Feeding Policy Research Articles

Evaluation of Accelerated Advancement of Enteral Feedings in VLBW Infants

Background: To improve growth and intestinal maturation, and to reduce risks associated with parenteral nutrition, we gradually accelerated enteral feeding advancement in very low birthweight (VLBW) infants admitted to our NICU. Objectives: Retrospective cohort analysis of the effects of accelerated enteral feeding advancement on the time to full enteral feeds in VLBW infants and on the frequency of necrotizing enterocolitis (NEC) and focal intestinal perforation (FIP). Methods: VLBW infants born between 1/1/2006 and 31/12/2007 were compared with infants born 1/1/2010-30/6/2010. Feeding policy in 2006/07 was to start enteral feeds on day 1 with 10-15ml/kg/d and advance them at 15-20ml/kg/d, in 2010 enteral feeds were initiated with 20ml/kg/d and advanced by 25-30ml/kg/d, if clinical status permitted. Full enteral feeds were defined as ≥140ml/kg/d. Data are presented as median (P25-P75). Results: Gestational age and birth weight were similar (28+0/7 wk (25+3/7-30+2/7) in 2006/07 vs. 28 1/7 wk (26+2/7-30+4/7) in 2010, and 945 g (680-1400) vs. 1100 g (711-1310)). Time to establish full enteral feeds was shorter in 2010: 6d (5-7d) vs. 8d (7-10d) (p< 0.001). The Incidence of NEC was 2.9% in 2006/07 and 2.6% in 2010, the incidence of FIP was 4.3% in 2006/07, and 0% in 2010. Conclusion and discussion: The new approach was associated with a significantly shorter period to establish full enteral feeds. An increase in the incidence of FIP or NEC was not observed. However, the study was underpowered to detect group differences in the proportion of infants with NEC or FIP.

Audit of Human Breast-Milk Provision for Very Low Birth Weight Babies in a Tertiary Neonatal Unit Over A 10 Year Period

Background and aims: Professionals involved in the care of sick preterm babies are familiar with difficulties in making decisions about feeding. This audit looks at the provision of human-milk to very low birth weight (VLBW) babies in a tertiary neonatal unit over a 10 year period and the impact of opening a human milk-bank.Methods: Data was collected retrospectively using a regional neonatal database. All VLBW babies born in-house or transferred in within 7 days of life were included. The first 3 months of each year (2001-2010) were studied.Gestational age, weight and type of feed at weeks 1, 2, 3 and discharge were analysed. Feeding interventions, service and educational strategies developed in each year were noted.Results: Results demonstrated consistent improvement in breast-milk provision for VLBW babies, particularly with the opening of a milk-bank. More than 80% babies were discharged receiving breast milk and 100% babies received exclusive human-milk for first two weeks in the audit's final two years. Improvement in breast-milk provision occurred due to: i) Robust, closely adhered to, feeding guidelines for VLBW babies, ii) Earlier interventions with parents, iii) Nursing and medical staff education, iv) Successful milk-bank established in 2004 to ensure continuous supply of donor breast-milk; and v) Community nurses pro-actively supporting breastfeeding mothers pre-discharge. Conclusion: This 10 year audit confirms the impact of a coherent feeding policy for VLBW babies in a hospital with a donor milk-bank. This strategy led to more than 80% of the smallest and sickest babies being discharged still receiving maternal milk.

Programming effect of breast-feeding in infant nutrition policy documents in Hungary

Aims: To identify and describe infant feeding policy documents in Hungary and compare them to the documents of other four European countries (England, Finland, Germany and Spain). The question was also addressed how the phenomenon of nutritional programming was represented in the documents. Subjects: Policy documents on infant feeding were identified and analyzed in the five European countries by using uniform methods for searching and coding. Results: Twenty-six documents were identified: 4 in England, 2 in Finland, 9 in Germany, 6 in Hungary and 5 in Spain. Altogether 203 statements linked to references were identified: benefits of breast-feeding in general (24%), protection against infections (32%), long-term advantages like the prevention of diabetes (31%) or allergy (12%). Considerable variations were found within and between countries in the evaluation of the duration and character of the positive effects. The majority of the statements in the Hungarian documents referred either to the role of breast-feeding in infection protection (n = 8), or to long-term protective effects (n = 13). Conclusion: Policy documents in the study countries varied both in their extent and in the description of the long-term effects of infant nutrition. Majority of the documents failed to contain evidence based discussion of the phenomenon of early nutritional programming. Orv. Hetil., 2011, 152, 1641–1647.

