Monoclonal antibodies against major rye-grass pollen allergens have been used to detect cross-reactive determinants in other grass pollen extracts. Antibody binding was detected by the dot blotting immunoassay in which alkaline phosphatase-conjugated anti-mouse IgG was used as secondary antibody. Taxonomically ordered variations were found between pollen of 22 grass species representing all major natural groups. One of the antibodies, that bound to the 28 to 30Kd allergen, showed high species specificity; immunoblotting showed binding to similar polypeptides in Festuca elatior but to none of the other grasses tested. This simple assay has applications in standardizing grass pollen extracts.

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Combining a training package to improve the knowledge and skills of health care workers in managing sick and preterm neonates with pointof-care quality improvement skills successfully reduced the unindicated use of oxygen, antibiotics, and phototherapy while increasing the use of enteral feeds.n Despite a significant reduction in the use of 2 lifesaving medical interventions-oxygen and antibiotics-no increase in mortality or short-term adverse outcome was observed, indicating an overuse of these interventions in the preintervention period.

Non-judicious oxygen use in preterm infants is associated with increased risk of retinopathy of prematurity, bronchopulmonary dysplasia and longer hospital stay. Despite established guidelines on oxygen therapy, compliance with the best oxygen practices remains suboptimal. Excessive use of oxygen also consumes a large proportion of the annual maintenance budget of special newborn care units (SNCUs) in the districts. In this project, we aimed to reduce the oxygen consumption in the SNCU at Sehore, Madhya Pradesh, India from eight to four cylinders per day, by rationalising the indications, monitoring and method of oxygen delivery.We tested two sets of interventions using the Plan–Do–Study–Act (PDSA) approach. The first intervention was the introduction of a written ‘oxygen policy’ regarding indications of starting/stopping oxygen and the use of saturation targets. The second was using short binasal infant prongs (at 0.5–1 L/min), instead of oxygen hoods as the primary method of oxygen delivery in spontaneously breathing neonates requiring oxygen. In the first PDSA cycle, we assessed the feasibility of the intervention in a small set (n=30) of neonates and later scaled up to all eligible neonates in the second phase.We observed a significant reduction in oxygen consumption (from median (IQR) 8 (7–8) to 3 (3–4) cylinders per day) that can lead to a direct saving of 590 000 Indian rupees (US$9000) per year. There was a significant reduction in the number of neonates on oxygen support on a given day. We did not observe any increase in mortality or nasal injury. The change was sustained for the next 8 months.We conclude that by having a contextual oxygen policy and using nasal prongs instead of oxygen hoods as the preferred delivery method, we can achieve a sustainable reduction in oxygen consumption.

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