Safety of Multifood Oral Immunotherapy in Children Aged 1 to 18 Years at an Academic Pediatric Clinic

BACKGROUND

Oral immunotherapy (OIT) aims to increase the reaction threshold to a food allergen and decrease the risk of a potentially life-threatening allergic reaction in the event of an accidental ingestion. Whereas single-food OIT is the most extensively studied, data on multifood OIT are limited.

OBJECTIVE

Our study aimed to examine the safety and feasibility of single-food and multifood immunotherapy in a large cohort in an outpatient pediatric allergy clinic setting.

METHODS

A retrospective review of patients enrolled in single-food and multifood OIT between September 1, 2019, and September 30, 2020, and data collection of those patients until November 19, 2021, were performed.

RESULTS

There were 151 patients who underwent either an initial dose escalation (IDE) or a standard oral food challenge. Seventy-eight patients were receiving single-food OIT with 67.9% reaching maintenance. Fifty patients were undergoing multifood OIT with 86% reaching maintenance to at least 1 OIT food and 68% reaching maintenance for all their foods. Of the 229 IDEs, there were low frequencies of failed IDEs (10.9%), epinephrine administration (8.7%), emergency department referrals (0.4%), and hospital admission (0.4%). Cashew accounted for one-third of failed IDEs. Epinephrine administration during home dosing occurred in 8.6% of patients. Eleven patients discontinued OIT owing to symptoms during up-dosing. No patients discontinued once reaching maintenance.

CONCLUSIONS

Desensitization to 1 food or multiple foods simultaneously through OIT appears to be safe and feasible using the OIT protocol that has been established. The most common adverse reaction causing discontinuation of OIT was gastrointestinal symptoms.

Understanding national barriers to climate change adaptation for public health - a global survey

Background

Climate change has introduced a series of unprecedented threats to human health, ranging from rising food and water insecurity to deteriorating air quality, novel disease outbreaks, and intensifying natural disasters. The Paris Agreement pushes countries to develop adaptation plans that will protect human health from the worst impacts of climate change -a process referred to as climate change adaptation (CCA). Yet despite international pressure and escalating health threats, vast shortcomings persist in national CCA for public health progress. Thus, we investigated the major governance constraints underlying these trends.

Methods

A mixed-methods online survey was distributed to representatives of national public health associations and societies of 82 member countries under the World Federation of Public Health Associations.

Results

9 of the 11 respondent countries (82%) affirmed the existence of a national CCA plan that includes an explicit public health focus. All respondees listed governance challenges in developing and operationalising their national CCA agenda. The major identified barriers to CCA for public health progress were lack of inter-government policy coordination and insufficient political will to mobilize human and non-human resources in support of public health-oriented adaptation efforts.

Conclusions

Climate change-driven amplification of global health risks necessitates that all nations generate clear CCA plans to protect human health. Our findings assist by highlighting the need for new platforms for organizational collaboration/networked governance and enhanced forums for CCA agenda-setting and ambition-raising. Such forms of enriched knowledge may facilitate decision-making amongst key public health stakeholders and global institutions for how best to align climate advocacy and country-wide support initiatives with cross-cutting national needs and constraints.

Key messages

Climate change-driven amplification of global health risks necessitates that all nations generate clear climate change adaptation plans to protect human health. New platforms for organizational collaboration/networked governance and enhanced forums for adaptation agenda-setting and ambition-raising may significantly bolster public health adaptation progress.

Equine dietary supplements: an insight into their use and perceptions in the Irish equine industry

Background

Nutritional supplements are frequently used by horse owners/caregivers to supplement their horse(s) diets. Some work has been done to identify the types of supplements fed and the reasons for doing so; however, this has been predominantly disciple-specific and with little focus on participants’ perceptions of supplement testing and regulation. The aim of this study was to gain an insight into the use and perceptions of equine dietary supplements in the Irish equestrian industry.

Methods

An online survey was designed to ascertain the following information: demographics, types of supplements fed and reasons for use, factors that influenced respondents’ choice of supplement, where advice was sought and perceptions of testing and regulation of equine supplements

Results

The survey yielded 134 responses, 70% non-professionals and 30% professionals. A greater percentage of professionals included supplements in their horse(s) diets (98%) compared to non-professionals (86%). Almost 70% of professionals fed more than two supplements, whereas 80% of non-professionals reported to feed only one supplement. Joint supplements were most commonly fed by all respondents (22%) followed by calming supplements (13%). The enhancement of performance (35%) and prevention of joint disorders (34%) were the most common reasons reported by respondents for using a supplement. Over 53% of respondents sought advice on choosing a supplement from their feed merchant, followed by their veterinarian (46%). Veterinary recommendation was given as the most influential factor when choosing a supplement by 90% of respondents, followed by cost (69%). Most (93%) respondents thought that feed supplements had to meet legal standards, with each batch analysed for quality (72%) and the supplement tested on horses before being launched on to the market (92%).