Experimental Investigation of Initial Coke Formation over Stainless Steel, Chromium, and Iron in Thermal Cracking of Ethane with Hydrogen Sulfide as an Additive

The effect of injection of hydrogen sulfide, an available inexpensive byproduct in Iran’s petrochemical industry, on the rate of coke formation over chromium, iron, and stainless-steel (SS) coupons in thermal cracking of ethane was investigated. In a laboratory reactor, coke formation on the metal coupons was measured in the temperature range of 1098–1148 K after a fixed time of 900 s. Nitrogen was used as an inert diluent to exclude the concomitant coke oxidation in the commonplace steam-cracking process. The role of hydrogen sulfide was examined through an additive feeding policy either as a pure presulfidation of the coupons with a 200 ppmw concentration for 20 min or via continuous introduction of 25 and 50 ppmw amounts of hydrogen sulfide into the gas feed stream. The presulfidation reduced the rates of coke formation up to 20, 45, and 30% over Cr, Fe, and SS samples, respectively. However, the continuous injection of hydrogen sulfide showed a complex behavior depending upon the temperature, so that ...

Secular trends in the prevalence of stunting, overweight and obesity among South African children (1994–2004)

Various nutrition programs and free health care for children less than 6 years old were introduced in South Africa in the mid-1990s. We aim to describe secular trends for nutritional status of South African (SA) children in the 10-year period following these reforms. The SA National Primary Schools' Anthropometric Survey (n=105 000) is a cross-sectional survey of children from all SA Education Departments sampled during 1994. The Health of the Nation Study (n=10 295) is a cross-sectional study, including children from primary schools in five SA Provinces sampled from 2001 to 2004. Height and weight of SA children were measured during both surveys. In 8-11 year olds, the National Centre for Health Statistics reference was used to calculate the prevalence of mild and moderate stunting, and overweight and obesity were calculated according to the International Obesity Task Force reference. Coexistence of stunting, overweight and obesity among these two age- and sex-matched cohorts were also calculated. When compared with previous SA data, moderate stunting (24.6-4.9%, P<0.001) decreased over the 7-10 years considered, whereas overweight (1.2-13.0%, P<0.001) and obesity (0.2-3.3%, P<0.001) prevalence increased. There were lower levels of mild stunting and similar levels of moderate stunting among overweight/obese children when compared with non-overweight/non-obese children. Our findings suggest that feeding policies may have been effective in reducing the prevalence of under-nutrition. However, inter-sectoral policies should recognize the apparent secular trend for an increased prevalence in overweight/obesity among young South Africans.

Oxidative coupling of methane in a fluidized bed reactor: Influence of feeding policy, hydrodynamics, and reactor geometry

Oxidative coupling of methane (OCM) is suggested to be a promising process for the conversion of the abundant natural gas into useful chemicals. However, this reaction faces many drawbacks such as low yields for higher hydrocarbons, fast catalyst deactivation, and huge heat effects of the reaction. Only a well-designed fluidized bed reactor is able to overcome effectively those disadvantages and to provide a satisfactory continuous operation. However, design approaches for fluidized bed reactors are still based on models developed during 70s and 80s, which cannot take into account various hydrodynamic effects on the reactor performance. Thus, a reactor designer has usually to rely on extensive experiments in order to improve the classical fluidized bed reactor design. In this work, the relevance of hydrodynamics, reactor geometry, and feeding policy on the performance of a fluidized bed reactor for the OCM is shown. For this purpose, several case studies of fluidized bed reactors are simulated in full 3D geometry under the same reaction conditions, but with different reactor geometries and feeding policy. These studies show the significance of hydrodynamic parameters for the reactor performance, and moreover, how fluidized bed reactor performance can be improved by a careful study of coupled momentum-mass transport-reaction phenomena. Furthermore, it can be demonstrated that a suitable distributed feeding policy of oxygen provides an improved yield while a traditional fluidized bed reactor design results in an inferior performance among all investigated cases.

