Human milk products in the National Health Service: a cross-sectional survey of use and industry contact across England's trusts.

Objectives: Commentators and professional organisations note that an expanding market in human milk-based products (HMBPs) could reduce breastfeeding, compromising maternal and infant health, and undermine public milk bank donations. We investigate whether English NHS trusts purchased these products and whether HMBP companies have marketed to them. Design: Freedom of Information (FOI) requests asking: (1) whether trusts obtained human milk; (2) if so, how; and (3) whether HMBP companies had approached them. We analysed trusts' responses qualitatively. In 2023, an FOI request to the Food Standards Authority (FSA) following a product recall. Setting: England. Participants: One hundred and ninety-four NHS trusts, the FSA. Main Outcome Measures: Obtaining human milk, approaches by companies, and trust responses to approaches. Results: One hundred and seventy-six trusts responded, 102 reporting human milk from milk banks. No trusts reported purchasing from companies in 2022. In 2023, the FSA confirmed six English hospitals used HMBPs from one company; an FOI for trusts' names was refused on law enforcement grounds. Two trusts reported participating in clinical trials funded by companies. Twenty-one reported approaches, using several strategies, including uninvited ward visits. Trusts rejected marketing based on guidance from: (1) trust dieticians or physicians; (2) regional regulatory bodies; (3) professional bodies; and (4) perceived application of an International Code on breastfeeding. Conclusions: Companies market to trusts, adopting methods previously used by the formula industry. Trusts express confusion over whether this infringes agreements designed to promote breastfeeding. We encourage clarification and guidance for professionals and trusts to ensure safety, infant and maternal health, and protect public provision.

Variation in personality shaped by evolutionary history, genotype and developmental plasticity in response to feeding modalities in the Arctic charr.

Animal personality has been shown to be influenced by both genetic and environmental factors and shaped by natural selection. Currently, little is known about mechanisms influencing the development of personality traits. This study examines the extent to which personality development is genetically influenced and/or environmentally responsive (plastic). We also investigated the role of evolutionary history, assessing whether personality traits could be canalized along a genetic and ecological divergence gradient. We tested the plastic potential of boldness in juveniles of five Icelandic Arctic charr morphs (Salvelinus alpinus), including two pairs of sympatric morphs, displaying various degrees of genetic and ecological divergence from the ancestral anadromous charr, split between treatments mimicking benthic versus pelagic feeding modalities. We show that differences in mean boldness are mostly affected by genetics. While the benthic treatment led to bolder individuals overall, the environmental effect was rather weak, suggesting that boldness lies under strong genetic influence with reduced plastic potential. Finally, we found hints of differences by morphs in boldness canalization through reduced variance and plasticity, and higher consistency in boldness within morphs. These findings provide new insights on how behavioural development may impact adaptive diversification.

Is sexual misconduct training sufficient in the UK's medical schools: Results of a cross-sectional survey and opportunities for improvement.

Objective: Sexual misconduct adversely affects the mental and physical health of millions of people each year and has been declared a global pandemic. Incidence in both educational and clinical settings remains high. In the last 5 years, the NHS spent over £4 million settling sexual misconduct-related claims. Effective prevention requires training across all stages of career, beginning in clinical school. Here, we explore training in the UK's medical schools to identify provision and areas for improvement. Design: Freedom of Information Act 2000 requests for data on training delivery and curricula content. Setting: 34 public UK universities offering medical education. Participants: not applicable. Main Outcome Measures: Provision and delivery of training, mode of delivery, theme, and continuation of training. Results: All 34 universities responded. Twenty-two identified offering training. Seventeen made it compulsory. A review of curricula identified, however, only 18 did more just than mentioned sexual misconduct. Nine offered training more than once. Twelve did not offer training, of which three identified no plans to offer such training in the future. The most common delivery modes for training were workshops and lectures. The training was most often within the sexual health curriculum, disconnecting it from professionalism. Conclusions: There is no standardisation of sexual harassment training across the UK's public medical schools. Many future doctors will not have received relevant education when they assume posts in the NHS. Considering the magnitude of this issue and its critical connection to professionalism and collegiality, universities and professional bodies urgently should address this deficiency.

