Challenges in translating scientific evidence into mandatory food fortification policy: an antipodean case study of the folate- neural tube defect relationship

Objective: To identify challenges in translating scientific evidence of a  nutrient and health relationship into mandatory food fortification policy.
Design: A case study approach was used in which available evidence  associated with the folate–neural tube defect relationship was reviewed against the Australia New Zealand Food Regulation Ministerial Council's Policy Guideline for mandatory food fortification. Results: Three particular challenges were identified. The first is knowing when and how to act in the face of scientific uncertainty. The second is knowing how to address the special needs of at-risk individuals without compromising the health and safety of the population as a whole. The third is to ensure that a policy is sufficiently monitored and evaluated. Conclusions: Despite the availability of compelling evidence of a relationship between a particular nutrient and a health outcome, a definitive policy response may not be apparent.  Judgement and interpretation inevitably play significant roles in influencing whether and how authorities translate scientific evidence into mandatory food fortification policy. In relation to the case study, it would be prudent to undertake a risk–benefit analysis of policy alternatives and to implement nutrition education activities to promote folic acid supplement use among the target group. Should mandatory folate fortification be implemented,  comprehensive monitoring and evaluation of this policy will be essential to know that it is implemented as planned and does more good than harm. In relation to mandatory food fortification policy-making around the world,  ongoing national nutrition surveys are required to complement national policy guidelines.

Evalutaion of the implementation of the folate-neural tube defect health claim and its impact on the availability of folate-fortified food in Australia

Objective: To evaluate the implementation of the folate-neural tube defect (NTD) health claim and its impact on the availability of folate-fortifed food in Australia.

Methods: During late 2005, a survey was conducted in 16 supermarkets across all Australian capital cities to identify the use of the folate-NTD health claim on the labels of the 128 food products listed in food standard 1.1A.2: 'Transitional standard - Health claims' and the number of products fortifed with folic acid.

Results: Seventy-nine per cent of existing listed food products were found and two of these were implementing the folate-NTD health claim. Forty-four per cent of these listed products, previously fortifed with folic acid, were no longer fortifed. One hundred and seventeen generally available food products were fortifed with folic acid, predominantly breakfast cereals (73%). Twenty-seven per cent of these folate-fortifed products were listed in the transitional standard.

Conclusions: The health claim was not used widely to inform women of child-bearing age of the importance of periconceptional folate intake. The increased availability of folate-fortifed products generally has occurred independently of the health claim. Defciencies in the verifcation system of the tested regulatory framework are identifed. The voluntary regulatory provisions for both folate fortifcation and the use of the health claim diminished the States' infuence over their implementation of public health tools.

Rapid composite tube manufacture utilizing the quickstep™ process

In this study, a novel method for manufacturing composite tubes utilizing the Quickstep^TM process has been developed. Tubes manufactured from `quick-cure' Toray G83C prepreg have demonstrated highly repeatable axial crush behavior with an average specific energy absorption (SEA) of 86 kJ/kg. The cure cycle is optimized by comparing the results from compression, dynamic mechanical thermal analysis (DMTA), differential scanning calorimetry (DSC), and porosity testing. The tube lay-up is optimized using compression and porosity test results. The effect of changes in fiber-orientation on SEA is also investigated. Process development has resulted in a robust manufacturing method capable of producing fully cured, high performance composite tubes with a cure cycle of 7 min. This corresponds to a 95% reduction in time compared to an equivalent autoclave cycle.

Gardner; re BWW: Victorian Supreme Court makes landmark Australian ruling on tube feeding

• The Victorian Supreme Court has decided that artificial nutrition and hydration provided through a percutaneous gastrostomy tube to a woman in a persistent vegetative state may be withdrawn.
• The judge ruled, in line with a substantial body of international medical, ethical and legal opinion, that any form of artificial nutrition and hydration is a medical procedure, not part of palliative care, and that it is a procedure to sustain life, not to manage the dying process.
• Thus, the law does not impose a rigid obligation to administer artificial nutrition or hydration to people who are dying, without due regard to their clinical condition. The definition of key terms such as “medical treatment”, “palliative care”, and “reasonable provision of food and water” in this case will serve as guidance for end-of-life decisions in other states and territories.
• The case also reiterates the right of patients, and, when incompetent, their validly appointed agents or guardians, to refuse medical treatment.
• Where an incompetent patient has not executed a binding advance directive and no agent or guardian has been appointed, physicians, in consultation with the family, may decide to withdraw medical treatment, including artificial nutrition or hydration, on the basis that continuation of treatment is inappropriate and not in the patient’s best interests. However, Victoria and other jurisdictions would benefit from clarification of this area of the law

The normative distribution of chest tube drainage volume after coronary artery bypass grafting

Background
Little evidence exists to describe expected volumes of chest tube (CT) drainage after coronary artery bypass grafting (CABG).

Objectives
The study objective was to map the trajectory of CT drainage volumes from insertion to removal after CABG.

Design

This was a retrospective, descriptive study.
Patients
The study included 239 patients who underwent CABG at a single metropolitan hospital in Melbourne, Australia.

Results
The sample (N = 234), aged 68.7 years (standard deviation [SD] 9.9), was predominantly male (N = 185, 79.1%). The mean duration of CT insertion was 45.2 hours (SD 26.7), and total drainage volume was 1300.6 mL (SD 763.8). Drainage volumes plateau to 31 mL per hour, 8 hours after surgery. From 24 to 48 hours, the mean drainage was 21 mL per hour. Drainage volumes varied between genders.