A methodology for selecting assembly systems feeding policy

PurposeAssembly systems require uninterrupted components' availability to feed workstations. This paper aims to propose a methodology to help managers in evaluating and selecting the most suitable policy for materials delivery to the shop floor. The analysis focuses on three basic policies, namely kitting, just in time kanban‐based continuous supply and line storage, even including class‐based hybrid policies.Design/methodology/approachDescriptive models are developed to design components' delivery systems and to compute their performances. Empirical criteria are utilized to associate specific policies to components classes in order to implement customized hybrid line feeding policies. A case study is then included to exemplify the method application and to show its capabilities as a decision making tool.FindingsHybrid feeding policies may be preferable to a single feeding policy common to all components. This is shown in a representative case study. However, in general there is a priori superior method and only a comparison of alternative feeding policies based on objective performance measures can determine the best approach in specific industrial applications.Research limitations/implicationsThe methodology is aimed at preliminary sizing and selection of alternative line feeding systems in deterministic environments. It is not intended for detailed performance analysis of assembly systems.Practical implicationsProduction managers are given quantitative decision tools to properly select the components' delivery method at an early decision stage. This allows trade‐offs between alternatives to be explored in order to deploy customized feeding policies differentiated on components basis to better fit specific company requirements.Originality/valueThe paper extends previous descriptive models for line feeding systems and includes the possibility of hybrid policies.

Infant‐feeding practices and associated factors of HIV‐positive mothers at Gert Sibande, South Africa

To assess knowledge, infant-feeding education and practices, factors that affect choice of infant feeding option, determinants of mixed feeding, psychosocial challenges and attitudes of HIV-positive women with infants between ages 3-6 months who attended prevention of mother-to-child transmission of HIV services in Gert Sibande district. A cross-sectional study was conducted with 815 HIV-positive mothers at 47 postnatal clinics. Trained field workers collected data at health facilities, using structured questionnaires. HIV-infected women who were at least 18 years of age were interviewed. The mean age was 27.7 years (SD 6.4). Seventy-eight percent agreed that HIV could be transmitted by breastfeeding. Fifty per cent were exclusively formula feeding, 35.6% breastfed exclusively and 12.4% mixed fed. In multivariate analysis, having a vaginal delivery, infant hospital admissions, and currently pregnant were associated with mixed feeding. Being older, knowing the HIV status of the infant and higher knowledge on HIV transmission through breastfeeding were associated with formula feeding. The study identified gaps in prevention of mother-to-child transmission (PMTCT) knowledge and infant feeding policy which seem to affect appropriate infant feeding. Various determinants of mixed feeding and exclusive formula feeding in the context of PMTCT were identified that can guide infant feeding counselling and support services of PMTCT programmes.

On Markovian approximations for virtual-build-to-order systems

The Virtual Build-to-Order (VBTO) approach strives to allow a producer to fulfil customers with the specific product variants they seek more efficiently than a conventional order fulfilment system. It does so by opening the planning pipeline. Here the feasibility of modelling the VBTO system as a Markov process is investigated. Two system configurations are considered—a random pipeline feed policy that assumes only knowledge of the overall demand pattern and an informed policy that ensures a mix of different variants in the system. First-order Markov models, which assume stationarity requirements are satisfied, are developed for small VBTO systems. The model for the informed feed policy has excellent agreement with simulation results and confirms the superiority of this policy over the random policy. The model for the random policy is more accurate at high variety than at low variety levels. Accuracy is improved with a second-order Markov model. Although impractical for modelling large scale VBTO systems for either configuration, the Markov approach is valuable in providing insights, theoretical foundations and validation for simulation models. It aids the interpretation of observations from simulations of large scale systems and explains the mechanism by which an unrepresentative stock mix develops over time for the random policy.

