We present a methodology for a new composite, quantitative “mash-up” index of health system sustainability and resilience, drawing on a qualitative framework developed to assess these dimensions of the health system. The paper summarises quantifiable measures of sustainability and resilience, with sustainability defined through 7 domains and 50 indicator variables, while health system resilience is based on 6 domains and 23 variables. Each domain is captured by a separate index. A composite index is constructed through aggregation across the two dimensions, and their associated domains and indicators. All indices are aggregated through estimation of a geometric means, and are bound between 0 and 100. We pilot across 5 countries over 23 years, with the ultimate aim of identifying health policy strategies for improving national health system capacities and performances; as well as facilitating policy responses to address problematic issues of sustainability and resilience. Face validity suggests that the index captures the non-resilience to the COVID-19 pandemic. The pilot study reveals considerable differences at both the dimension and domain levels within and between the examined countries, while suggesting scope for improvement in both dimensions across all countries. The index thus provides an indicative approach for temporal and spatial yardstick comparison.

Breakfast clubs create an opportunity for children to have a nutritious breakfast before school starts(1). Due to the perceived benefits, about 80% of schools across the United Kingdom run breakfast clubs, though this is likely to increase following the new government manifesto commitment on free breakfast provision in schools(2). Breakfast clubs are presently offered through the National School Breakfast Programme(3), charities or funded by schools’ budget(2). There is no standard model for delivery of breakfast clubs and research are limited. This study aimed to investigate how breakfast clubs are delivered, types of food provided and the benefits and constraints of delivery.

Primary schools offering breakfast clubs (n=17) across Yorkshire were visited and researchers observed and engaged with students and staff (including those involved in delivery) through participatory research. Researchers conducted interviews with 17 school leads and focus group discussions with 103 children (between 3-7 children from each school). Topic guides were developed by the research team to understand the food system within schools, including barriers to food provision, nutrition education and whole school approaches to food. The data was audio recorded and transcribed verbatim. Thematic analysis was conducted using the CONNECTS-Food principles Framework(4).

Our findings revealed that breakfast clubs provided children with an enjoyable start to the school day. The main themes developed were Type/quality of provision, Eating environment and Pastoral care. The delivery schemes varied and most schools offered places free or subsidised for children on Free School Meals (FSM) or other government schemes. Several schools considered children from disadvantaged families and offered a free breakfast regardless of FSM eligibility. Our findings revealed that there was diversity of foods on offer. However, the quality was perceived to relate to availability and price and was often dictated by providers rather than through school or child preferences. Offers commonly included bagels, cheese sandwiches, toast, cereals, milk, spreads and juice. The potential of schools to offer breakfast was key, particularly for families who do not have the resources or time to provide breakfast for their children. The eating environment was largely dependent on space and facilities; although, pleasant and supportive atmospheres were commonplace. Activities included drawing, reading books and games. We learnt about the value of breakfast clubs to create an environment with social and educational benefits. Our research specifically highlights the importance of breakfast clubs to support working parents through the childcare provision.

The findings suggest that further research is needed to investigate the adherence of the food provided to school food standards. This study is important as it provides insights into how breakfast clubs can be better delivered considering the new government’s manifesto commitment on school breakfast.

FixOurFood Project is funded by UKRI Transforming Food Systems with grant number BB/V004581/1

Excessive calorie, sugar and salt intake in children’s diets is a public health concern(1). The UK government introduced voluntary salt(2) and sugar(3) reduction programmes to improve the nutritional content of key food categories. Breakfast cereals are an important breakfast choice in children’s diet and are frequently marketed using child-appealing packages(4). This study aims to assess the impact of these initiatives on improving breakfast cereals with child-appealing packaging from 2020 to 2023.

We conducted repeated cross-sectional surveys yearly from 2020 to 2023, collecting data on energy, total sugars, fibre, and salt content per 100g from the nutrition information panel of breakfast cereals available in nine major UK retailers and meeting the child-appealing packaging (e.g. cartoons) criteria(5). Statistical analysis, including the Friedman test and χ2 tests, was performed to assess changes in nutritional content over time and compliance with the salt and sugar reduction programmes.

