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BACKGROUND: Women seeking a vaginal birth after a caesarean section (VBAC) frequently want to keep their subsequent labour and birth free from intervention. Water immersion (WI) during labour is potentially an effective tool for women having a VBAC for its natural pain-relieving properties. However, negotiating access to WI can be difficult, especially in the context of VBAC. AIM: To explore women's experiences of negotiating WI for labour and birth in the context of VBAC. METHODOLOGY: This Grounded Theory study followed Strauss and Corbin's framework and analytic process. Twenty-five women planning or using WI for their VBAC labour or birth were recruited from two midwifery practices and a social media group across Australia. Participants were interviewed during pregnancy and/or postnatally. FINDINGS: 'Taking the reins', the core category explaining the women's experiences of assuming authority over their birth, comprised five categories: 'Robbed of my previous birth experience'; 'My eyes were opened'; 'Water is my tool for a successful VBAC'; 'Actioning my choices and rights for WI', and 'Empowered to take back control'. 'Wanting natural and normal' was the driving force behind women's desire to birth vaginally. Two mediating factors: Having someone in your corner and Rules for birth facilitated or hindered their birth choices, respectively. CONCLUSION: The women became active participants in their healthcare by seeking information and options to keep their birth experience natural and normal. Support from other women and advocacy in the form of continuity of midwifery care was crucial in successfully negotiating WI for their VBAC when navigating the complex health system.

Objectives To identify key predictors of general practitioner (GP) consultations for allergic rhinitis (AR) using meteorological and environmental data. Design A retrospective, time series analysis of GP consultations for AR. Setting A large GP surveillance network of GP practices in the London area. Participants The study population was all persons who presented to general practices in London that report to the Public Health England GP in-hours syndromic surveillance system during the study period (3 April 2012 to 11 August 2014). Primary measure Consultations for AR (numbers of consultations). Results During the study period there were 186 401 GP consultations for AR. High grass and nettle pollen counts (combined) were associated with the highest increases in consultations (for the category 216-270 grains/m3, relative risk (RR) 3.33, 95% CI 2.69 to 4.12) followed by high tree (oak, birch and plane combined) pollen counts (for the category 260-325 grains/m3, RR 1.69, 95% CI 1.32 to 2.15) and average daily temperatures between 15°C and 20°C (RR 1.47, 95% CI 1.20 to 1.81). Higher levels of nitrogen dioxide (NO 2) appeared to be associated with increased consultations (for the category 70-85 μg/m3, RR 1.33, 95% CI 1.03 to 1.71), but a significant effect was not found with ozone. Higher daily rainfall was associated with fewer consultations (15-20 mm/day; RR 0.812, 95% CI 0.674 to 0.980). Conclusions Changes in grass, nettle or tree pollen counts, temperatures between 15°C and 20°C, and (to a lesser extent) NO 2 concentrations were found to be associated with increased consultations for AR. Rainfall has a negative effect. In the context of climate change and continued exposures to environmental air pollution, intelligent use of these data will aid targeting public health messages and plan healthcare demand.

Background/Aim: Grass (Poaceae) pollen is the most significant outdoor aeroallergen, and is linked to asthma exacerbations and respiratory allergic response. Understanding of the relative contributions of different grass taxa to respiratory health outcomes is currently unknown. We investigate associations between a range of grass genera and proxies of both asthma exacerbation (hospital admissions) and respiratory allergic response (prescribing rates). A better understanding of allergenic exposures will allow better disease management by patients and healthcare providers. This work forms part of the PollerGEN Project. Methods: Combining metagenomics and pollen count data, we produced semi-quantitative estimates of concentrations of the pollen of 14 grass genera and undifferentiated (i.e. unidentified) Poaceae, at six sites across the UK during the pollen season (May to September) of 2016. Using a series of generalised additive models (GAMs), these data are being combined with hospital admissions and prescribing datasets (and various confounding datasets) to assess associations between different types of grass pollen with serious asthma exacerbations and respiratory allergic response at a population level. Results: Preliminary GAMs, adjusted for weather, air pollution, rural-urban status, deprivation, health organisation and time period, explain >95% of variation in health outcome variables (adjusted R2 = 0.912). Notably, they suggest a potential positive relationship between respiratory antihistamines and concentrations of Holcus pollen during the 2016 UK pollen season (F = 25.9, P = 2.41 x 10^-8), whereas overall grass pollen concentrations (i.e. standard pollen ‘counts’), did not provide significant correlation. Conclusions: Our preliminary results suggest that certain grass taxa may contribute more than others to respiratory health outcomes in the UK, including contributing more than overall grass pollen concentrations. This

