Sensitization profiles to purified plant food allergens among pediatric patients with allergy to banana.

Banana fruit allergy is well known, but neither immunoglobulin E recognition patterns to purified plant food allergens nor true prevalences of putative banana allergens have been established. This study aimed to characterize β-1,3-glucanase and thaumatin-like protein (TLP) as banana allergens, testing them, together with other plant food allergens, in 51 children with allergic reactions after banana ingestion and both positive specific IgE and skin prick test (SPT) to banana. Banana β-1,3-glucanase and TLP were isolated and characterized. Both banana allergens, together with kiwifruit TLP Act d 2, avocado class I chitinase Pers a 1, palm pollen profilin Pho d 2 and peach fruit lipid transfer protein (LTP) Pru p 3, were tested by in vitro and in vivo assays. Banana β-1,3-glucanase (Mus a 5) was glycosylated, whereas banana TLP (Mus a 4) was not, in contrast with its homologous kiwi allergen Act d 2. Specific IgE to both banana allergens, as well as to peach Pru p 3, was found in over 70% of sera from banana-allergic children, and Mus a 4 and Pru p 3 provoked positive SPT responses in 6 of the 12 tested patients, whereas Mus a 5 in only one of them. Both peptidic epitopes and cross-reactive carbohydrate determinants were involved in the IgE-binding to Mus a 5, whereas cross-reactivity between Mus a 4 and Act d 2 was only based on common IgE protein epitopes. Profilin Pho d 2 elicited a relevant proportion of positive responses on in vitro (41%) and in vivo (58%) tests. Therefore, Mus a 4 and LTP behave as major banana allergens in the study population, and profilin seems to be also a relevant allergen. Mus a 5 is an equivocal allergenic protein, showing high IgE-binding to its attached complex glycan, and low in vivo potency

Factors influencing utilisation of ‘free-standing’ and ‘alongside’ midwifery units for low-risk births in England: a mixed-methods study

Background Midwifery-led units (MUs) are recommended for ‘low-risk’ births by the National Institute for Health and Care Excellence but according to the National Audit Office were not available in one-quarter of trusts in England in 2013 and, when available, were used by only a minority of the low-risk women for whom they should be suitable. This study explores why. Objectives To map the provision of MUs in England and explore barriers to and facilitators of their development and use; and to ascertain stakeholder views of interventions to address these barriers and facilitators. Design Mixed methods – first, MU access and utilisation across England was mapped; second, local media coverage of the closure of free-standing midwifery units (FMUs) were analysed; third, case studies were undertaken in six sites to explore the barriers and facilitators that have an impact on the development of MUs; and, fourth, by convening a stakeholder workshop, interventions to address the barriers and facilitators were discussed. Setting English NHS maternity services. Participants All trusts with maternity services. Interventions Establishing MUs. Main outcome measures Numbers and types of MUs and utilisation of MUs. Results Births in MUs across England have nearly tripled since 2011, to 15% of all births. However, this increase has occurred almost exclusively in alongside units, numbers of which have doubled. Births in FMUs have stayed the same and these units are more susceptible to closure. One-quarter of trusts in England have no MUs; in those that do, nearly all MUs are underutilised. The study findings indicate that most trust managers, senior midwifery managers and obstetricians do not regard their MU provision as being as important as their obstetric-led unit provision and therefore it does not get embedded as an equal and parallel component in the trust’s overall maternity package of care. The analysis illuminates how provision and utilisation are influenced by a complex range of factors, including the medicalisation of childbirth, financial constraints and institutional norms protecting the status quo. Limitations When undertaking the case studies, we were unable to achieve representativeness across social class in the women’s focus groups and struggled to recruit finance directors for individual interviews. This may affect the transferability of our findings. Conclusions Although there has been an increase in the numbers and utilisation of MUs since 2011, significant obstacles remain to MUs reaching their full potential, especially FMUs. This includes the capacity and willingness of providers to address women’s information needs. If these remain unaddressed at commissioner and provider level, childbearing women’s access to MUs will continue to be restricted. Future work Work is needed on optimum approaches to improve decision-makers’ understanding and use of clinical and economic evidence in service design. Increasing women’s access to information about MUs requires further studies of professionals’ understanding and communication of evidence. The role of FMUs in the context of rural populations needs further evaluation to take into account user and community impact. Funding This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 8, No. 12. See the NIHR Journals Library website for further project information

Factors influencing the utilisation of free-standing and alongside midwifery units in England: a qualitative research study

