No description available.

Thesis (M.D.)—Boston University

Thesis (M.D.)--Boston University

No description available.

Thesis (Ph.D.)--Boston University / This study was designed to investigate whether individuals with perennial rhinitis, a disorder conceived of as psychosomatic, would evidence fantasies either of maternal domination or of maternal rejection. It was hypothesized that: (1) Cases of perennial rhinitis evidence more intense fantasies of maternal domination than do cases of seasonal rhinitis or do symptom-free individuals; and (2) Cases of perennial rhinitis evidence no more intense fantasies of maternal rejection than do cases of seasonal rhinitis or normals. [TRUNCATED]

2 pp.

Revised; Originally Published 2006 / 2 pp.

The first part of this research was undertaken to assess the impact of documented penicillin allergy on the choice of antibiotics and the clinical and financial consequences of changes in prescribing patterns in an Australian teaching hospital. The medical records of all patients aged >/= 18 years admitted with community-acquired pneumonia (CAP) to Sir Charles Gairdner Hospital (SGGH) over a 15-week period were reviewed prospectively. The severity of patients' penicillin allergies was assessed using a structured questionnaire. The antibiotic cost was calculated using acquisition, delivery (labour and equipment) and laboratory monitoring costs. The appropriateness of antibiotic prescribing was assessed using the Therapeutic Guidelines: Antibiotic (TG:A). The antimicrobial selections and costs were then compared for those patients with (Group A) and without (Group B) penicillin allergy. 155 patients were reviewed (males 71, females 84) with an average age of 68 ± 18 years. Of these, 27 (17.4%) had documented penicillin allergies; of which 12 were classified as Severity I (e.g. anaphylaxis, urticaria), 12 as Severity II (e.g. rash, itch) and three as intolerance (e.g. GI upset). The current TG:A recommends cephalothin or cephazolin as the drugs of choice for mild to moderate CAP patients with a history of penicillin allergy. However, combinations of cephalothin intravenously and azithromycin orally were the most commonly prescribed antimicrobials for such patients. The TG:A recommends erythromycin plus cefotaxime or ceftriaxone as the first-line therapy for severe CAP patients with a documented penicillin allergy. Yet, combinations of intravenous cephalothin, erythromycin and gentamicin were the most frequently prescribed antimicrobials for such patients. / A history of penicillin allergy significantly (p<0.05) increased the cost of antibiotic treatment and total cost of admission. The adherence of antibiotic prescribing to the TG:A for patients with penicillin allergies is variable. Patients with labelled penicillin allergies had greater antibiotic costs and total cost of admission. Identifying patients with intolerance rather than allergies would reduce the total inpatient costs at SCGH by A$ 463.01 a year for mild to moderate CAP patients and A$ 39 614.54 a year for severe CAP patients. The second part of the project was a prospective study of patients admitted to SCGH who had a history of penicillin allergy, but were not suffering from CAP. This study was conducted in order to ensure that the pattern of penicillin allergies of patients admitted to the hospital could be adequately characterised. Over a 5-week period, all adult patients admitted without CAP to SCGH who claimed to have a history of penicillin allergy were interviewed with regard to their penicillin allergies. The standard of allergy documentation was also assessed for each patient. Of the 140 patients assessed (males 63, females 77, average age 61 ± 17 years), 108 (77.1%) were classified as allergic: 61 (56.5%) as Severity I and 47 (43.5%) as Severity 11, 26 (18.6%) as intolerant and the remaining six (4.3%) as not substantiated. / The standard documentation of the patients' penicillin allergies was poor - only 40 (38.6%) of either medical records or drug charts had the type of reaction and only five (3.6%) had the date of reaction. In general, penicillin allergies were poorly documented in both patients' medical records and on drug charts. Inadequate detail of reported reactions often made it difficult to assess their clinical significance. These findings prompted a recommendation that pharmacists should help to ensure accurate allergy documentation by evaluating patients and educating both patients and health care professionals.

This thesis is designed to explore the hypothesis that settled dust in a domestic environment can contain significant levels of allergens and that common cleaning methods employed to remove dust can result in sufficient airborne exposure to potentially trigger an allergic reaction. Qualitative feedback from respondents in studies of furniture dusting habits indicated that household furniture dusting could elicit an allergic response. A consumer questionnaire was fielded to confirm the problem and it's magnitude. This indicated that it affected approximately 20% of allergy sufferers (or approximately 5% of the total UK population). Further work was performed to estimate the level of allergen exposure during dusting. Additional consumer research was fielded to ascertain the surface area being dusted, (approximately 54000cm2 for frequently dusted areas and 10000cm2 for frequently dusted areas). Domestic dusting habits were probed for the relative frequency of dusting method, which split evenly between dry dusting, wet dusting with water and wet dusting with a furniture polish. Surface sampling techniques were adapted to make in-home measurements of the rate of dust settling which was found to be approximately 3.19x10 -7 g.cm-2,day-1. In-home sampling was also undertaken to measure the mean allergen content of surface dust for major allergens, yielding 24667ng.g-1 combined dust mite, 47696ng.g-1 Fel d 1 and approximately 126 8 08ng.g-1 Can f 1. Laboratory-based studies determined the relative amount of dust rendered airborne during dusting of different furniture surface types and comparing different cleaning methods. This was found to be between 2.3- 43.0%. From these experiments, a model "average" home was constructed and used to estimate the exposure towards dust allergens during a typical dusting task. Exposure was estimated to be as much as 16500ng total dust mite, 124000 mug (31000 mU) cat allergen and 275000 ng (IU) dog allergen per dusting method. These results indicated that allergen exposure, under certain circumstances, could exceed the threshold levels that have been proposed for the onset of sensitisation.

Lung spirometry data from three working-class industry populations were analyzed using logistic and linear regression to see if seasonality adversely affected test outcomes. Populations included emergency responders, general industry, and shipwrights. The data was organized into allergy and non-allergy seasons using NOAA meteorological data and regression and logistic analysis was run on these separate populations to test for demographic and seasonal effects on lung spirometry test outcomes. The American Thoracic Society gold standard was as a point for determining impaired lung function (FEV1/FVC > 0.80). It was found that seasonality imparted a slight linear effect on the predictive values of FEV1 and FVC for determining impaired lung function FEV1 and FVC values were Pr > 0.0003 and Pr > 0.0002, respectively. For demographic variables, age imparted the greatest linear effect for FEV1 and FVC, with significant p-values of 0.0002 and