Boston Bowel Preparation Scale scores provide a standardized definition of adequate for describing bowel cleanliness.

BACKGROUND: Establishing a threshold of bowel cleanliness below which colonoscopies should be repeated at accelerated intervals is important, yet there are no standardized definitions for an adequate preparation. OBJECTIVE: To determine whether Boston Bowel Preparation Scale (BBPS) scores could serve as a standard definition of adequacy. DESIGN: Cross-sectional observational analysis of colonoscopy data from 36 adult GI endoscopy practices and prospective survey showing 4 standardized colonoscopy videos with varying degrees of bowel cleanliness. SETTING: The Clinical Outcomes Research Initiative. PATIENTS: Average-risk patients attending screening colonoscopy. INTERVENTIONS: Colonoscopy. MAIN OUTCOME MEASUREMENTS: Recommended follow-up intervals among average-risk, screening colonoscopies without polyps stratified by BBPS scores. RESULTS: We evaluated 2516 negative screening colonoscopies performed by 74 endoscopists. If the BBPS score was ≥2 in all 3 segments (N = 2295), follow-up was recommended in 10 years in 90% of cases. Examinations with total BBPS scores of 3 to 5 (N = 167) had variable recommendations. Follow-up within 1 year was recommended for 96% of examinations with total BBPS scores of 0 to 2 (N = 26). Similar results were noted among 167 participants in a video survey with pre-established BBPS scores. LIMITATIONS: Retrospective study. CONCLUSION: BBPS scores correlate with endoscopist behavior regarding follow-up intervals for colonoscopy. A total BBPS score ≥6 and/or all segment scores ≥2 provides a standardized definition of adequate for 10-year follow-up, whereas total scores ≤2 indicate that a procedure should be repeated within 1 year. Future work should focus on finding consensus for management of examinations with total scores of 3 to 5.

Validity of a Web-based educational program to disseminate a standardized bowel preparation rating scale.

GOALS: Our goal was to assess the validity of a Web-based educational program on the Boston Bowel Preparation Scale (BBPS). BACKGROUND: Data on Web-based education for improving the practice and quality of colonoscopy are limited. STUDY: Endoscopists worldwide participated in the BBPS Educational Program. We assessed program completion rates, satisfaction, short-term (0 to 90 d) and long-term (91 to 180 d) uptake of the BBPS, and the validity of the program by measuring the reliability of the BBPS among participants. RESULTS: A total of 207 endoscopists completed the program. Overall, 93% found the content relevant, 89% felt confident in using the BBPS, and 97% thought the quality was good or excellent. Uptake of the BBPS into clinical practice was robust with 91% and 98% of colonoscopy reports containing the BBPS at short-term and long-term follow-up, respectively. The interobserver and test-retest reliability of BBPS segment and total scores were both substantial. CONCLUSIONS: A BBPS Web-based educational program facilitates adoption into clinical practice and teaches the BBPS to be used reliably by a diverse group of endoscopists worldwide.

Migration by 'direct' or 'indirect' food contact? 'Dry' and 'wetting' foods? Experimental data for 'touching' contact of dry foods with paper and board.

Food contact is characterised in various terms, all of which are somewhat ill-defined. This work investigated the simplification that migration from food contact materials into dry food virtually exclusively proceeds through the gas phase, which would imply that the migration of essentially non-volatile components is negligible. It is shown here that this is not necessarily appropriate: for newspaper printed with an ink based on essentially non-volatile polyalphaolefins (PAO) as the main solvent, the migration into polenta and a baking mix reached 64% and 66% respectively of the content in the paper in merely 20 days at ambient temperature. Migration of involatile substances into dry foods implies diffusion through the paper to the small contact points. It depended on particle size, as this determines the density of the contacts. The diffusion rates within the food contact material and the food, including the transfer from one particle to the next, are other determining factors. This leaves the question whether such migration can be modelled or tested in a systematic manner (simulation), or whether it needs to be determined on a case-by-case basis.

Simulation of the migration of mineral oil from recycled paperboard into dry foods by Tenax®?