OBJECTIVE: To identify factors influencing the provision, utilisation and sustainability of midwifery units (MUs) in England. DESIGN: Case studies, using individual interviews and focus groups, in six National Health Service (NHS) Trust maternity services in England. SETTING AND PARTICIPANTS: NHS maternity services in different geographical areas of England Maternity care staff and service users from six NHS Trusts: two Trusts where more than 20% of all women gave birth in MUs, two Trusts where less than 10% of all women gave birth in MUs and two Trusts without MUs. Obstetric, midwifery and neonatal clinical leaders, managers, service user representatives and commissioners were individually interviewed (n=57). Twenty-six focus groups were undertaken with midwives (n=60) and service users (n=52). MAIN OUTCOME MEASURES: Factors influencing MU use. FINDINGS: The study findings identify several barriers to the uptake of MUs. Within a context of a history of obstetric-led provision and lack of decision-maker awareness of the clinical and economic evidence, most Trust managers and clinicians do not regard their MU provision as being as important as their obstetric unit (OU) provision. Therefore, it does not get embedded as an equal and parallel component in the Trust's overall maternity package of care. The analysis illuminates how implementation of complex interventions in health services is influenced by a range of factors including the medicalisation of childbirth, perceived financial constraints, adequate leadership and institutional norms protecting the status quo. CONCLUSIONS: There are significant obstacles to MUs reaching their full potential, especially free-standing midwifery units. These include the lack of commitment by providers to embed MUs as an essential service provision alongside their OUs, an absence of leadership to drive through these changes and the capacity and willingness of providers to address women's information needs. If these remain unaddressed, childbearing women's access to MUs will continue to be restricted

PERBANDINGAN DAYA BUNUH WARFARIN 0,105% DAN BRODIFACOUM 0,005% TERHADAP MENCIT (Mus Musculus)

Tikus adalah rodensia yang berperan sebagai tuan rumah perantara untuk beberapa jenis penyakit yang dikenal sebagai penyakit tular rodensia, selain dapat menimbulkan berbagai gangguan dan kerugian ekonomi. Dalam setahun tikus mampu berbiak menjadi 50 ekor. Umpan dengan bahan aktif Warfarin 0,105% dan Brodifacoum 0,005% termasuk jenis racun yang bekerja secara lambat dan menghambat proses koagulasi serta memecah pembuluh darah kapiler. Binatang yang sering digunakan dalam penelitian di laboratorium adalah Mencit (Mus Musculus) Strain albino, sehingga dilakukan penelitian tentang perbandingan daya bunuh Warfarin 0,105% dan Brodifacoum 0,005% terhadap Mencit ( Mus Musculus). Sampel penelitian sebanyak 20 ekor untuk perlakuan Warfarin 0,105% dan 20 ekor untuk perlakuan Brodifacoum 0,005%, sedangkan seekor untuk kontrol. Metode yang digunakan adalah eksperimen murni dengan sistem randomisasi. Penelitian selama 7 hari mendapatkan data kematian Mencit karena Warfarin 0,105% mulai terjadi pada hari ke 4, sedangkan kematian mencit karena Brodifacoum 0,005% mulai terjadi pada hari ke 3. Bobot kematian terendah pada 19,4 gram dan tertinggi dengan berat 30 gram. Uji statistik dengan rancangan Acak Lengkap dan analisis ragam menunjukkan bahwa ada perbedaan daya bunuh nyata antara Warfarin 0,105% dan Brodifacoum 0,005% terhadap Mencit (Mus Musculus). Hal ini dapat dilihat dari nilai F-Hitung> nilai F-tabel pada alfa 0,05 dan 0,01 yaitu 37,69> 4,10 dan 7,35. Perbandingan daya bunuh warfarin 0,105% dan Brodifacoum 0,005% terhadap Mencit (Mus Musculus) adalah 1:8, artinya daya bunuh Brodifacoum 0,005% terhadap Mencit (Mus Musculus) 8 kali lebih besar dibandingkan Warfarin 0,105%. Warfarin 0,105% dan Brodifacum 0,005% sama-sama mempunyai daya bunuh terhadap Mencit (Mus Musculus), sehingga dapat digunakan sebagai pengendalian tikus dan mencit liar, tetapi dalam cakupan yang luas agar menggunakan Brodifacoum 0,005%. Kata Kunci: Warfarin 0,105%, Brodifacoum 0,005%, Mencit

The effects of pictures on the order of accessing online war stories

Research on how people read news stories has shown that readers chose to read and access news stories associated with pictures that contained an element of attraction. Researchers have found that the emotional elements within the picture could also play a role. It is unclear how neutral human interest pictures influence readers to access news stories. Is the access process influenced by less emotive pictures or more human interest elements? These issues were explored in an experiment in which 24 students participated. The experiment compared similar news that was accompanied with a human interest picture, information graphic and without information graphic. The focus of the news stories was on war news which almost always contained human interest elements that could be neutral or emotion-laden. The experiment suggested that human interest pictures of war stories could be equally effective in attracting readers to read and remember the news stories