Adaptive cellular evolution or cellular system drift in hares.

Adaptations occur at many levels, for example, from DNA sequence of regulatory elements and cellular homeostatic systems to organismal physiology and behaviour (Mayr, 1997). Established adaptations are maintained by purifying and stabilizing selection. Students of animal diversity tend to focus on higher order traits, anatomy, physiology, organismal function and interactions. The core cellular and metabolic systems of metazoans evolved early in their history and are assumed to be rather similar between groups. The housekeeping functions and core metabolic functions of cells are generally considered relatively static, especially among closely related species. The extent to which evolution shapes core cellular metabolism and physiology in animals is largely unexplored. Ecological opportunities or strong positive selection can alter basal metabolic rate, activity levels and life-history traits (e.g., life span, age of maturity, offspring number) and potentially lead to divergence in core cellular and metabolic trait systems (Norin & Metcalfe, 2019; Speakman, 2005). Furthermore, systems under stabilizing selection can also change. Developmental systems of related species may produce the same phenotype or structure, but experience drift that can alter connections and even lead to turnover of cogs in the system (True & Haag, 2001). Are the cellular functions of animals highly constrained, subject to cellular system drift or affected by positive selection? This was tackled by a new study by Kateryna Gaertner and colleagues in a From the Cover manuscript in this issue of Molecular Ecology (Gaertner et al., 2022), using fibroblasts from the closely related but ecologically distinct brown and mountain hares.

A cross-sectional survey of English NHS Trusts on their uptake and provision of active bystander training including to address sexual harassment.

Objective: Reports identify that sexual harassment is troublingly pervasive in the NHS. Active bystander training (ABT) has been promoted to address sexual harassment, alongside other forms of poor behaviour, discrimination, and harassment. We explore ABT across all English NHS Trusts and determine whether the programmes address sexual misconduct in the training content. Design: Freedom of Information requests asking whether Trusts offer ABT, and if so, about the programme content and delivery, and to NHS England on centrally commissioned ABT. Setting: 213 NHS Trusts in England, and NHS England. Participants: Not applicable. Main Outcome Measure: Provision of ABT, and presence of sexual harassment content in the training. Results: 199 Trusts responded by August 2022. Of these, 35 Trusts provide ABT, the majority of which deliver content that is not specific to sexual misconduct, are in London, outsource training using private providers, and only provide workshops on an opt-in basis. One Trust offers a standalone ABT module on sexual harassment. Private providers prohibit Trusts from sharing training material, inhibiting content analysis and evaluation. Among the 163 Trusts without ABT programmes, only 23 (13%) have plans to implement training. Conclusions: ABT is underutilised in the NHS, despite being identified as an effective intervention in other settings like the military, higher education, and government workplaces. Studies should explore whether wider NHS adoption is warranted. Robust monitoring and evaluation processes are critical to strengthening the available literature regarding the effectiveness of ABT in the healthcare context and engaging in global knowledge sharing across health systems.

Paleomagnetic evidence for a long-lived, potentially reversing martian dynamo at ~3.9 Ga.

The 4.1-billion-year-old meteorite Allan Hills 84001 (ALH 84001) may preserve a magnetic record of the extinct martian dynamo. However, previous paleomagnetic studies have reported heterogeneous, nonunidirectional magnetization in the meteorite at submillimeter scales, calling into question whether it records a dynamo field. We use the quantum diamond microscope to analyze igneous Fe-sulfides in ALH 84001 that may carry remanence as old as 4.1 billion years (Ga). We find that individual, 100-µm-scale ferromagnetic mineral assemblages are strongly magnetized in two nearly antipodal directions. This suggests that the meteorite recorded strong fields following impact heating at 4.1 to 3.95 Ga, after which at least one further impact heterogeneously remagnetized the meteorite in a nearly antipodal local field. These observations are most simply explained by a reversing martian dynamo that was active until 3.9 Ga, thereby implying a late cessation for the martian dynamo and potentially documenting reversing behavior in a nonterrestrial planetary dynamo.