Total number of breakfast cereals surveyed each year were n=119, n=126, n=138, and n=133, respectively, with 80 products consistently surveyed (matched) across all four years. Matched breakfast cereals (n=80) showed statistically significant reductions in median total sugars and salt content in 2023 compared to 2020: median (Interquartile Range) total sugars reduced from 22g/100g (15.6-25.9) in 2020 to 19.9g/100g (15.5-22.6) in 2023 (P<0.001), and median (IQR) salt reduced from 0.50g/100g (0.28-0.70) in 2020 to 0.43g/100g (0.24-0.65) in 2023, (P=0.037). No significant changes were observed in energy or fibre contents, (p>0.05). Despite the modest reductions, 81% of breakfast cereals (n=133) collected in 2023 continued to exceed the recommended sugar reduction guideline (12.3g/100g), while only 6% exceeded the maximum salt target (0.90g/100g). Additionally, around 40% of breakfast cereals cereals in 2023 contained a third (per 30g) of a 4-6-year-old’s maximum daily recommendation of free sugars (19 g/d). There were significant variations in sugar, fibre and salt content between and across different retailers and manufacturers (P<0.05).

Our findings show modest yet ongoing reductions in sugar and salt content since 2020, demonstrating the potential feasibility of reformulating breakfast cereals. However, breakfast cereals with child-appealing packaging continue to be a major source of sugar in children’s diets. These findings demonstrate the urgent need for mandatory and comprehensive sugar reduction policies to effectively reduce children’s sugar consumption. Additionally, regulatory measures should be introduced to ensure companies use child-appealing tactics on their healthiest breakfast cereals to improve children’s food preferences, and diet. These steps are essential, building on the potential impact of the UK voluntary reduction programmes to improve children’s health and help reduce childhood obesity.

When leveraged together, variable-centered and person-centered statistical methods have the potential to illuminate the factors predicting mental health recovery. However, because extant studies have largely relied on only one of these methods, we do not yet understand why some youth demonstrate recovery while others experience chronic symptoms. This omission limits our understanding of trajectories of physical aggression (AGG) in particular, which are frequently characterized by desistance. The present study examined the development of AGG across childhood and adolescence via variable-centered and person-centered modeling, with neighborhood and family characteristics considered as predictors. Variable-centered results indicated a mean-level decline in AGG with age but were more useful for illuminating predictors of AGG at baseline than predictors of declining engagement. Person-centered analyses, by contrast, identified low parent-child conflict and high household income as predictors of desistance. Although variable-centered analyses were integral to modeling the average AGG trajectory and identifying predictors of engagement at baseline, person-centered techniques proved more useful for understanding predictors of desistance.

The out-of-home (OOH) food sector has a growing importance on the UK population diet, but the nutritional quality of the most influential OOH menu items has not yet been comprehensively characterised(1). It is also unclear how OOH food healthiness should be assessed. The primary study objectives were to assess the compliance of best-selling menu items in the UK with the ongoing calorie, salt, and sugar reduction programmes(2) and to compare the use of UK official healthiness assessment models and metrics,(3,4) using data collected in 2023/24. A secondary objective was to examine item-level changes in nutritional composition over time using 2021 data for a subset of menu items.

A cross-sectional survey of the 10 best-selling menu items of the 20 largest OOH companies in the UK was conducted online between September 2023 and March 2024, with manual imputation of missing nutrition data. Candidate healthiness assessment approaches included the UK Nutrient Profile Model (NPM)(3), Multiple Traffic Light Labelling (MTL),(4) and the targets, guidelines, and levy threshold included in the UK calorie, salt, and sugar reduction programmes.(2) Longitudinal item-level changes in nutrition composition were assessed retrospectively using archived August 2021 web-extracted data.

After excluding items where data imputation was not possible, 189 menu items were included in 2023/24, consisting mostly of main meals (25%), starter/side dish/small plates (18%), and sandwiches (18%). 59% of 184 products met their respective maximum calorie, salt, and/or sugar target/guideline; and 8 of the 20 applicable average target/guidelines were achieved. Depending on the healthiness assessment approach used, 46-78% of the menu items would not be deemed healthy. The NPM yielded the most lenient assessment due to not accounting for portion size; combining it with either category-specific or across-the-board maximum thresholds resulted in more stringent assessments. 117 food and 23 drink menu items could be tracked from 2021 to 2023/24; an increase in the median [interquartile range] salt content per serve was found in food (from 2.0g [1.3–3.7g] to 2.2g [1.4–3.8g], p=0.004). No other change in nutrition composition was observed over time at the menu item level.

