Consensus statement on the epidemiology, diagnosis, prevention, and management of cow's milk protein allergy in the Middle East: a modified Delphi-based study.

BACKGROUND: This study aimed to develop an expert consensus regarding the epidemiology, diagnosis, and management of cow's milk protein allergy (CMPA) in the Middle East. METHODS: A three-step modified Delphi method was utilized to develop the consensus. Fifteen specialized pediatricians participated in the development of this consensus. Each statement was considered a consensus if it achieved an agreement level of ≥ 80%. RESULTS: The experts agreed that the double-blind placebo-controlled oral challenge test (OCT) should be performed for 2-4 weeks using an amino acid formula (AAF) in formula-fed infants or children with suspected CMPA. Formula-fed infants with confirmed CMPA should be offered a therapeutic formula. The panel stated that an extensively hydrolyzed formula (eHF) is indicated in the absence of red flag signs. At the same time, the AAF is offered for infants with red flag signs, such as severe anaphylactic reactions. The panel agreed that infants on an eHF with resolved symptoms within 2-4 weeks should continue the eHF with particular attention to the growth and nutritional status. On the other hand, an AAF should be considered for infants with persistent symptoms; the AAF should be continued if the symptoms resolve within 2-4 weeks, with particular attention to the growth and nutritional status. In cases with no symptomatic improvements after the introduction of an AAF, other measures should be followed. The panel developed a management algorithm, which achieved an agreement level of 90.9%. CONCLUSION: This consensus document combined the best available evidence and clinical experience to optimize the management of CMPA in the Middle East.

A versatile droplet on demand generator based on active pressure control.

The development of a novel on-demand droplet generator is reported in this paper based on off-the-shelf electromechanical components. With the ability to produce a broad range of droplet sizes, this device was designed to have minimum components without compromising reliability. The generator performance was assessed by producing water droplets for fire dynamics and suppression studies. Droplet formation at the tip of the nozzle was visualized using high-speed imaging. Stable and unstable regions can be identified easily through the images. Interchangeable nozzles can be used, allowing different droplet sizes. The setting parameters of the device allow accurate control of droplet size and initial speed. The device controls the liquid pressure actively and precisely. The active control of pressure and the ability to have specific droplet ejection parameters ensured the repeatability of droplet conditions. Characterization of the device is presented along with the calibration data, which can be collected in an efficient methodology. These data enable the selection of droplet size and speed when required. This system could easily be implemented in other research areas. Hence, the intention is to share and highlight the generator features for its use in a range of other scientific applications.