Caregiver perceptions of England's universal infant school meal provision during the COVID-19 pandemic.

The United Nations (UN) recognises free school meals as critical, yet widely disrupted by COVID-19. We investigate caregiver perceptions and responses to interruptions to the universal infant free school meal programme (UIFSM) in Cambridgeshire, England, using an opt-in online survey. From 586 responses, we find 21 per cent of respondents' schools did not provide UIFSM after lockdown or advised caregivers to prepare packed lunches. Where provided, caregivers perceived a substantial decline in quality and variety of meals, influencing uptake. Direction to bring packed lunches, which caregivers reported to have contained ultra-processed foods of lower nutritional quality, influenced caregiver behaviour rather than safety concerns as claimed by industry. The quality and variety of meals, and school and government policy, had greater impact than concerns for safety. In the UK and at the international level, policymakers, local governments, and schools must act to reverse the trend of ultra-processed foods in packed lunches, while improving the perceived quality of meals provided at schools.

Big food and drink sponsorship of conferences and speakers: a case study of one multinational company's influence over knowledge dissemination and professional engagement.

OBJECTIVES: Research identifies that multinational corporations, including The Coca-Cola Company ('Coca-Cola'), seek to influence public health research and policy through scientific events, such as academic and professional conferences. This study aims to understand how different forms of funding and sponsorship impact the relationship between Coca-Cola, academic institutions, public health organisations, academics and researchers. DESIGN: The study was conducted using Freedom of Information (FOI) requests and systematic website searches. SETTING: Data were collected by twenty-two FOI requests to institutions in the USA and UK, resulting in the disclosure of 11 488 pages, including emails and attachments relating to 239 events between 2009 and 2018. We used the Wayback Machine to review historical website data to evaluate evidence from 151 available official conference websites. PARTICIPANTS: N/A. RESULTS: Documents suggest that Coca-Cola provides direct financial support to institutions and organisations hosting events in exchange for benefits, including influence over proceedings. Coca-Cola also provided direct financial support to speakers and researchers, sometimes conditional on media interviews. Also, indirect financial support passed through Coca-Cola-financed non-profits. Often, such financial support was not readily identifiable, and third-party involvement further concealed Coca-Cola funding. CONCLUSION: Coca-Cola exerts direct influence on academic institutions and organisations that convene major public health conferences and events. These events offer Coca-Cola a vehicle for its messaging and amplifying viewpoints favourable to Coca-Cola's interests. Such corporate-sponsored events should be viewed as instruments of industry marketing. Stronger rules and safeguards are needed to prevent hidden industry influence, such as complete disclosure of all corporate contributions for public health conferences and their speakers.

A systematic review of modified electroconvulsive therapy (ECT) to treat delirium.

BACKGROUND: Delirium is costly for patients, carers, and healthcare systems. In addition, non-pharmacological and pharmacological management of delirium is challenging. Electroconvulsive therapy (ECT) has been proposed and used as an anecdotal treatment of delirium in clinical practice. However, the efficacy and safety of this approach are not well understood. OBJECTIVE: To synthesise and review the evidence relating to the safety and efficacy of ECT as a treatment for delirium. METHODS: A systematic review was completed according to PRISMA guidelines using the PubMed, CINAHL, Cochrane Library, and PsycINFO databases. Studies were eligible for inclusion if modified ECT was used to treat delirium symptoms. ECT for delirium in people with neuroleptic malignant syndrome, catatonia, or confusional states associated with acute primary psychiatric conditions were excluded. All included records were first ranked using the hierarchy of evidence-based medicine; quality was then assessed using the Joanna Briggs critical appraisal checklists. Pooled data across the cases identified were analysed using descriptive statistics. RESULTS: Of 1226 records screened, 10 studies met inclusion criteria: six case reports, three case series, and one quasi-experimental study. The literature base was of mixed quality. A single quasi-experimental study was assessed to be of 'fair' quality, the remainder of the case series and case reports were rated as 'poor' to 'fair' quality. A total of only 40 individual people with delirium who were treated with ECT were identified. In 33/40 cases, the aetiology of delirium was substance withdrawal. The number of ECT treatments administered ranged from 1 to 13. ECT was reported to positively contribute towards treatment of delirium in all cases, although objective measures of improvement were reported in only 6/13 patient cases from case reports and case series (46%). The singular quasi-experimental study reported a statistically significant decrease in duration of delirium, time spent in physical restraint, and in benzodiazepine requirement when ECT was used as an adjunct in benzodiazepine withdrawal delirium. When adverse events were described these included mild confusion and memory deficits; all were reported as time limited and reversible. Considerable limitations in the quality of the evidence base were identified, including the risk of selection, publication and reporting bias. Much data reporting on safety and efficacy of ECT in delirium was missing. CONCLUSION: There is insufficient literature to support modified ECT as a clinical treatment for delirium. The few studies identified were generally of weak evidence lacking important data on safety and objective outcome measures, and not including populations with broad delirium aetiologies. Further research using more robust methodologies and broader populations (age, aetiology) of people with delirium treated with ECT is needed.