Objectives/Hypothesis: The aim of this study is to elucidate transcriptional changes that occur in response to tympanic membrane (TM) perforation in rats and to infer key genes and molecular events in the healing process. Study Design: A prospective cohort study of 393 male Sprague-Dawley (Rattus norvegicus) rats. Methods: Sprague-Dawley rats were randomly allocated into either control or perforation groups spanning a 7-day time period. Perforation groups consisted of 12-hour, 24-hour, 36-hour, 2-day, 3-day, 4-day, 5-day, six-day, and 7-day time points. The left TMs of all perforation groups were perforated and the RNA extracted at the specified time point postperforation. Subsequent analysis was performed using Agilent's 4 × 44 k whole rat genome arrays (40 in total) to assess wound-healing gene expression over a 7-day time period. Results: Over a 7-day time course and at nine time points that encompassed the wounding and progression of healing, a total of 3,262 genes were differentially expressed. In this study the transcripts most upregulated occurred at 12 hours. These were Stefin A2 (344-fold), Stefin 2 (143-fold), and Natriuretic peptide precursor type B (222-fold). Those most downregulated also occurred at 12 hours. These were alcohol dehydrogenase 7 (13.1-fold) and gamma-butyrobetaine hydroxylase (10.4-fold). Results were validated by quantitative real-time polymerase chain reaction. Conclusions: The findings of this study provide a baseline against which to identify disease-related molecular signatures, biomarkers, and to develop new treatments for TM conditions based on molecular evidence. Copyright © 2011 The American Laryngological, Rhinological, and Otological Society, Inc.

MassCode PCR is a novel technology for the rapid, sensitive and simultaneous detection of multiple gene sequences. This technique utilises a library of molecular tags, each unique in its molecular weight. MassCode tags are conjugated to oligonucleotide primers using a UV-cleavable linker that enables separation of primer and tag. Different primers are labelled each with a different molecular weight tag and are used to amplify target nucleic acids in a multiplex RT-PCR. After removing unincorporated primers, tags are released by UV irradiation and analysed using a single quadrupole liquid chromatography mass spectrometer (LC/MS). Thus, amplification of the gene target produces a unique dual signal in LC/MS analysis that allows its identification. Respiratory disease represents a diagnostic challenge, with multiple microbial agents associated with infection, and co-infection frequently observed. We have evaluated a commercial multiplex (28-plex) MassCode PCR assay developed by Agilent Technologies to detect viral pathogens, including types or subtypes of coronavirus, metapneumovirus, parainfluenza virus, influenza virus, respiratory syncytial virus, enterovirus and rhinovirus, as well important bacterial and fungal pathogens that infect the airways. The performance of this assay was evaluated in a clinical diagnostic laboratory using clinical specimens obtained from the upper and lower respiratory tract from human cases of disease in Western Australia. The performance of the MassCode assay was compared to established in-house (RT-)PCR assays. Our findings indicate that MassTag PCR offers an inexpensive and sensitive diagnostic platform suitable for high-throughput testing.

BACKGROUND: Third-stage larvae (L3) of the canine hookworm, Ancylostoma caninum, undergo arrested development preceding transmission to a host. Many of the mRNAs up-regulated at this stage are likely to encode proteins that facilitate the transition from a free-living to a parasitic larva. The initial phase of mammalian host invasion by A. caninum L3 (herein termed "activation") can be mimicked in vitro by culturing L3 in serum-containing medium. METHODOLOGY/PRINCIPAL FINDINGS: The mRNAs differentially transcribed between activated and non-activated L3 were identified by suppression subtractive hybridisation (SSH). The analysis of these mRNAs on a custom oligonucleotide microarray printed with the SSH expressed sequence tags (ESTs) and publicly available A. caninum ESTs (non-subtracted) yielded 602 differentially expressed mRNAs, of which the most highly represented sequences encoded members of the pathogenesis-related protein (PRP) superfamily and proteases. Comparison of these A. caninum mRNAs with those of Caenorhabditis elegans larvae exiting from developmental (dauer) arrest demonstrated unexpectedly large differences in gene ontology profiles. C. elegans dauer exiting L3 up-regulated expression of mostly intracellular molecules involved in growth and development. Such mRNAs are virtually absent from activated hookworm larvae, and instead are over-represented by mRNAs encoding extracellular proteins with putative roles in host-parasite interactions. CONCLUSIONS/SIGNIFICANCE: Although this should not invalidate C. elegans dauer exit as a model for hookworm activation, it highlights the limitations of this free-living nematode as a model organism for the transition of nematode larvae from a free-living to a parasitic state.