This study comprehensively highlights the generally poor nutritional quality of best-selling OOH menu items in the UK, the lack of success of current voluntary programmes in driving impactful OOH product reformulation, and the limitations of the NPM for OOH application. Limitations include uncertainty around nutrition data accuracy (as either extracted from company websites or estimated using single purchases) and assessment of compliance with the calorie, salt, and sugar reduction programmes based solely on reformulation or portion size adjustments, not capturing mechanisms such as shifting sales. Our findings suggest that healthiness assessment in the OOH sector requires using either category-specific or across-the-board maximum thresholds for energy and ‘negative’ nutrients (e.g., salt, sugars) per serve.

Given that children’s dietary intakes often fail to meet national dietary guidelines, it is particularly relevant to focus on school settings, where children consume approximately 30% of their food/beverage intake (1). However, we do not have current information on what children consume at school - only what they are offered. This study aimed to explore and compare the extent to which lunch served and consumed in primary schools with nurseries fulfils children’s nutritional requirements.

This work is part of the FixOurFood project, a research program in school settings across Yorkshire, and followed the guidelines laid down in the Declaration of Helsinki (ethical approval number: HSRGC/2021/466/D). Using pre- and post-meal plate photographs from 1063 children across eight Yorkshire schools, we conducted an energy and nutrient analysis of food served and consumed during school lunch. Nutritional composition of the meals served and consumed was compared to government dietary recommendations (2) for children aged 4–10 years (averaged when values differed by age or sex) and adjusted to 30% (estimated proportion for lunch)(3). The percentages of lunches served and consumed in schools meeting the energy and nutritional requirements of children were compared using a paired t-test, and the results were summarised as mean ± SEM.

For most nutrients, we found that the proportion of consumed meals that met dietary requirements was significantly lower than the served meal for: energy (67.7±1.2% vs. 86±1.2%), total (73.2±1.6% vs. 90.3±1.7%), saturated (86.4±2.4% vs. 104.8±2.7%), monounsaturated (69.7±1.7% vs. 84.3±1.8%), and polyunsaturated fats (66±1.5% vs. 85.7±1.7%), carbohydrate (61.5±1.2% vs. 80.4±1.2%), total sugars (182.4±4.6% vs. 229.1±5.1%), protein (187.7±3% vs. 235.4±2.8%), fibre (39.3±1.2% vs. 58.5±1.6%), sodium (78.1±1.6% vs. 96.1±1.7%), calcium (92.3±2.5% vs. 112.2±2.8%), iron (63.1±1.3% vs. 79.9±1.4%), and zinc (65.2±1.5% vs. 81.8±1.7%) (p<0.001).

This study provides the first data on children’s actual school food intake in many years. Our findings show that while food that is offered to children provides a greater opportunity to meet dietary recommendations, children’s actual consumption falls short, particularly for essential nutrients. When adjusting lunch to contribute approximately 30% of daily energy and nutrient intake, the consumed meals were insufficient (<66%) in key nutrients such as carbohydrates, fibre, iron, and zinc. Moreover, there was an overconsumption of total sugars and protein, exceeding the recommended levels. These imbalances highlight a significant gap in meeting children’s nutritional needs. Therefore, a more comprehensive approach to school meal programs is needed, focussing not only on the nutritional value of the served food but also on the quantity children consume. Suggestions for future studies may include a closer examination of children’s consumption habits and the development of strategies to increase consumption rates by offering more appealing, nutrient-dense alternatives. We may also recommend policy changes to balance the energy and sugar content of school meals.

Graduates from life sciences, including nutrition, will be at the forefront of promoting environmental, social, and food systems sustainability. The requisite competencies for their future roles include systems thinking, interdisciplinary collaboration, and effective communication, which are essential to navigating the complex interrelationship between human health and the environment [1,2]. To address this need, a 'Living Laboratory’ (LL) within a higher education (HE) food service setting could enrich the traditional laboratory experience, allowing students to cultivate these skills through experiential learning. This project aimed to i) scope the published literature to characterise LL examples within a HE food environment and ii) explore the understanding and perceptions of a LL concept in a food service setting for final year student research projects among students and academics at King’s College London.

A systematic scoping review was conducted in accordance with PRISMA-ScR guidelines (Registration OSF:d7y96). Two databases were searched (PubMed/Medline, Web of Science) from January 2010 to July 2024 to identify articles reporting the design, implementation or evaluation of LL in HE food service settings. A narrative synthesis was performed, and the resulting themes were used to inform focus groups (KCL Ethics:LRM-23/24-42657) with academic staff (two groups, nine participants) and students (four groups, seven postgraduate and nine undergraduate participants). Focus group discussions were audio-recorded and transcribed verbatim. Data were analysed using an inductive thematic approach [3].

