Assessing the Potential for Integrating Routine Data Collection on Complementary Feeding to Child Health Visits: A Mixed-Methods Study.

There is no routine data collection in the UK on infant dietary diversity during the transition to solid foods, and health visitors (HVs) (nurses or midwives with specialist training in children and family health) have the potential to play a key role in nutrition surveillance. We aimed to assess items for inclusion in routine data collection, their suitability for collecting informative data, and acceptability among HVs. A mixed-methods study was undertaken using: (i) an online survey testing potential questionnaire items among parents/caregivers, (ii) questionnaire redevelopment in collaboration with community staff, and (iii) a survey pilot by HVs followed by qualitative data collection. Preliminary online questionnaires (n = 122) were collected to identify useful items on dietary diversity. Items on repeated exposure to foods, aversive feeding behaviors, flavor categories, and sugar intake were selected to correspond to nutrition recommendations, and be compatible with electronic records via tablet. HVs surveyed 187 parents of infants aged 12 months. Semi-structured interviews indicated that HVs found the questionnaire comparable with standard nutrition conversations, which prompted helpful discussions, but questions on eating behavior did not prompt such useful discussions and, in some cases, caused confusion about what was 'normal.' Lack of time among HVs, internet connectivity issues, and fear of losing rapport with parents were barriers to completing electronic questionnaires, with 91% submitted by paper. Routine nutrition data collection via child health records seems feasible and could inform quality improvement projects.

Coliform bacteria, fabrics, and the environment.

BACKGROUND: People come into contact with coliform bacteria at recreational sites. Previous research on bacteria adhering to fabrics and surfaces focused on the viability of clinically significant microbes, but did not examine the quantity of bacteria. This study examined the viability and quantity of coliform bacteria adhered to common fabrics. METHODS: The fabrics of 100% cotton, blended cotton, and silk were exposed to a mixture of environmental coliform isolates. Fabrics were incubated in the dark at 25°C or 37°C or in direct sunlight at room temperature for 30, 60, 90, and 120 days. The quantity and viability of the bacteria were determined by the Most Probable Number technique using Colilert reagent (IDEXX Laboratories, Westbrook, ME) and eosin methylene blue agar, respectively. RESULTS: The highest numbers of bacteria were detected for each type of fabric when stored in the dark at 25°C, whereas the lowest numbers of bacteria were detected when fabrics were stored in the dark at 37°C. Low numbers of bacteria were detected on silk and blended cotton exposed to sunlight at room temperature, but not 100% cotton. CONCLUSION: It appears that coliform bacteria can survive on fabrics longer than previous studies have reported. Coliform bacteria survive better in the dark, at lower temperatures, and on fabrics that can retain moisture. These findings can be applied directly to the viability of bacteria on clothing and potential human exposure to fecal pathogens.

His and hers abdominal pain.

Abdominal pain should not be dismissed without proper evaluation. A patient presenting with acute, severe abdominal pain is best transported to the emergency room for treatment. While gender issues remain a delicate subject, proper prehospital care prevents patient deterioration, tissue loss and loss of life. Prehospital information is invaluable. Due to unforeseen complications, including patient deterioration, the history you obtain on scene may be the only information available to the medical team at the hospital. Professional care begins in the prehospital setting. Knowledge, skill and experience will guide you.

Presence and maturity of dendritic cells in melanoma lymph node metastases.

Immune avoidance mechanisms play a key role in the successful dissemination of melanoma. One mechanism whereby this could be achieved is by interfering with dendritic cell (DC) presentation of tumour-associated antigens to naïve T cells. In particular, immature DCs characterized by the absence of accessory molecules are known to be immunosuppressive and to be involved in the induction of tolerance. The present study has investigated the presence and activation status of DCs within melanoma metastases in the regional lymph nodes. Using image analysis techniques, the expression of Factor XIIIa (FXIIIa), CD40, CD83 and HLA-DR and the morphological features of DCs were examined in paraffin sections from 26 lymph nodes containing melanoma metastases. DCs expressing FXIIIa were found in 70% of the lymph nodes. The number of DCs identified was generally small but there were more concentrated areas of DCs designated as hotspots. In these areas of high FXIIIa staining, the percentage area occupied by DCs varied between 0.1% and 10%. The majority of FXIIIa-positive cells did not express the DC maturation markers CD83 or CD40 and morphologically were rounded with few dendrites, indicating that they were immature. The cells did, however, express high levels of HLA-DR, suggesting that they have the ability to present antigen but lack the accessory molecules required to initiate an immune response. Immature DCs, characterized by phenotypic and morphological features, are therefore present within the tumour deposits in lymph nodes infiltrated by melanoma and may specifically modulate the anti-melanoma immune response.