More extensive land loss expected on coastal deltas due to rivers jumping course during sea-level rise.

River deltas are home to hundreds of millions of people worldwide and are in danger of sinking due to anthropogenic sea-level rise, land subsidence, and reduced sediment supply. Land loss is commonly forecast by averaging river sediment supply across the entire delta plain to assess whether deposition can keep pace with sea-level rise. However, land loss and deposition vary across the landscape because rivers periodically jump course, rerouting sediment to distinct subregions called delta lobes. Here, we developed a model to forecast land loss that resolves delta lobes and tested the model against a scaled laboratory experiment. Both the model and the experiment show that rivers build land on the active lobe, but the delta incurs gradual land loss on inactive lobes that are cut off from sediment after the river abandons course. The result is a band of terrain along the coast that is usually drowned but is nonetheless a sink for sediment when the lobe is active, leaving less of the total sediment supply available to maintain persistent dry land. Land loss is expected to be more extensive than predicted by classical delta-plain-averaged models. Estimates for eight large deltas worldwide suggest that roughly half of the riverine sediment supply is delivered to terrain that undergoes long periods of submergence. These results draw the sustainability of deltas further into question and provide a framework to plan engineered diversions at a pace that will mitigate land loss in the face of rising sea levels.

HIV Self-testing Among Previously Diagnosed HIV-Positive People in Khayelitsha, South Africa: No Evidence of Harm but may Facilitate Re-engagement in ART Care.

In South Africa, where an estimated 34% of nearly 7-million HIV-positive people were not on antiretroviral therapy (ART) in 2019, innovative strategies to diagnose and link people to care are needed. HIV self-testing (HIVST) is one such strategy. However, there is concern that access to HIVST might result in re-testing among people on ART, with a risk of false negative results and disengagement from care. Between November 2017 and December 2018, HIVST kits were distributed at a private pharmacy and at HIV testing outreach events. Each participant was instructed to report their result via SMS and those who did not were followed-up telephonically 10 days later. Electronic medical records of participants were searched for evidence of HIV services 6 months before and after enrollment. Of 1482 participants, 163 (11%) were previously diagnosed HIV-positive prior to taking the test. Of these, 123 reported a result, however 87% reported a negative result. Of the 163 previously diagnosed, 84 were not in ART care prior to the test, with 15 (18%) linking to care post-test. Of 79 who were in ART care prior to the test, 76 (96%) remained in care, even though 51 (67%) had reported a negative result. Overall, 29% of participants reported their result via SMS, and 48% when telephoned. Despite efforts to dissuade them, some previously diagnosed HIV-positive utilised HIVST. For those disengaged from care this may facilitate re-engagement. Self-testing among those already in care, regardless of the reported result, did not disrupt their treatment, and their reasons for doing the test remain unclear.

Confronting potential food industry 'front groups': case study of the international food information Council's nutrition communications using the UCSF food industry documents archive.