Conclusion

This study has identified the main types of supplements used in the Irish equestrian industry along with the reasons for their use. However, it has also highlighted major misperceptions in how supplements are tested before being launched for sale and further work on this aspect of the findings would be beneficial.

A 'Healthy Islands' framework for climate change in the Pacific

Small Pacific Island countries (PICs) are among the most vulnerable countries in the world to the anticipated detrimental health effects of climate change. The assessment of health vulnerabilities and planning adaptation strategies to minimize the impacts of climate change on health tests traditional health governance structures and depends on strong linkages and partnerships between actors involved in these vital processes. This article reviews the actors, processes and contexts of the climate change and health vulnerability assessment and adaptation planning project carried out by the World Health Organization and health sector partners in three island countries in the Micronesian region of the Pacific throughout 2010 and 2011: Federated States of Micronesia, Marshall Islands and Palau. Despite their shared history and cultural characteristics, the findings and implications of this article are considered to have substantial relevance and potential application to other PICs. The modified 'Healthy Islands' framework for climate change and health adaptation presented in this article draws upon real-world experience and governance theory from both the health and climate change literature and, for the first time, places health systems adaptation within the vision for 'Healthy Islands' in the Pacific region.

Climate change, food, water and population health in China

Anthropogenic climate change appears to be increasing the frequency, duration and intensity of extreme weather events. Such events have already had substantial impacts on socioeconomic development and population health. Climate change's most profound impacts are likely to be on food, health systems and water. This paper explores how climate change will affect food, human health and water in China. Projections indicate that the overall effects of climate change, land conversion and reduced water availability could reduce Chinese food production substantially - although uncertainty is inevitable in such projections. Climate change will probably have substantial impacts on water resources - e.g. changes in rainfall patterns and increases in the frequencies of droughts and floods in some areas of China. Such impacts would undoubtedly threaten population health and well-being in many communities. In the short-term, population health in China is likely to be adversely affected by increases in air temperatures and pollution. In the medium to long term, however, the indirect impacts of climate change - e.g. changes in the availability of food, shelter and water, decreased mental health and well-being and changes in the distribution and seasonality of infectious diseases - are likely to grow in importance. The potentially catastrophic consequences of climate change can only be avoided if all countries work together towards a substantial reduction in the emission of so-called greenhouse gases and a substantial increase in the global population's resilience to the risks of climate variability and change.

Arctic cut-off high drives the poleward shift of a new Greenland melting record

Large-scale atmospheric circulation controls the mass and energy balance of the Greenland ice sheet through its impact on radiative budget, runoff and accumulation. Here, using reanalysis data and the outputs of a regional climate model, we show that the persistence of an exceptional atmospheric ridge, centred over the Arctic Ocean, was responsible for a poleward shift of runoff, albedo and surface temperature records over the Greenland during the summer of 2015. New records of monthly mean zonal winds at 500 hPa and of the maximum latitude of ridge peaks of the 5,700±50 m isohypse over the Arctic were associated with the formation and persistency of a cutoff high. The unprecedented (1948–2015) and sustained atmospheric conditions promoted enhanced runoff, increased the surface temperatures and decreased the albedo in northern Greenland, while inhibiting melting in the south, where new melting records were set over the past decade.

Atmospheric circulation controls the mass and energy balance of the Greenland ice sheet, yet the exact dynamics remain unknown. Here, the authors show that record conditions over Greenland during the summer of 2015 were associated with the formation and persistency of an Arctic cut-off high.

Solitary cavernous lymphangioma of the duodenum: a case report

Duodenal lymphangioma is an extremely rare benign tumor of the gastrointestinal tract. In this case report, we describe the case of a 39-year-old Lebanese female with cystic lymphangioma of the duodenum diagnosed by exploratory laparotomy and immunohistochemical analysis. Herein our findings are described.