Lifetime health outcomes of breast-feeding: a comparison of the policy documents of five European countries

To (i) identify and describe prevailing infant feeding policy documents in five diverse European countries; (ii) analyse types of health outcomes for the infant that are associated with feeding breast milk rather than formula milk in the documents of different countries; and (iii) assess the extent to which documents reflect the WHO global recommendation of exclusive breast-feeding for 6 months. Documentary review and analysis. Five geographically dispersed countries of Europe (England, Finland, Germany, Hungary and Spain). Policy documents on infant feeding were identified; statements that linked choice between breast- and formula-feeding to a health outcome for the infant were extracted. Twenty-six documents (varied authorships, dates, length and character) were identified: four from England; two from Finland; nine from Germany; six from Hungary; and five from Spain. There was no consistency in the way in which health outcomes were cited as factors in the recommendations for breast- rather than formula-feeding. Seven documents contained no reference to the health implications of infant feeding choice. Of 203 statements in remaining documents citing health outcomes, 24.1 % mentioned general health effects, 32.5 % protection against infections, 31.5 % long-term conditions (e.g. diabetes, CVD) and 11.8 % mentioned allergy. Health outcomes were linked to exclusive breast-feeding in only 25 % of statements. Policy documents in the study countries varied in the extent to which they reflect the health outcomes for the baby of breast-feeding, and this may limit effective promotion by health professionals. There is scope to improve the process of bringing evidence and recommendations into policy documents.

Modeling and optimization of a seeded suspension polymerization process

A mathematical model is developed and validated for a seeded suspension polymerization process that manufactures polystyrene beads starting from pretreated polyolefin seeds. For the manufacture of this specialty product, we focus on prediction of the dynamics of particle growth, polymerization rate and particle average molecular weight. Particular emphasis is placed on acquisition of reliable parameters which must be estimated from available analytical measurements of the product. A hybrid approach is proposed for parameter subset selection and estimation. Excellent agreement is obtained with experimental results for different product grades. The monomer feeding rate, which is a key controlling factor of bead properties, is determined based on the proposed model and an optimum semi-batch feeding policy is determined. This improved policy is also implemented and validated by pilot plant experiments.

Model-Based Analysis of Reactor Feeding Policies for Methane Oxidative Coupling

In this work, a new feeding policy structure for an alternative operation mode of the packed bed membrane reactor (PBMR) is proposed in order to increase the efficiency of the OCM—oxidative coupling of methane—process. This structure has a high potential to improve the process performance in comparison to fixed bed reactors (PFRs) and even to a conventional PBMR design structure. The main drawbacks in operating PFR or PBMR have been to find suitable operation policies toward the enhancement of both yield and selectivity at the same time. In this work, a model-based comparative study of the OCM process performance for these three reactors types is presented. For this purpose, the effect of oxygen accessibility in the different design structures is investigated. Basically, the new proposed feeding policy structure combines the advantages of PFR and the conventional PBMR so as to get a high yield amount by cofeeding methane and oxygen into the reactor entrance while guaranteeing an acceptable level of select...