BACKGROUND: There are growing concerns that the public's trust in science is eroding, including concerns that vested interests are corrupting what we know about our food. We know the food industry funds third-party 'front groups' to advance its positions and profits. Here we ask whether this is the case with International Food Information Council (IFIC) and its associated Foundation, exploring its motivations and the potential for industry influence on communications around nutritional science. METHOD: We systematically searched the University of California San Francisco's Food Industry Documents Archive, for all documents pertaining to IFIC, which were then thematically evaluated against a science-communication influence model. RESULTS: We identified 75 documents which evidence that prominent individuals with long careers in the food industry view IFIC as designed to: 1) advance industry public relations goals; 2) amplify the messages of industry-funded research organizations; and 3) place industry approved experts before the press and media, in ways that conceal industry input. We observed that there were in some cases efforts made to conceal and dilute industry links associated with IFIC from the public's view. DISCUSSION: Instances suggesting IFIC communicates content produced by industry, and other industry-funded organisations like ILSI, give rise to concerns about vested interests going undetected in its outputs. IFIC's deployment to take on so-called "hard-hitting issues" for industry, summating evidence, while countering evidence that industry opposes, give rise to concerns about IFIC's purported neutrality. IFIC's role in coordinating and placing industry allies in online and traditional press outlets, to overcome industry's global scientific, legislative, regulatory and public relations challenges, leads also to concerns about it thwarting effective public health and safety measures. CONCLUSIONS: IFIC's promotion of evidence for the food industry should be interpreted as marketing strategy for those funders. Effective science communication may be obfuscated by undeclared conflicts of interests.

Delivering PrEP to Young Women in a Low-Income Setting in South Africa: Lessons for Providing Both Convenience and Support.

Daily oral pre-exposure prophylaxis (PrEP) is a key tool in addressing high HIV incidence among young women, and breaking the cycle of transmission. From 2017 to 2020, Médecins Sans Frontières (MSF) offered PrEP, in conjunction with contraception and risk-reduction counselling, to women aged 18-25, in a government-run clinic in Khayelitsha, a low income high HIV prevalence area in South Africa. Drawing on clinical, quantitative, and qualitative interview data, we describe participants' experiences and engagement with the PrEP program, participant adherence (measured by TFV-DP levels in dried blood spots) over time, and the indirect benefits of the PrEP program. Of 224 screened and eligible participants, 164 (73.2%) initiated PrEP, with no large differences between those who initiated and those who did not. Overall, 47 (29%) completed 18 months follow-up, with 15 (9.1%) attending all visits. 76 (46.9%) participants were lost to follow-up, 15 (9.1%) exited when leaving the area, and 28.7% of exits happened in the first month of the study. We identified two different trajectories of PrEP adherence: 67% of participants had, on average, consistently low TFV-DP levels, with the remaining 33% having sustained high adherence. Few baseline characteristics predicted good adherence. The main reported barrier to taking PrEP was forgetting to take or travel with the pills. Encouragement from others declined as a reported facilitator from month 6 to 18 (family: 93.1% vs 77.6%, p = 0.016, friends: 77.6% vs 41.4%, p ≤ 0.001, partners: 62.1% vs 46.6%, p = 0.096, other PrEP users: 89.7% vs 74.1%, p = 0.020). Disclosure to friends and family in some cases opened dialogue around sex, and helped to educate others about PrEP. Self-reported sex with more than one partner, and sex without a condom, decreased significantly after enrolment (p < 0.001, p = 0.063). In the individual interviews, participants credited their PrEP experience with changing their behaviour. Recognising the challenges with, but overall benefits from a package of care that includes the option of PrEP, lessons drawn from this study can help maximise persistence on PrEP within resource constraints. PrEP providers need to address participants' need for both convenience and social support.

Cutting edge or ignored resource: assessing the uptake and content of the NHS e-Learning for healthcare on "identifying and supporting survivors of modern slavery".

