Healthy diets ASAP - Australian Standardised Affordability and Pricing methods protocol.

BACKGROUND: This paper describes the rationale, development and final protocol of the Healthy Diets Australian Standardised Affordability and Pricing (ASAP) method which aims to assess, compare and monitor the price, price differential and affordability of healthy (recommended) and current (unhealthy) diets in Australia. The protocol is consistent with the International Network for Food and Obesity / non-communicable Diseases Research, Monitoring and Action Support's (INFORMAS) optimal approach to monitor food price and affordability globally. METHODS: The Healthy Diets ASAP protocol was developed based on literature review, drafting, piloting and revising, with key stakeholder consultation at all stages, including at a national forum. DISCUSSION: The protocol was developed in five parts. Firstly, for the healthy (recommended) and current (unhealthy) diet pricing tools; secondly for calculation of median and low-income household incomes; thirdly for store location and sampling; fourthly for price data collection, and; finally for analysis and reporting. The Healthy Diets ASAP protocol constitutes a standardised approach to assess diet price and affordability to inform development of nutrition policy actions to reduce rates of diet-related chronic disease in Australia. It demonstrates application of the INFORMAS optimum food price and affordability methods at country level. Its wide application would enhance monitoring and utility of dietary price and affordability data from a health perspective in Australia. The protocol could be adapted in other countries to monitor the price, price differential and affordability of current and healthy diets.

Testing the price and affordability of healthy and current (unhealthy) diets and the potential impacts of policy change in Australia.

BACKGROUND: Price and affordability of foods are important determinants of health. Targeted food pricing policies may help improve population diets. However, methods producing comparable data to inform relevant policy decisions are lacking in Australia and globally. The objective was to develop and pilot standardised methods to assess the price, relative price and affordability of healthy (recommended) and current (unhealthy) diets and test impacts of a potential policy change. METHODS: Methods followed the optimal approach proposed by INFORMAS using recent Australian dietary intake data and guidelines. Draft healthy and current (unhealthy) diet baskets were developed for five household structures. Food prices were collected in stores in a high and low SES location in Brisbane, Australia. Diet prices were calculated and compared with household incomes, and with potential changes to the Australian Taxation System. Wilcoxen-signed rank tests were used to compare differences in price. RESULTS: The draft tools and protocols were deemed acceptable at household level, but methods could be refined. All households spend more on current (unhealthy) diets than required to purchase healthy (recommended) diets, with the majority (53-64 %) of the food budget being spent on 'discretionary' choices, including take-away foods and alcohol. A healthy diet presently costs between 20-31 % of disposable income of low income households, but would become unaffordable for these families under proposed changes to expand the GST to apply to all foods in Australia. CONCLUSIONS: Results confirmed that diet pricing methods providing meaningful, comparable data to inform potential fiscal and health policy actions can be developed, but draft tools should be refined. Results suggest that healthy diets can be more affordable than current (unhealthy) diets in Australia, but other factors may be as important as price in determining food choices.

A 6-day clinical pathway after a pancreaticoduodenectomy is feasible, safe and efficient.

BACKGROUND: The utilization of post-operative clinical pathways leads to shorter hospital stays and decreased healthcare costs. This study evaluated patient outcomes after implementation of a 6-day discharge pathway after a pancreaticoduodenectomy. METHODS: A post-operative clinical pathway was developed and implemented for patients undergoing a pancreaticoduodenectomy at the present institution aimed at discharge by post-operative day six. Patient charts were retrospectively reviewed to determine the rates of adherence to the pathway at each step, readmission and post-operative complications. RESULTS: In total, 113 consecutive patients underwent a pancreaticoduodenectomy, receiving post-operative care under the clinical pathway guidelines. The median length of stay was 7 days (mode 6 days); 41% of patients were discharged by post-operative day six, 62% by day seven and 79% by day eight. In univariate analysis, delayed gastric emptying was associated with a delayed discharge after post-operative day six (P = 0.002). There were no post-operative deaths and 16% of patients required readmission within 30 days of discharge. In univariate analysis, obesity was the only variable associated with an increased rate of readmission (P < 0.001). DISCUSSION: Clinical pathway utilization after a pancreaticoduodenectomy allows a high percentage of patients to be discharged within a week and is associated with a low rate of readmission. Clinical pathway implementation allows for safe and efficient patient care.

An audit of local government planning tools for their potential use in addressing community food and nutrition issues.

ISSUES ADDRESSED: This project aimed to identify how local government planning tools could be used to influence physical and policy environments to support healthy eating behaviours in communities. METHODS: An audit of Queensland's legislative and non-legislative local government planning tools was conducted by a public health nutritionist to assess their potential use in addressing strategies to achieve positive nutrition outcomes. Ten strategies were identified and covered the following themes: improving access to healthy foods and drinks; increasing access to breastfeeding facilities; decreasing fast food outlet density; and unhealthy food advertising. RESULTS: The audit found that all of the 10 strategies to achieve positive nutrition outcomes could be considered through three or more of the planning tools. CONCLUSION: Based on the findings of this audit, local government planning tools provide opportunities to address food and nutrition issues and contribute toward creating physical and policy environments that support healthy eating behaviours.

Satellite observations of surface temperature during the March 2015 total solar eclipse.

The behaviour of remotely sensed land surface temperatures (LSTs) from the spinning-enhanced visible and infrared imager (SEVIRI) during the total solar eclipse of 20 March 2015 is analysed over Europe. LST is found to drop by up to several degrees Celcius during the eclipse, with the minimum LST occurring just after the eclipse mid-point (median=+1.5 min). The drop in LST is typically larger than the drop in near-surface air temperatures reported elsewhere, and correlates with solar obscuration (r=-0.47; larger obscuration = larger LST drop), eclipse duration (r=-0.62; longer duration = larger LST drop) and time (r=+0.37; earlier eclipse = larger LST drop). Locally, the LST drop is also correlated with vegetation (up to r=+0.6), with smaller LST drops occurring over more vegetated surfaces. The LSTs at locations near the coast and at higher elevation are also less affected by the eclipse. This study covers the largest area and uses the most observations of eclipse-induced surface temperature drops to date, and is the first full characterization of satellite LST during an eclipse (known to the author). The methods described could be applied to Geostationary Operational Environmental Satellite (GOES) LST data over North America during the August 2017 total solar eclipse.This article is part of the themed issue 'Atmospheric effects of solar eclipses stimulated by the 2015 UK eclipse'.

The next generation of medications for kidney transplant patients.

Transplant pharmacotherapy evolves as new agents are investigated and approved for use. Clinical immunosuppression has been plagued with maintaining a balance between rejection of the transplanted organ and complications of over-immunosuppression, including infection and malignancy. Clinicians must understand current immunosuppressive regimens and their associated effects when caring for transplant patients. While all transplant patients receive some form of immunosuppressive therapy, the combinations and choices increase as new drugs are developed. In the critical and acute care settings, newly transplanted patients will likely receive induction therapy. The goal of induction therapy is to increase long-term patient and allograft survival while preventing or reducing rejection episodes. Several agents are available for induction therapy, and each transplant center designs its own protocol. The foundation for maintenance therapy rests on the combining immunosuppressives to prevent rejection through a variety of pathways. An understanding of the mechanism of action and additive effects of a drug allows practitioners to optimize therapy while decreasing adverse effects. Immunosuppressive therapy offers potential for reducing detrimental patient outcomes and improving allograft survival. It is well established that repeated rejection episodes correlate with poor long-term graft survival. Challenges facing researchers and clinicians focus on improved patient outcomes and options to address financial constraints of transplantation.