Blood Glucose Control in the Intensive Care Unit: Benefits and Risks

Abnormal blood glucose levels are common during critical illness and are associated with outcomes that correspond to a J-shaped curve, the lowest risk associated with normoglycemia. Three proof-of-concept randomized-controlled-trials performed in the surgical, medical, and pediatric intensive care units of the Leuven University Hospital in Belgium demonstrated that maintaining strict age-adjusted normal fasting levels of glycemia (80-110 mg/dl in adults, 70-100 mg/dl in children, 50-80 mg/dl in infants) with intensive insulin therapy reduced morbidity and mortality as compared with tolerating stress hyperglycemia as a potentially beneficial response. Recently, concern has risen about the safety of this intervention, as a multicenter adult study reported an, as yet unexplained, increased mortality with targeting normoglycemia as compared with an intermediate blood glucose level of around 140 mg/dl. This apparent contradiction may be explained by several methodological differences among studies, comprising, among others, different glucose target ranges in the control groups, different feeding policies, and variable accuracy of tools used for glucose measurement and insulin infusion. Hence, efficacy and safety of intensive insulin therapy may be affected by patient-related and ICU setting-related variables. Therefore, no single optimal blood glucose target range for ICU patients can be advocated. It appears safe not to embark on targeting "age-normal" levels in intensive care units (ICUs) that are not equipped to accurately and frequently measure blood glucose, and have not acquired extensive experience with intravenous insulin administration using a customized guideline. A simple fallback position could be to control blood glucose levels as close to normal as possible without evoking unacceptable blood glucose fluctuations, hypoglycemia, and hypokalemia.

Framework to optimise the inventory centralisation/ decentralisation degree and feeding policy in assembly systems

In the modern industrial context, complex materials handling systems and inventory management are necessary to guarantee the high levels of flexibility and efficiency required by production systems. This paper addresses a practical decision-making approach to optimise the correct management of the components in production/assembly systems. Typically, in an Assemble-to-Order (ATO) system, the centralisation/decentralisation degree of the parts stocking point and feeding system are the most important problems to face in order to guarantee the economic and flexible level of the whole production/assembly system. In the international scientific literature, several contributions have been developed about warehouse locations and others have studied feeding system management. This paper introduces a framework that allows the choice of the right degree of centralisation inventory and the optimal feeding system using an integrated approach.

The Risks of Not Breastfeeding

The Risks of Not Breastfeeding

"On our own, we can't manage": experiences with infant feeding recommendations among Malawian mothers living with HIV

BackgroundInfant feeding in communities with a high prevalence of HIV and AIDS is a potential challenge for mothers who must ultimately decide how to feed their infants within contexts that constrain their choices.MethodsWe investigated how infant feeding policy recommendations translate into maternal infant feeding decisions and practices using ethnographic research conducted between August 2004 and June 2005 among women participating in a prevention of mother-to-child transmission (PMTCT) program in Lilongwe, Malawi.ResultsQualitative findings are that maternal ability to adhere to recommendations to breastfeed exclusively for the first six months of infant life was constrained by expectations and psycho-social support. The most salient were women's pre-existing views on breastfeeding, their understanding of the medico-scientific information, and the quality of counselling received. In contrast, maternal decisions to wean were largely influenced by household economic factors and food insecurity.ConclusionsWe conclude that PMTCT programs delivered in ways which "download" the responsibility of adhering to recommendations to women in the absence of adequate psycho-social and livelihood supports contribute to substantial maternal psychosocial distress in this and, likely, similar settings.

Modeling and Control of Sequence Length Distribution for Controlled Radical (RAFT) Copolymerization

Controlled/living radical polymerization (CRP) allows a high degree of control over polymeric molecular architecture with narrow molecular weight distributions and desired polymer properties. Although the control of copolymer composition for RAFT copolymerization systems in a semibatch reactor has been studied, the control of sequence length receives little attention. In this work, using moment equations, a chain model and a sequence model were developed to describe both chain and sequence properties such as chain and sequence lengths and their distributions, for RAFT copolymerization in semibatch operations. It is seen that a copolymer with constant composition or linear gradient composition can be obtained through an optimized feeding policy. With the sequence model, it was possible to show the sequence length and distributions while controlling constant composition or linear gradient composition. More importantly, it was demonstrated that sequence length distribution can be designed and controlled usin...