BACKGROUND: Across the last decade, healthcare emerged as a critical space for combatting modern slavery. Accurate and informative training of healthcare professionals is, therefore, essential. In the UK, the National Health Service (NHS) plays a central role in the identification and care of survivors. With training at the local-level variable, an e-Learning programme was developed. We ask: has this programme reached NHS staff? Is it accurate? Should the e-Learning approach be replicated around the world? METHOD: A Freedom of Information request has been sent to the NHS's Health Education England for data held on registrations, sessions and completions since 2014. An open session was used to assess the content. RESULTS: Across the past 5 years, there have been 31 191 registrations (≈2% of the workforce) and 1763 completed sessions (≈0.12%). Uptake remains low. We also identify deficiencies in the ways the programme represents modern slavery, and how the program engages with the complexities of national and international law and UK policy, as well as reporting mechanisms. CONCLUSIONS: e-Learning, while flexible and on-going, must be engaging and, we suggest, accompanied by in-person sessions. Materials should be co-produced with survivors and healthcare workers around the world to improve interest and relevance. Updating content regularly is critical.

Serological identification of SARS-CoV-2 infections among children visiting a hospital during the initial Seattle outbreak.

Children are strikingly underrepresented in COVID-19 case counts. In the United States, children represent 22% of the population but only 1.7% of confirmed SARS-CoV-2 cases as of April 2, 2020. One possibility is that symptom-based viral testing is less likely to identify infected children, since they often experience milder disease than adults. Here, to better assess the frequency of pediatric SARS-CoV-2 infection, we serologically screen 1,775 residual samples from Seattle Children's Hospital collected from 1,076 children seeking medical care during March and April of 2020. Only one child was seropositive in March, but seven were seropositive in April for a period seroprevalence of ≈1%. Most seropositive children (6/8) were not suspected of having had COVID-19. The sera of seropositive children have neutralizing activity, including one that neutralized at a dilution > 1:18,000. Therefore, an increasing number of children seeking medical care were infected by SARS-CoV-2 during the early Seattle outbreak despite few positive viral tests.

Serological identification of SARS-CoV-2 infections among children visiting a hospital during the initial Seattle outbreak.

Children are strikingly underrepresented in COVID-19 case counts1-3. In the United States, children represent 22% of the population but only 1.7% of confirmed SARS-CoV-2 cases1. One possibility is that symptom-based viral testing is less likely to identify infected children, since they often experience milder disease than adults1,4-7. To better assess the frequency of pediatric SARS-CoV-2 infection, we serologically screened 1,775 residual samples from Seattle Children's Hospital collected from 1,076 children seeking medical care during March and April of 2020. Only one child was seropositive in March, but seven were seropositive in April for a period seroprevalence of ≈ 1%. Most seropositive children (6/8) were not suspected of having had COVID-19. The sera of seropositive children had neutralizing activity, including one that neutralized at a dilution >1:18,000. Therefore, an increasing number of children seeking medical care were infected by SARS-CoV-2 during the early Seattle outbreak despite few positive viral tests.

Pushing partnerships: corporate influence on research and policy via the International Life Sciences Institute.

OBJECTIVE: There are concerns that some non-profit organisations, financed by the food industry, promote industry positions in research and policy materials. Using Freedom of Information (FOI) requests, we test the proposition that the International Life Sciences Institute (ILSI), one prominent non-for profit in international health and nutrition research, promotes industry positions. DESIGN: U.S. Right to Know filed five FOI from 2015 to 2018 covering communications with researchers at four US institutions: Texas A&M, University of Illinois, University of Colorado and North Carolina State University. It received 15 078 pages, which were uploaded to the University of California San Francisco's Industry Documents Library. We searched the Library exploring it thematically for instances of: (1) funding research activity that supports industry interests; (2) publishing and promoting industry-sponsored positions or literature; (3) disseminating favourable material to decision makers and the public and (4) suppressing views that do not support industry. RESULTS: Available emails confirmed that ILSI's funding by corporate entities leads to industry influence over some of ILSI activities. Emails reveal a pattern of activity in which ILSI sought to exploit the credibility of scientists and academics to bolster industry positions and promote industry-devised content in its meetings, journal and other activities. ILSI also actively seeks to marginalise unfavourable positions. CONCLUSIONS: We conclude that undue influence of industry through third-party entities like ILSI requires enhanced management of conflicts of interest by researchers. We call for ILSI to be recognised as a private sector entity rather than an independent scientific non-profit, to allow for more appropriate appraisal of its outputs and those it funds.