Managing Stress and Pain to Prevent Patient Discomfort, Distress and Delayed Wound Healing.

Evidence suggests stress slows the healing of wounds but pain may also play a part. Regular assessment could improve patients' quality of life and recovery time.

Ragweed Pollen Source Inventory for France - the Second Largest Centre of Ambrosia in Europe

France, in particular the Rhône-Alpes region, is one of the three main centres of ragweed (Ambrosia) in Europe. The aim of this study is to develop a gridded ragweed pollen source inventory for all of France that can be used in assessments, eradication plans and by atmospheric models for describing concentrations of airborne ragweed pollen. The inventory combines information about spatial variations in annual Ambrosia pollen counts, knowledge of ragweed ecology, detailed land cover information and a Digital Elevation Model. The ragweed inventory consists of a local infection level on a scale of 0–100% (where 100% is the highest plant abundance per area in the studied region) and a European infection level between 0% and 100% (where 100% relates to the highest identified plant abundance in Europe using the same methodology) that has been distributed onto the EMEP grid with 5 km × 5 km resolution. The results of this analysis showed that some of the highest mean annual ragweed pollen concentrations were recorded at Roussillon in the Rhône-Valley. This is reflected by the inventory, where the European infection level has been estimated to reach 67.70% of the most infected areas in Europe i.e. Kecskemét in central Hungary. The inventory shows that the Rhône Valley is the most heavily infected part of France. Central France is also infected, but northern and western parts of France are much less infected. The inventory can be entered into atmospheric transport models, in combination with other components such as a phenological model and a model for daily pollen release, in order to simulate the dispersion of ragweed pollen within France as well as potential long-distance transport from France to other European countries.

Ragweed (Ambrosia) Pollen Source Inventory for Austria

This study improves the spatial coverage of top-down Ambrosia pollen source inventories for Europe by expanding the methodology to Austria, a country that is challenging in terms of topography and the distribution of ragweed plants. The inventory combines annual ragweed pollen counts from 19 pollen-monitoring stations in Austria (2004–2013), 657 geographical observations of Ambrosia plants, a Digital Elevation Model (DEM), local knowledge of ragweed ecology and CORINE land cover information from the source area. The highest mean annual ragweed pollen concentrations were generally recorded in the East of Austria where the highest densities of possible growth habitats for Ambrosia were situated. Approximately 99% of all observations of Ambrosia populations were below 745 m. The European infection level varies from 0.1% at Freistadt in Northern Austria to 12.8% at Rosalia in Eastern Austria. More top-down Ambrosia pollen source inventories are required for other parts of Europe.

Exercise Prescription for Patients with Non-specific Chronic Low Back Pain: a Qualitative Exploration of Decision Making in Physiotherapy Practice

Background: Providing an effective exercise prescription process for patients with non-specific chronic low back pain (NSCLBP) is a challenging task. Emerging research has indicated that partnership in care and shared decision making are important for people with NSCLBP and calls for further investigation into the approaches used to prescribe exercise. Objective: To explore how shared decision making and patient partnership are addressed by physiotherapists in the process of exercise prescription for patients with NSCLBP. Design: A qualitative study using a philosophical hermeneutic approach. Methods: Eight physiotherapists were each observed on three occasions undertaking their usual clinical activities (total n=24 observations). They conducted brief interviews after each observation and a later in depth semi-structured interview. Iterative hermeneutic strategies were used to interpret the texts and identify the characteristics and processes of exercise prescription for patients with NSCLBP. Findings: The findings revealed how physiotherapy practice often resulted in unequal possibilities for patient participation which were in turn linked to the physiotherapists? assumptions about the patients, clinical orientation, cognitive and decision making processes. Three linked themes emerged: (1) I want them to exercise, (2) Which exercise? - the tension between evidence and everyday practice and (3) Compliance-orientated more than concordance based. Conclusions: This research, by focusing on a patient-centred approach, makes an important contribution to the body of evidence relating to the management of NSCLBP. It challenges physiotherapists to critically appraise their approaches to the prescription of exercise therapy in order to improve outcomes for these patients.