‘Pollen potency’: the relationship between atmospheric pollen counts and allergen exposure

Pollen allergies are responsible for a considerable global public health burden, and understanding exposure is critical to addressing the health impacts. Atmospheric pollen counts are routinely used as a predictor of risk; however, immune responses are triggered by specific proteins known as allergens, which occur both within and on the surface of the pollen grain. The ratio between atmospheric pollen counts and allergen concentrations (‘pollen potency’) has been shown to be inconsistent, with potentially important implications for pollen monitoring practice. Despite this, there has been no previous synthesis of the literature and our understanding of the factors that influence pollen potency remains poor. We conducted a scoping review with the aim of deriving a current understanding of: (a) the factors that influence pollen potency; (b) its variation through time, between taxa and by location; and (c) the implications for pollen monitoring practice. Our synthesis found that pollen potency is highly variable within and between seasons, and between locations; however, much of this variability remains unexplained and has not been deeply investigated. We found no predictable pollen potency patterns relating to taxon, geography or time, and inconclusive evidence regarding possible driving factors. With respect to human health, the studies in our synthesis generally reported larger associations between atmospheric allergen loads and allergy symptoms than whole pollen counts. This suggests that pollen potency influences public health risk; however, the evidence base remains limited. Further research is needed to better understand both pollen potency variability and its implications for health.

Long-term nitrofurantoin: analysis of complication awareness, monitoring and pulmonary injury cases

BackgroundLong-term nitrofurantoin (NF) treatment can result in pulmonary and hepatic injury. Current guidelines do not outline the type or frequency of monitoring required for detection of these injuries.AimsTo assess (1) awareness of NF complications among prescribers, (2) monitoring practice and (3) to describe the pulmonary sequelae of NF-related complications.Methods(1) Electronic questionnaire to prescribers, interrogating prescribing/monitoring practices and awareness of complications; (2) Case-note review (June-July 2020) of NF monitoring among general practitioners (GPs) in our local clinical commissioning group; (3) Case review of patients diagnosed with nitrofurantoin-induced interstitial lung disease (NFILD) at our interstitial lung disease (ILD) centre (2014-2020).Results125 prescribers of long-term NF responded to the questionnaire (82% GPs; 12% urologists). Many were unaware of the potential for liver (42%) and lung (28%) complications. 41% and 53% never monitored for these, respectively. Only 53% of urologists believed themselves responsible for arranging monitoring, whilst nearly all GPs believed this to be the prescriber’s responsibility (94%). One third of all respondents considered current British National Formulary (BNF) guidelines “not at all sufficient/clear”, with mean clarity scoring of 2.2/5. Amongst NFILD patients (n=46), NF had been prescribed most often (70%) for treatment of recurrent UTI and 59% (n=27) were prescribed for >6 months. Upon withdrawal of the medication 61% displayed resolution (completely/minimal fibrosis), whilst 16% of patients had progressive lung fibrosis.ConclusionNF can cause marked or irreversible lung complications and there is currently a shortfall in awareness and monitoring. Existing monitoring guidelines should be augmented.

Session 6: Bringing Mindfulness to Our Relationships

In this session, we will take time to review your experiences of “falling down the hole”—having a sustained emotional reaction to something like a cognitive slip-up. This is connected to further cultivation of awareness as a way to track our experience without reacting to it. The discussion of reacting versus responding is broadened to incorporate our experiences with others, and how we communicate with others. We will then discuss different communication styles and for homework, you will be encouraged to track your use of these communication styles, as well as the tendency to respond versus react. Finally, you will continue with Open Monitoring practice and you are invited to track your mindfulness in daily life and to find ways of adding to your mental bank account.

Prospective Audit of Gentamicin Drug Monitoring Practice in a Pediatric Cancer Center

Zusammenfassung Hintergrund Gentamicin kommt in vielen pädiatrisch onkologischen Behandlungszentren in der Erstlinien-Kombinationstherapie bei Fieber und Granulozytopenie zum Einsatz. Seit 2011 verwenden wir hierzu eine Dosierung von 250 mg/m2 KOF (max. 10 mg/kg, max. 400 mg) als tgl. Einmalgabe nach der deutschen Leitlinie. Patienten und Methoden In diesem prospektiven Audit (Februar 2011 – Dezember 2019) wurden bei 66 kinderonkologischen Patienten 105 Gentamicin-Zyklen in Hinblick auf die Adhärenz zum Dosierungsstandard und auf die Ergebnisse des Drug Monitorings analysiert. Ergebnisse Die Adhärenz mit dem neuen Dosierungsschema war hoch (89%). In 64% der Zyklen wurde ein Spitzenspiegel (1 h nach der 2. Gabe) im Zielbereich (Cmax; 10–20 µg/ml) erreicht. Cmax korrelierte signifikant mit der Dosis in mg/m2 KOF (p=0,007), jedoch nicht mit der Dosis in mg/kg (p=0,366). Ein Lebensalter unter 6 Jahre beeinflusste dieses Ergebnis nicht. Der Gentamicin Ctrough (8–10 h nach der zweiten Gabe) lag in 93% der Zyklen unter 2 µg/ml und korrelierte nicht mit der Dosis. Kein Patient in diesem Audit erfüllte die Kriterien für eine Gentamicin-assoziierte Nephrotoxizität. Diskussion und Schlussfolgerung Dieses prospektive Audit der tgl. Einmalgabe von Gentamicin bei nierengesunden pädiatrisch-onkologischen Patienten bestätigt die praktische Anwendbarkeit und Sicherheit der Dosierung in mg/m2 nach der deutschen Leitlinie. Aufgrund der eingeschränkten Indikationen für Gentamicin in der Erstlinientherapie ist eine prospektive multizentrische Studie zur Bestätigung dieser Beobachtungen wünschenswert.