Design of the optimal feeding policy in an assembly system

This paper describes an innovative and integrated approach to component management optimization within a production/assembly system. In a mixed-models assembly process the handling of parts and components for each work station represents a substantial variable that can greatly affect job duration and efficiency. This paper is strictly related to Assembly to Order/Manufacturing to Order (ATO and MTO) systems, where lead time has to be very short and flexibility is at its maximum level. In Assembly to Order (ATO) or Make to Order (MTO) systems, the production is increasingly getting more customized in response to the demand, thanks to the progresses reached in both manufacturing and information technologies. It is becoming increasingly possible to assemble or make products specifically in response to the requests of either end customers or retailers. As a consequence of such customization, the design of the whole system must take into direct account several elements: parts warehouses location, feeding policies and feeding systems. In some cases the collection of parts and components required picking activities, in other the movement of entire units load. In several instances experts have analyzed the problems about material centralization/decentralization, storage policies and assembly feeding problem in different and independent ways, while the problem needs an integrated approach. While many researches regarding components allocation problems in ATO and MTO systems, did not consider feeding policies, material picking, packing activities and vehicles optimization, this paper cover focuses on filling such gap using an integrated framework that considers both aspects of the problem: the centralization/decentralization of components in order to minimize the total storage costs and the right feeding policies. Feeding problems in assembly lines are some of the most important aspects to consider during the analysis and design of an assembly system, to allow the maximization of efficiency and flexibility. To reach such goals, a multi-factorial analysis has been carried out during this experiment and will validate the introduced framework. An industrial application of the introduced framework is illustrated to explain its real significant production implication.

Gradient Copolymers by ATRP in Semibatch Reactors: Dynamic Monte Carlo Simulation

AbstractWe developed a dynamic Monte Carlo model for ATRP in semibatch reactors. Semibatch reactors can be used to produce gradient copolymers even if the difference between the reactivity ratios of the comonomers is not significant by using different comonomer feed policies. The model was used to predict average molecular weights, polydispersity index, copolymer composition and complete distributions of molecular weight, chemical composition, and comonomer sequence length at any polymerization time. Two case studies, poly[styrene‐co‐(methyl methacrylate)] and poly[acrylonitrile‐co‐(methyl methacrylate)], were chosen to demonstrate the effect of comonomer feed compositions on the final chemical composition distribution of the copolymer.magnified image

Rapid assessment of infant feeding support to HIV-positive women accessing prevention of mother-to-child transmission services in Kenya, Malawi and Zambia

The possibility of mother-to-child transmission (MTCT) of HIV through breast-feeding has focused attention on how best to support optimal feeding practices especially in low-resource and high-HIV settings, which characterizes most of sub-Saharan Africa. To identify strategic opportunities to minimize late postnatal HIV transmission, we undertook a review of selected country experiences on HIV and infant feeding, with the aims of documenting progress over the last few years and determining the main challenges and constraints. Field teams conducted national-level interviews with key informants and visited a total of thirty-six facilities in twenty-one sites across the three countries--eighteen facilities in Malawi, eleven in Kenya and seven in Zambia. During these visits interviews were undertaken with key informants such as the district and facility management teams, programme coordinators and health workers. A rapid assessment of HIV and infant feeding counselling in Kenya, Malawi and Zambia, undertaken from February to May 2007. Infant feeding counselling has, until now, been given low priority within programmes aimed at prevention of MTCT (PMTCT) of HIV. This is manifest in the lack of resources - human, financial and time--for infant feeding counselling, leading to widespread misunderstanding of the HIV transmission risks from breast-feeding. It has also resulted in lack of space and time for proper counselling, poor support and supervision, and very weak monitoring and evaluation of infant feeding. Finally, there are very few examples of linkages with community-based infant feeding interventions. However, all three countries have started to revise their feeding policies and strategies and there are signs of increased resources. In order to sustain this momentum it will be necessary to continue the advocacy with the HIV community and stress the importance of child survival--not just minimization of HIV transmission - and hence the need for integrating MTCT prevention.