relieve them of simple and repetitive tasks. However, these robots currently face significant difficulties when deployed in everyday scenarios due to a number of factors. Most of these factors are related to insufficient consideration of the user perspective and incorrect evaluation procedures. This paper aims to address these issues. Its objective is to analyze the long-term accessibility, usability, social acceptance and user experience for two different socially assistive robots performing the same tasks in a retirement home. The evaluation procedure is based on a framework specifically designed to consider these criteria. Collected results show that both robots received an overall positive feedback. Although the number of users participating in the evaluation was not very high, due to the chosen recruitment criteria and the period of activity of this research project, during the COVID19 pandemic, these results allow to extract relevant insights towards a meaningful use of social robots in shared social care contexts.

The use of new assistive technologies in general, and Socially Assistive Robots (SARs) in particular, is becoming increasingly common for supporting people’s health and well-being. However, it still faces many issues regarding long-term adherence, acceptability and utility. Most of these issues are due to design processes that insufficiently take into account the needs, preferences and values of intended users. Other issues are related to the currently very limited amount of long-term evaluations, performed in real-world settings, for SARs. This study presents the results of two regional projects that consider as a starting hypothesis that the assessment in controlled environments and/or with short exposures may not be enough in the design of an SAR deployed in a retirement home and the necessity of designing for and with users. Thus, the proposed methodology has focused on use-cases definitions that follow a human-centred and participatory design approach. The main goals have been facilitating system acceptance and attachment by involving stakeholders in the robots design and evaluation, overcoming usage barriers and considering user’s needs integration. The implementation of the first use-case deployed and the two-phase pilot test performed in a retirement home are presented. In particular, a detailed description of the interface redesign process based on improving a basic prototype with users’ feedback and recommendations is presented, together with the main results of a formal evaluation that has highlighted the impact of changes and improvements addressed in the first redesign loop of the system.

The use of new assistive technologies in general, and Socially Assistive Robots (SAR) in particular is becoming increasingly common for supporting people’s health and well-being. However, it still faces many issues regarding long-term adherence, acceptability and utility. Most of these issues are due to design processes that insufficiently take into account the needs, preferences and values of intended users. Other issues are related to the currently very limited amount of long-term evaluations, performed in real world settings, for SAR. This study presents the results of two regional projects that consider as a starting hypothesis that the assessment in controlled environments and/or with short exposures may not be enough in the design of a SAR deployed in a retirement home and the necessity of designing for and with users. Thus, the proposed methodology has focused in use cases definitions that follow a human-centred and participatory design approach. The main goals have been facilitating system acceptance and attachment by involving stakeholders in the robots design and evaluation, overcoming usage barriers and considering user’s needs integration. The implementation of the first use case deployed and the two-phase pilot test performed in the retirement home are presented. In particular, a detailed description of the interface re-design process based on improving a basic prototype with users’ feedback and recommendations is presented together with main results of a formal evaluation that has highlighted the impact of changes and improvements addressed in the first redesign loop of the system.

Pulmonary arterial hypertension (PAH) is the most serious complication of congenital heart disease (CHD), constituting a heterogeneous clinical entity classified within Group 1 of the Clinical Classification of Pulmonary Hypertension (PH). PAH associated with congenital heart disease (PAH-CHD) affects approximately 3–10% of patients with CHD and accounts for up to one-third of all PAH cases in the adult population. This review provides an educational and up-to-date perspective on the epidemiology, pathophysiology, diagnosis, and management of PAH-CHD. The updated haemodynamic definitions of the 2022 European Society of Cardiology (ESC)/European Respiratory Society (ERS) guidelines (mean pulmonary artery pressure (PAP) ≥20 mmHg) and the importance of contemporary registries (COMPERA-CHD, HOPE) in defining prognosis are discussed. The pathophysiology is explored in depth, from initial shear stress to the imbalance in the three canonical pathways that regulate pulmonary vascular functions (endothelin, nitric oxide, prostacyclin), the role of inflammation and metabolism, and the central importance of the TGF-β/BMPR2 genetic pathway, which has led to new disease-modifying therapies. Moreover, this review addresses the crucial clinical distinction between paediatric management, constrained by limited evidence, and adult management (ACHD), with a focus on the multisystem disorder of Eisenmenger syndrome (ES) and the challenges of care transition. The gold-standard diagnostic (right heart catheterisation), the ‘treat and repair’ strategy in the haemodynamic ‘grey zone’, and the complex risk stratification in this population are also analysed. Additionally, the evidence from key trials (BREATHE-5, MAESTRO, REPLACE) and the paradigm shift towards initial combination therapy (AMBITION) are reviewed from a therapeutic perspective. Finally, the most significant advance is highlighted: Sotatercept, a vascular remodelling reversal agent (STELLAR study), concluding with a review of chronic complications and prospects in the field.

Open-access immunosequencing data | Mustjoki, Satu | Nature Communications | Adaptive Biotechnologies | Graft versus host disease (GvHD) is the main complication of allogeneic hematopoietic stem cell transplantation (HSCT). Here we report studies of a patient with chronic GvHD (cGvHD) carrying persistent CD4+ T cell clonal expansion harboring somatic mTOR, NFKB2, and TLR2 mutations. In the screening cohort (n = 134), we detect the mTOR P2229R kinase domain mutation in two additional cGvHD patients, but not in healthy or HSCT patients without cGvHD. Functional analyses of the mTOR mutation indicate a gain-of-function alteration and activation of both mTORC1 and mTORC2 signaling pathways, leading to increased cell proliferation and decreased apoptosis. Single-cell RNA sequencing and real-time impedance measurements support increased cytotoxicity of mutated CD4+ T cells. High throughput drug-sensitivity testing suggests that mutations induce resistance to mTOR inhibitors, but increase sensitivity for HSP90 inhibitors. Our findings imply that somatic mutations may contribute to aberrant T cell proliferations and persistent immune activation in cGvHD, thereby paving the way for targeted therapies.