Boundary violations

Professional boundaries can be described as the ‘edge’ or limit of appropriate behaviour by the practitioner in the clinical setting. The therapeutic frame comprised of this set of boundaries allows the clinician and the patient to interact in a safe and productive way. These boundaries can be violated by sexual contact between the practitioner and the patient or by nonsexual overinvolvement. The mental health clinicians who transgress boundaries may do so for different reasons, and there are varied characterological and symptomatic clinical pictures that lead to boundary violations. Detailed evaluation of each individual case is necessary to determine if the clinician can be rehabilitated or not. Rehabilitation generally involves psychotherapy, monitoring, practice limitations, continuing education, and supervision. The digital era has brought about new forms of boundary violations involving cyberspace and the relative ease with which information about patients can be accessed.

Does Delivery Length Impact Measures of Whole-Body Biomechanical Load During Pace Bowling?

Purpose: To investigate whether changes in delivery length (ie, short, good, and full) lead to alterations in whole-body biomechanical loading as determined by ground reaction force during front-foot contact of the delivery stride for pace bowlers. Current load-monitoring practices of pace bowling in cricket assume equivocal biomechanical loading as only the total number of deliveries are monitored irrespective of delivery length. Methods: A total of 16 male pace bowlers completed a 2-over spell at maximum intensity while targeting different delivery lengths (short, 7–10 m; good, 4–7 m; and full, 0–4 m from the batter’s stumps). In-ground force plates were used to determine discrete (vertical and braking force, impulse, and loading rates) and continuous front-foot contact ground reaction force. Repeated-measures analysis of variance (P < .05), effects size, and statistical parametrical mapping were used to determine differences between delivery lengths. Results: There were no significant differences between short, good, and full delivery lengths for the discrete and continuous kinetic variables investigated (P = .19–1.00), with trivial to small effect sizes. Conclusion: There were minimal differences in front-foot contact biomechanics for deliveries of different lengths (ie, short, good, and full). These data reinforce current pace bowling load-monitoring practices (ie, counting the number of deliveries), as changes in delivery length do not affect the whole-body biomechanical loading experienced by pace bowlers. This is of practical importance as it retains simplicity in load-monitoring practice that is used widely across different competition levels and ages.

A focused ethnography of how endoscopy practitioners utilize capnography in sedated patients

The literature shows that respiratory complications are common with sedation. Given the inherent risk, capnography monitoring is recommended whenever sedation is administered. We aimed to explore sedation practitioners’ behavior patterns and perceptions regarding capnography monitoring during endoscopy sedation and examine how capnography influenced clinical decision making when assessing respiration. We conducted a focused ethnography with triangulated observations and semi-structured interviews, and we purposively sampled and recruited five sedation practitioners as participants at a hospital in Saudi Arabia. Through data analysis, we identified representative themes and found cultural differences between anesthesia practitioners and nurses when using capnography during sedation. Anesthesia practitioners linked safety and the use of capnography to maintain adequate respiration, while nurses believed capnography was a secondary supportive monitor to patient observation and assessment. Findings also captured the unique cultures and values of each professional group to be associated with the varying perceptions. We also identified several factors facilitating and barring adequate utilization of capnography. In conclusion, professional culture, hospital policy, knowledge and previous experience with capnography guided the monitoring practice of endoscopy practitioners when assessing respiration during sedation.

The Contribution of Monitoring for Academic Education

Monitoring in universities and university centers aims to initiate students in teaching and contribute to the improvement of undergraduate education through the articulation of theoretical and practical content, thus favoring the production of knowledge under the guidance of the teacher responsible for a specific curricular component. Monitoring allows students to develop skills associated with teaching and deepening their knowledge; however, there are elements that can hinder this practice, such as the conciliation of monitoring activities with regular academic activities. The objective of this study is to analyze the contribution of monitoring to learning and academic training in the Dentistry Course at UFBA. The sample of this research was composed of 34 students of both sexes, all in the condition of student-monitors of the Faculty of Dentistry at the Federal University of Bahia (UFBA), city of Salvador, Bahia, Brazil. A quantitative questionnaire was applied to students in order to analyze various aspects on the monitoring practice. Students interviewed believed that monitoring is relevant for academic training and that this activity brings greater learning during its performance. Of all respondents, 94% believe that monitoring is relevant in initiating students in higher education teaching. Most interviewees reported that they have good relationship with the Advisor Teacher and with monitored students. Monitoring gives the student the opportunity to develop skills and competences associated with teaching, provides personal and professional growth and qualifies the curriculum of those who participate in this process.