A century of variation in the dependence of Greenland iceberg calving on ice sheet surface mass balance and regional climate change

Iceberg calving is a major component of the total mass balance of the Greenland ice sheet (GrIS). A century-long record of Greenland icebergs comes from the International Ice Patrol's record of icebergs (I48N) passing latitude 48° N, off Newfoundland. I48N exhibits strong interannual variability, with a significant increase in amplitude over recent decades. In this study, we show, through a combination of nonlinear system identification and coupled ocean–iceberg modelling, that I48N's variability is predominantly caused by fluctuation in GrIS calving discharge rather than open ocean iceberg melting. We also demonstrate that the episodic variation in iceberg discharge is strongly linked to a nonlinear combination of recent changes in the surface mass balance (SMB) of the GrIS and regional atmospheric and oceanic climate variability, on the scale of the previous 1–3 years, with the dominant causal mechanism shifting between glaciological (SMB) and climatic (ocean temperature) over time. We suggest that this is a change in whether glacial run-off or under-ice melting is dominant, respectively. We also suggest that GrIS calving discharge is episodic on at least a regional scale and has recently been increasing significantly, largely as a result of west Greenland sources.

All for one and one for all: understanding health professionals' experience in individual versus collaborative online learning

INTRODUCTION

Computer-supported collaborative learning (CSCL) may facilitate continuing interprofessional education while overcoming barriers of time and place for busy health care professionals. The purpose of this study was to understand the experiences, advantages, and challenges of group versus individual online learning.

METHODS

Fifteen multidisciplinary health professionals participated in a 12-week online course on either diabetes or traumatic brain injury. This consisted of background e-modules and a longitudinal build-a-case exercise, done either individually or as a group. Focus group sessions exploring participants' experiences after course completion and at 4 months were conducted, transcribed, and analyzed for recurring themes. Participant reflection homework and video-recorded group sessions were used for triangulation of results.

RESULTS

Individual learners appreciated the flexibility and control, but experienced decreased motivation. Group learners appreciated the immediate feedback from their co-learners and felt social pressure to come to the weekly sessions prepared but expressed challenges in determining group goal-setting for the session. Both groups felt they learned about interprofessional roles; however, group learners described a richer learning experience and understanding of interprofessional roles through the online collaboration exercise. The intense resources necessary for interprofessional CSCL, including time, faculty development, and technological issues, are described.

DISCUSSION

CSCL is a valuable educational strategy in online learning. While individual online learning may be better suited for short and simple educational interventions such as knowledge acquisition, CSCL seems to allow for richer and deeper learning in complex and interprofessional educational experiences. However, strategies, resources, and faculty development required to enhance CSCL need to be addressed carefully.

"They put you on your toes": Physical Therapists' Perceived Benefits from and Barriers to Supervising Students in the Clinical Setting

PURPOSE

To identify the perceived benefits of and barriers to clinical supervision of physical therapy (PT) students.

METHOD

In this qualitative descriptive study, three focus groups and six key-informant interviews were conducted with clinical physical therapists or administrators working in acute care, orthopaedic rehabilitation, or complex continuing care. Data were coded and analyzed for common ideas using a constant comparison approach.

RESULTS

Perceived barriers to supervising students tended to be extrinsic: time and space constraints, challenging or difficult students, and decreased autonomy or flexibility for the clinical physical therapists. Benefits tended to be intrinsic: teaching provided personal gratification by promoting reflective practice and exposing clinical educators to current knowledge. The culture of different health care institutions was an important factor in therapists' perceptions of student supervision.

CONCLUSIONS

Despite different disciplines and models of supervision, there is considerable synchronicity in the issues reported by physical therapists and other disciplines. Embedding the value of clinical teaching in the institution, along with strong communication links among academic partners, institutions, and potential clinical faculty, may mitigate barriers and increase the commitment and satisfaction of teaching staff.

The tumour microenvironment: a novel target for cancer therapy

Cancer therapy is in the midst of a major paradigm shift. Traditionally, cancer treatments have focused on tumour cells. However, studies over the past few decades have demonstrated that cancer is a vastly complex entity with multiple components affecting a tumour's growth, invasion and metastasis. These components, collectively termed the 'tumour microenvironment', include endothelial cells, pericytes, fibroblasts, inflammatory cells, leucocytes and elements of the extracellular matrix (ECM). Biological agents that target components of the tumour microenvironment may provide an interesting alternative to traditional tumour cell-directed therapy. Because of the complexity of the tumour milieu, the most beneficial therapy will likely involve the combination of one or more agents directed at this new target. This review highlights recent preclinical and clinical studies involving agents that target tumour vasculature, leucocytes, pericytes, cancer-associated fibroblasts and ECM components. We pay particular attention to combination therapies targeting multiple components of the tumour microenvironment, and aim to demonstrate that this strategy holds promise for the future of cancer treatment.