A randomized controlled trial comparing right lateral decubitus and left lateral decubitus starting position on outcomes in colonoscopy

Patient positioning in colonoscopy has been proposed as a simple and inexpensive technique to increase luminal distention and improve navigation through the large bowel. We sought to determine if right lateral (RL) starting position compared to the standard left lateral (LL) starting position could improve outcomes in colonoscopy. Patients presenting for their scheduled colonoscopy were consented for the trial and randomized to RL or LL starting position. Variables including age, sex, BMI, time to cecal intubation, adenoma detection rate (ADR), NAPCOMs pain score, amount of sedation administered, and quality of bowel preparation were collected during their colonoscopy. The primary outcome was time to cecal intubation. All colonoscopists who had successfully completed upskilling courses were included in the trial. A total of 185 patients were included in the analysis - 94 patients were randomized to RL and 91 patients were randomized to LL. No difference was found in time to cecal intubation comparing the starting position of RL (542.6s) to LL (497.85s) (p=0.354). There was also no difference in cecal intubation rate (RL - 94.9%, LL – 94.8%, p=0.960), ADR (RL – 56.3%, LL – 64.8%, p=0.240), or patient comfort (p=0.078) comparing the starting position. In conclusion, no difference was found for outcomes in colonoscopy comparing the RL and LL starting position

Nutrition Education in Vermont Public Schools

Introduction. Despite positive changes, childhood obesity and food insecurity remain prevalent across the country. Vermont is not immune to these issues. We set out to: research the level of nutrition education Vermont elementary schools provide their students, understand teacher perceptions of these programs, and recommend ways to fill identified gaps. Methods. Our study is a cross-sectional survey of Vermont educators around nutrition education. The survey consisted of 17 questions, used LimeSurvey, and included demographic and nutrition education questions. The survey was distributed statewide through newsletters and list-servers. Results. 64 responses met inclusion criteria. Vermont elementary school (K-6) teachers report a mean satisfaction score of 2.51 out of 5.0 for their schools\u27 current nutrition education programs. School nurses reported a score of 2.5 out of 5.0. Highest satisfaction scores included school administrators and health and wellness coordinators (3.3 out of 5.0). When comparing teachers to non-classroom educators (administrators and nutrition educators) data showed a significant difference between high satisfaction (3-5) and low satisfaction (1-2); (Fischer p = 0.009). Overall, Vermont elementary school teachers report a high level of knowledge about nutrition, (4.1/5.0), but a lower level of understanding in their students (2.5/5.0). Conclusions. Given teacher perceptions regarding current school nutrition education programs, development and implementation of a state-wide nutrition education curriculum with dedicated teaching time may be warranted. Programs recommended by the CDC include Eat Well & Get Moving and Planet Health, designed by the Harvard School of Public Health. These could be adapted as a framework for Vermont.https://scholarworks.uvm.edu/comphp_gallery/1244/thumbnail.jp

Improving fluid consumption of older people in care homes: an exploration of the factors contributing to under-hydration

Background: Age-related changes which occur in older people put them at risk of dehydration and care home residents are particularly vulnerable. Evidence suggests that hydration care in this setting may be inadequate, but few UK studies have explored the extent of the problem. Aim: To determine the amount of fluids care home residents received and consumed, and identify the barriers and facilitators to optimising hydration care in two private nursing homes to inform the design and implementation of a subsequent service improvement initiative. Methods: A pragmatic descriptive observational design using multiple data collection methods. Results: Mean fluid intake was 1031ml/day; with 50% of residents offered more than 1500ml/day. Residents in communal areas received more drinks than those in their own rooms (74.8% vs 42.6%), and overall residents consumed 69% of fluids they were offered. Those who required assistance to drink consumed the least amount of fluids. Conclusion: Adequately hydrating older people is essential if associated morbidity and hospital admissions are to be prevented. This study has identified the challenges experienced by care homes and residents in meeting this fundamental care need. It demonstrates the importance of a coherent strategy to improve hydration in this population

Contextual and Cultural Influences on Parental Feeding Practices and Involvement in Child Care Centers among Hispanic Parents