Conventional migration testing for long-term storage at ambient temperature with Tenax® was applied to a recycled paperboard as well as to the same paperboard with a polyethylene or polypropylene film in between. Test conditions were from the European Union plastic Regulation 10/2011, that is, 10 days at 60°C, but previous standard conditions of 10 days at 40°C were also applied. The results were compared with the migration into real packs made of the same packaging material containing six test foods and stored over 9 months. For the direct contact, simulation at 60°C overestimated the maximum migration of the saturated hydrocarbons in the real packs by 73%. Simulation reflected hardly any effect by the plastic films and resulted in an overestimation of the maximum migration into the real packs by a factor of 5.1 and 27 for the polyethylene and the polypropylene film, respectively. Analogous simulation was performed with polenta (corn semolina) instead of Tenax®. Three main causes for this deviation were identified: (i) at 60°C, migration reached beyond n-C35, whereas it ends at about n-C24 in reality. (ii) Tenax® is a far stronger adsorbent than foods, resulting in almost complete extraction. (iii) The significant barrier effect of polypropylene films at ambient temperature is lost at increased temperature. The suitability of such simulation for the prediction of long-term migration is questioned.

Migration of cyclo-diBA from coatings into canned food: method of analysis, concentration determined in a survey and in silico hazard profiling.

Cyclo-diBA, the cyclic product formed from bisphenol A and bisphenol A diglycidyl ether during production of epoxy resins, was measured in canned food using reversed phase HPLC with fluorescence detection. Half (9 of 17) of the samples of canned fish in oil collected in April 2010 contained cyclo-diBA with an average concentration of 1025 µg/kg and a maximum of 1980 µg/kg. In September 2012, cyclo-diBA was detectable (>25 µg/kg) in merely 13 from 44 such products; the average concentration in these was 807 µg/kg and the maximum now reached 2640 µg/kg. Fish in brine contained far less cyclo-diBA. The majority of the canned meat products contained cyclo-diBA at a mean concentration of 477 µg/kg and a maximum of 1050 µg/kg. All prepared meals, such as ravioli or soups, contained cyclo-diBA, with a mean at 287 µg/kg. In canned tomatoes, peas and other vegetables in water or fruits in syrup, no cyclo-diBA was detected (<25 µg/kg). Since no experimental toxicity data are available except for its cytotoxicity, an in silico hazard profiling was performed. Cyclo-diBA seems to be stable and of low reactivity. There is indication for considerable oral bioavailability and for the potential to accumulate in the human body. Cyclo-diBA can be metabolized into cyclic and acyclic compounds. Based on SAR assessment for cyclo-diBA and read-across from BADGE to linear cyclo-diBA metabolites, genotoxic effects are improbable. Specific binding of cyclo-diBA to nuclear receptors, such as ERß, can be predicted, indicating a potential endocrine-disrupting potency. The limit by the EFSA guidelines of 50 µg/person/d for compounds shown not to be genotoxic as well as the TTC-based Cramer structural class III value of 90 µg/person/d could be exceeded several fold by high consumers of canned fish in oil with high brand loyalty. As a consequence, risk reduction measures were taken.

Migration of mineral oil, photoinitiators and plasticisers from recycled paperboard into dry foods: a study under controlled conditions.

Migration from recycled paperboard was monitored after 2, 4 and 9 months of storage for six test foods industrially packed in five configurations, four with internal plastic films. After 9 months, the migration of mineral oil saturated hydrocarbons into foods directly packed in the paperboard amounted to 30-52 mg/kg, which corresponded to 65%-80% of those of a volatility up to that of the n-alkane C24 in the paperboard. The concentration of the migrated aromatic hydrocarbons in the foods ranged from 5.5 to 9.4 mg/kg. More than half of this migration occurred in the first 2 months. Differences between the foods amounted to mostly less than a factor of 2 and seemed to be related to porosity or permeability more than fat content. Nine photoinitiators were detected in the paperboard, of which eight migrated into the packed food at up to 24%. Several plasticisers were present in the recycled paperboard, but only butyl phthalates showed significant migration. After 9 months, up to 40% of diisobutyl phthalate and 20% of dibutyl phthalate migrated into the food with direct contact. The internal polyethylene film hardly slowed migration, but the film and the tray absorbed approximately three times more mineral oil than the food, despite constituting merely 4% of the mass of the pack. Oriented polypropylene strongly slowed migration: The highest migration of saturated hydrocarbons measured after 9 months (2.3 mg/kg) corresponded to only 3% of the content in the paperboard and included migrated polyolefin oligomeric saturated hydrocarbons. Coating of polypropylene with an acrylate further slowed the migration, but the migration from the paperboard was still detectable in four of the six samples. Polyethylene terephthalate was a tight barrier.