Conclusions
Evidence of similar drainage patterns in other populations is difficult to locate. If the pattern of drainage shown in this study is consistent, experimental intervention studies comparing standard removal time and earlier removal are recommended. If not, prospective collection of relevant preoperative, intraoperative, and postoperative factors across multiple sites is necessary to determine which patient or practice variations influence CT drainage patterns after CABG.

A novel method of tube manufacture for vehicle crashworthiness utilising the QUICKSTEP™ Process.

A novel method of composite tube manufacture was developed for potential use in automotive crash structures. Tubes were crushed axially under quasi-static conditions and highly repeatable behaviour was observed with an average specific energy absorption of -85kJ/kg. DMTA results indicated that the tubes were fully cured, even when the cycle was reduced to 7 minutes, giving this process huge potential for high-volume production.

Confirming the position of a nasogastric tube what does the literature say?

Nasogastric tubes are a medical device that can be used for a number of purposes. The process of inserting them however can be complicated. Nurses must therefore use an evidence based approach to confirm the correct position of nasogastric tubes and there are three main techniques described in the literature to do so. To date, one group of authors has published the majority of the studies on these techniques. This paper reviews their work.

Demonstration of the advantages of using bamboo-like nanotubes for electrochemical biosensor applications compared with single walled carbon nanotubes

The modification of glassy carbon electrodes with random dispersions of nanotubes is currently the most popular approach to the preparation of carbon nanotube modified electrodes. The performance of glassy carbon electrodes modified with a random dispersion of bamboo type carbon nanotubes was compared with single walled carbon nanotubes modified glassy carbon electrodes and bare glassy carbon electrodes. The electrochemical performance of all three types for electrode were compared by investigating the electrochemistry with solution species and the oxidation of guanine and adenine bases of surface adsorbed DNA. The presence of edge planes of graphene at regular intervals along the walls of the bamboo nanotubes resulted in superior electrochemical performance relative to SWNT modified electrodes from two aspects. Firstly, with solution species the peak separation of the oxidation and reduction waves were smaller indicating more rapid rates of electron transfer. Secondly, a greater number of electroactive sites along the walls of the bamboo-carbon nanotubes (BCNTs) resulted in larger current signals and a broader dynamic range for the oxidation of DNA bases.

Experimental and numerical investigation of low pressure tube hydroforming on 409 stainless steel

Tube hydroforming has been widely used to produce automotive structural components due to the superior properties of the hydroformed parts in terms of their light weight and structural rigidity. Compared to the traditional manufacturing process for a closed-section member including stamping and followed by welding, tube-hydro forming leads to cost savings due to reduced tooling and material handling. However, the high pressure pumps and high tonnage press required in hydroforming, lead to increased capital investment reducing the cost benefits. This study explores low pressure tube hydro forming which reduces the internal fluid pressure and die closing force required to produce the hydroformed part. The experimental and numerical analysis was for low pressure hydro formed stainless steel tubes. Die filling conditions and thickness distributions are measured and critically analysed.

Numerical investigation of high and low pressure tube hydroforming

Hydroforming is one option to reduce vehicle weight while increasing component stiffness and rigidity. This typically involves using a fluid to form a component with high internal pressure. Tube hydroforming has gained increasing interest in the automotive and aerospace industries because of its many advantages such as part consolidation, good quality of the formed part etc. The main advantage is that the uniform pressure can be transferred to whole part at the same time. In low pressure hydroforming, the internal pressure is significantly and the hydroformed section length of line stays almost the same as the circumference of the blank tube. This paper details the comparison between high and low pressure hydroforming. It is shown that the internal pressure and holding force required for low pressure hydroforming process is much less than that of high pressure. Also stress and thickness distribution are more uniform and the process is highly suitable for the forming of advanced high strength steels.

Numerical investigation of ramp and constant pressurization system during tube crushing process

The requirement for the automotive industry at present and even more so in the future is to simultaneously develop materials, economic forming processes and techniques for weight reduction of the component. To fulfil this need steel manufacturers have developed Advanced High Strength Steels which have high strength and good formability. Due to high strength, material thickness can be reduced without compromising the function of the component. High pressure hydro forming is one process that can be used to produce complex components from these materials. However, reduction in material thickness of these steels does not result in a large decrease of internal fluid pressure and die closing force during tube hydro forming and hence the higher strengths of these steels will require higher pressures. Tube crushing is a process in which the component can be formed with low pressures. In this paper numerical comparison of ramp and constant pressurization system during tube crushing for a TRIP steel is studied. It is proposed that ramp pressure is the best option to obtain a part with accurate geometrical shape from tube crushing with less die closing force. The stress and thickness distribution of the part during tube crushing were critically analysed.

Bamboo fibres and their unique properties

This paper collates the different properties of bamboo fibres as claimed by bamboo fibre and product manufacturers. The available information suggests that bamboo fibres have unique properties such as excellent appearance and feel, natural antibacterial, UV-shielding and moisture-controlling characteristics. Hence bamboo fibres provide a very promising alternative to other natural fibres by virtue of their novel properties. However, those properties may largely depend on the manufacturing process, which is not widely disclosed. Moreover, common manufacturing process may require the use of a large amount of chemicals and hence further process development may be required in order to make the product truly eco-friendly. It is identified that the data of those unique properties rarely appear in scientific journals and the validity of those claims can be speculative. Therefore, there is a strong need for non-biased scientific research and evaluation on the unique properties of bamboo fibres.