Background: Parental feeding practices shape children\u27s dietary preferences and behaviors, which can influence a child\u27s weight status. Limited research exists on the precursors and contextual influences of feeding, particularly among Hispanic parents. Therefore, this study explored two areas potentially important for obesity prevention in young children: (1) precursors and contextual influences on parental feeding and (2) parental perceptions and knowledge of the child care food environment. Methods: Four focus groups (n=36) were held with Hispanic parents, predominantly mothers, of preschool children at two child care centers. Parents were asked about influences on what and how they feed their children, awareness of the child care center feeding environment, and current involvement in the child care center. Themes were coded using NVivo10 software (QSR International, Melbourne, Australia). Results: Participants\u27 childhood experiences influenced how they feed their children. Parents stated that both husbands and grandparents often indulged their children with unhealthy foods and thought this interfered with their efforts to maintain a healthy home environment. Participants reported that what their children ate while in child care sometimes influenced the home feeding environment. Conclusions: Cultural and environmental factors influence parental feeding and involvement in the child care setting. Consistent with socioecological system theory, exploring interactions between the environment and culture using a family focus framework, such as the Family Ecological Model, could provide a better understanding of these influences among Hispanic parents. Future obesity prevention interventions with Hispanic families should be culturally relevant and target the different environments where children spend their time

Visualisation of latent fingerprint on wild bird eggshells by alternate light sources following superglue fuming

The theft of the eggs of endangered or protected species of bird, and subsequent reduction in wildlife population, is a significant problem worldwide. Detection rates are comparatively low towards this type of crime and fingerprinting of egg shells is infrequently utilised due to the technical barrier. This paper explores a novel technique using cyanoacrylate (superglue) fuming in conjunction with fluorescent dye to visualise latent fingerprints upon avian eggshells assisted with alternate light sources. A systematic investigation of experimental parameters has also been carried out to optimise the condition for the fingerprint visualisation. This research project has successfully developed latent fingerprints upon smooth wild bird eggshells but was less successful on developing prints on more textured, porous eggshells.Published onlin

Characterizing the burden of premature ejaculation from a patient and partner perspective: a multi-country qualitative analysis

This is an Open Access article distributed under the terms of the Creative Commons Attribution Licens

Chlamydia trachomatis Immune Evasion via Downregulation of MHC Class I Surface Expression Involves Direct and Indirect Mechanisms

Genital C. trachomatis infections typically last for many months in women. This has been attributed to several strategies by which C. trachomatis evades immune detection, including well-described methods by which C. trachomatis decreases the cell surface expression of the antigen presenting molecules major histocompatibility complex (MHC) class I, MHC class II, and CD1d in infected genital epithelial cells. We have harnessed new methods that allow for separate evaluation of infected and uninfected cells within a mixed population of chlamydia-infected endocervical epithelial cells to demonstrate that MHC class I downregulation in the presence of C. trachomatis is mediated by direct and indirect (soluble) factors. Such indirect mechanisms may aid in priming surrounding cells for more rapid immune evasion upon pathogen entry and help promote unfettered spread of C. trachomatis genital infections

Screening prevalence of fetal alcohol spectrum disorders in a region of the United Kingdom: a population-based birth-cohort study

We are extremely grateful to all the families who took part in this study, the midwives for their help in recruiting them, and the whole ALSPAC team, which includes interviewers, computer and laboratory technicians, clerical workers, research scientists, volunteers, managers, receptionists and nurses. This study was funded by a doctoral studentship from Cardiff University (awarded to CM). The UK Medical Research Council and Wellcome Trust (Grant ref.: 102215/2/13/2) and the University of Bristol provide core support for the Avon Longitudinal Study of Parents and Children (ALSPAC). Funding for the facial scan data was provided by Cardiff University.Peer reviewedPublisher PD

Practical solutions for optimising hydration in care home residents

As people age, they become increasingly vulnerable to dehydration. Older people living in care homes are particularly at risk and ensuring that they receive and consume adequate amounts of fluid every day can be a challenge. This article describes the findings of a quality improvement project conducted in two London care homes aimed at optimising residents’ fluid intake. A range of simple and inexpensive practical solutions were developed and implemented with good results. The research team that worked with staff on the project has since developed a free resource pack on hydration in care homes