Twenty-one articles were included in the scoping review. Common terms used to describe the LL concept included ‘innovation’, ‘collaboration’, ‘diverse stakeholders’, ‘enabling students’ and ‘practical learning experiences’. Recommendations for implementing LLs were provided in six articles and included engagement and outreach with stakeholders; managing conflicts; assessing impact; and establishing ethical and governance frameworks. The focus group findings indicated that both students and academics view the LL concept as a dynamic, real-world setting, emphasizing engagement and collaboration with internal and external stakeholders. Academics perceived the educational benefits of LLs as fostering experiential learning and perceived the barriers to implementation as including a lack of resources, scheduling conflicts, insufficient stakeholder engagement and unclear governance frameworks. Students highlighted the importance of aligning projects with taught programme content. and identified challenges such as limited awareness, unequal engagement across disciplines, time constraints, and concerns about inclusivity and equity across campuses. Students agreed that the LL provided opportunities to develop skills and knowledge in sustainability, science communication and real-world evidence studies, opening new career options after graduation. Lastly, altruism to improve food environments for peers and future students was a significant driving factor in student engagement.

Implementing LLs in HE food service settings requires input from multiple stakeholders. This scoping project identified key considerations from both academic staff and students to inform the co-design of a LL in a HE food service setting.

We present the serendipitous radio-continuum discovery of a likely Galactic supernova remnant (SNR) G305.4–2.2. This object displays a remarkable circular symmetry in shape, making it one of the most circular Galactic SNRs known. Nicknamed Teleios due to its symmetry, it was detected in the new Australian Square Kilometre Array Pathfinder (ASKAP) Evolutionary Map of the Universe (EMU) radio–continuum images with an angular size of 1 320$^{\prime\prime}$$\times$1 260$^{\prime\prime}$ and PA = 0$^\circ$. While there is a hint of possible H$\alpha$ and gamma-ray emission, Teleios is exclusively seen at radio–continuum frequencies. Interestingly, Teleios is not only almost perfectly symmetric, but it also has one of the lowest surface brightnesses discovered among Galactic SNRs and a steep spectral index of $\alpha$=–0.6$\pm$0.3. Our best estimates from Hi studies and the $\Sigma$–D relation place Teleios as a type Ia SNR at a distance of either $\sim$2.2 kpc (near-side) or $\sim$7.7 kpc (far-side). This indicates two possible scenarios, either a young (under 1 000 yr) or a somewhat older SNR (over 10 000 yr). With a corresponding diameter of 14/48 pc, our evolutionary studies place Teleios at the either early or late Sedov phase, depending on the distance/diameter estimate. However, our modelling also predicts X-ray emission, which we do not see in the present generation of eROSITA images. We also explored a type Iax explosion scenario that would point to a much closer distance of $\lt$1 kpc and Teleios size of only $\sim$3.3 pc, which would be similar to the only known type Iax remnant SN1181. Unfortunately, all examined scenarios have their challenges, and no definitive Supernova (SN) origin type can be established at this stage. Remarkably, Teleios has retained its symmetrical shape as it aged even to such a diameter, suggesting expansion into a rarefied and isotropic ambient medium. The low radio surface brightness and the lack of pronounced polarisation can be explained by a high level of ambient rotation measure (RM), with the largest RM being observed at Teleios’s centre.

Anapachydiscus (Anapachydiscus) haegerti n. sp., an ammonite belonging to the Pachydiscidae, is reported for the first time from the upper Campanian Northumberland Formation of Hornby Island, British Columbia. Thirty-five specimens have allowed for the complete ontogenetic reconstruction of the taxon as well as thanatocoenosic (death assemblage) observations with paleoecological implications for ammonoid early life. Although isolated juvenile specimens occur, instances of concretions containing a multitude of individuals are typical. One concretion yielding twenty-six early-stage juveniles lends support to a mode of preservation reflective of life association through a taphonomic process of capture and burial. The new species presents age-diagnostic utility as a distinct fossil within the molluscan assemblage of the Nostoceras (Didymoceras?) adrotans regional subzone; a highly constrained interval of the upper Campanian in the eastern North Pacific. A specimen attributed to Anapachydiscus (Anapachydiscus) cf. A. (A.) fascicostatus from the upper Campanian of the Cedar District Formation on Denman Island is also described, and the genus Anapachydiscus is retained with an emended diagnosis. Additional collections have enabled revised conceptualizations of Pachydiscus (Pachydiscus) hornbyense and Pachydiscus (Pachydiscus) ootacodensis accounting for the spectrum of variance within these species. Recognition of an upper Campanian P. (P.) ootacodensis–Pachydiscus (Pachydiscus) suciaensis Concurrent-range Zone is proposed for the eastern North Pacific to assist broader efforts of interregional biostratigraphic correlation given the endemic limitation of the latter taxon.

