Libraries, learning, and porous boundaries: Reimagining the library landscape and its inhabitants

Learning landscapes have experienced a seismic shift in the who, how, and what of their delivery. Typically this focusses on how academic colleagues deliver their subject content, but now more than ever it is critical for students to be confident and skilled in information literacy in its broadest sense, managing, sharing, and redeveloping current knowledge for a smaller, yet local world. Libraries and librarians must respond with renewed agility and reposition themselves as educators and enablers within porous learning environments. The move to digital library collections is now matched by a need for digital library spaces, services, and librarians. This chapter will explore how librarians need to reconsider their professional identities, relocate from physical to digital library environments, and reshape knowledge creation and exchange within and through porous boundaries. © 2021 David Baker and Lucy Ellis Published by Elsevier Ltd.

Review of paediatric food challenges: Could more almond and tuna challenges be safely performed at home?

Background: Clinicians use serum immunoglobulin E (IgE) and/or skin prick test (SPT) to help decide whether a child is suitable for a food challenge. Performing a food challenge (FC) or supervised feed (SF) is the gold standard for a definitive diagnosis of type 1 food allergy. Food challenges are labour intensive and our unit currently has long waiting lists for food challenges, exacerbated by the COVID 19 pandemic. This study aims to determine if the current thresholds for home introduction can be altered. Method: Retrospective data analysis of tuna and almond challenges performed in the Paediatric Allergy Service at St George's Hospital. Electronic medical records were reviewed of all patients who underwent an oral food challenge between April 2018 to October 2020 at St George's Hospital. Clinical history, results of SPT and specific IgE to tuna and almond and the outcome of the challenge were extracted from the hospital database. Results: Tuna 14 children underwent a tuna food challenge. None were observed to have a positive result. One child had an inconclusive challenge as the final sample was refused;prior to this the child did not experience any signs of an allergy reaction. All these children had a known allergy to other fish. Almond 77 children underwent an almond only challenge;8% (6) of these were supervised feeds, the other 92% (71) were food challenges. 8% (6) children were observed to have a positive almond challenge. One child had an inconclusive challenge as the final sample was refused;prior to this the child did not experience any signs of an allergy reaction. 50% (3) of children with a positive challenge were managed with cetirizine alone, at the correct dosage for age. The other 3 children complained of mild symptoms which resolved with no treatment. Conclusion: No children had a positive tuna challenge and the thresholds for home introduction of tune could be reviewed and relaxed. 96% of children who had an SPT less than 2mm tolerated the almond challenge. For those that reacted, all reactions observed were mild to moderate. The threshold for home introduction of almond could also be reviewed and relaxed.

P315 Increased clinician confidence and uptake of event-based PrEP by men who have sex with men during the COVID-19 pandemic

BackgroundHIV pre-exposure prophylaxis (PrEP) is an effective, safe strategy to prevent HIV. PrEP can be used either daily or as an event based dosing (EBD) regimen by men who have sex with men (MSM) having condom-less anal sex, however clinicians with expertise delivering daily PrEP often lack confidence delivering EBD-PrEP. During the COVID-19 pandemic, MSM appear to have tailored their sexual behaviour in-line with local social restrictions including the way they use PrEP.MethodWe aimed to investigate the proportion of MSM using EBD-PrEP between October-December 2020 and to survey clinician confidence in delivering EBD-PrEP through an online questionnaire.Results551 MSM were seen who were eligible for PrEP in the study period, of which 448 were prescribed PrEP (64-declined, 2-stopped, 8-new patients and 29-repeat attenders accessed PrEP from another source). The median age of PrEP users was 37 years (IQR=29–48). Overall, 94/448 (21%,95%CI=17–25) of MSM were using EBD-PrEP. New starters were significantly more likely to use EBD-PrEP compared to existing PrEP users (34%.v.13%, χ2=27.6, p<0.00001). There was no significant difference in age between daily and EBD-PrEP users (37years. v.41years,p=0.2). There were 33/38 clinicians who responded to the online survey. Clinicians felt equally confident at delivering daily PrEP as EBD-PrEP (Likert scores=4.4/5 v 4.2/5, p=0.2). However, potential barriers identified to providing EBD-PrEP by clinicians were;assessing which MSM would be suitable for using EBD-PrEP, having access to appropriate information for patients to support their understanding of using EBD PrEP;and clinician knowledge and belief in the efficacy of EBD-PrEP.ConclusionThe uptake by MSM and clinician confidence in discussing EBD-PrEP appears to have increased since the start of the COVID-19 pandemic. Giving MSM greater choice in how PrEP is used will optimise its effect on reducing HIV transmission. More research is needed to support both MSM and clinicians to deliver EBD-PrEP.