UUID: http://zoobank.org/d8eb27f6-7221-4efb-9548-ec2001986b19

We present a dataset of 1,119 radiocarbon dates and their contexts for Oaxaca, Mexico, a best effort to include all published dates, plus hundreds of unpublished samples. We illustrate its potential and limitations with five examples: (1) dated stratigraphy in stream cutbanks show how aggradation, downcutting, and stability responded to global climate and human activities; (2) 14C samples from Late/Terminal Formative contexts allow interregional comparisons of temple and palace construction, use, and abandonment; (3) new 14C dates provide better understanding of events during the Late Classic/Epiclassic, a problematic time in the ceramic chronology; (4) individual Classic/Postclassic residential contexts had long durations—several hundred years; and (5) model constraints from other data permit refinement at times of calibration curve deviation, as during AD 1400–1600. We recommend further chronological refinement with best-practice standards, new samples, existing collections, and statistical modeling.

Understanding the stock structure of a commercial species is essential for sustainable management. Failure to do so can lead to the depletion of regional sub-populations, erosion of genetic diversity, and ecosystem services loss. Plaice, Pleuronectes platessa, is a commercially exploited species inhabiting the continental shelf around Iceland. Despite a tagging study providing support for strong spawning site and feeding ground fidelity, and otolith microstructure analysis revealing local population structure, plaice is managed as a single stock in Icelandic waters. Here, we describe and quantify the parasite fauna of plaice and assess the potential of parasites as biological tags for stock identification of plaice in Icelandic waters. A total of 82 plaice were sampled from different geographical locations (north and south) and seasons (summer and winter) in Iceland. Our sampling identified 11 parasites, five of which are new parasite records for plaice in Icelandic waters: the trematodes Zoogonoides viviparus (adults) and Rhipidocotyle sp. (metacercariae), and the nematodes Contracaecum osculatum (larvae), Dichelyne sp. (adults), and Hysterothylacium aduncum (larvae and adults). Additionally, we recovered metacercariae of the trematode genus Apatemon, which has not been recorded previously from plaice. Two parasites were identified as potential biological tags for stock identification – namely, the nematode Anisakis simplex and the trematode Z. viviparus. Our findings support a complex stock structure for plaice in Icelandic waters and the need for an integrative strategy to stock identification to provide fine spatial scale data required to inform fisheries managers.

Cardiovascular disease (CVD) is the most potent killer in Aotearoa New Zealand (NZ) with South Asians being one of the three high-risk groups. This study aimed to investigate health beliefs, knowledge, and behaviours related to diet among NZ South Asians at risk of CVD, using a mixed-methods approach. Demographics and dietary data were collected via an online Qualtrics survey and qualitative data on health beliefs and knowledge about heart-healthy foods were collected using semi-structured phone interviews. Twenty-one South Asian participants with diagnosed type 2 diabetes and/or hypertension and/or hypercholesterolemia were recruited via stakeholder engagement and advertisements through South Asian cultural and religious organisations.The majority of participants (62%) were aged 35-50 years, 10 were female, 11 were male and 67% were long-term residents of NZ. Most participants were unsure of the recommendations for fruit and vegetable consumption and only 48% and 29% met these guidelines, respectively. This is worrying as NZ Health survey data show a steady decrease in fruit and vegetable consumption among South Asians over 20 years with only 27% meeting the guidelines in 2021. (1) Sixty-two percent of participants consumed milk and yoghurt ≥ 4 times a week; 63% consumed full-fat milk and 45% consumed full-fat yoghurt regularly. These findings are consistent with that found for healthy South Asians in NZ,(2) where dairy, the primary source of saturated fats in South Asian cuisine, increased post-migration. Some participants believed that full-fat dairy increases the risk of heart disease, yet they still preferred to use full-fat milk and ghee as they believed it is healthier than low-fat varieties. Most participants believed that salty foods and pickles increase the risk of heart disease with 33% consuming salted pickles “sometimes” and only 28% choosing “low or reduced salt” food varieties “regularly/always”. More than half (57%) chose reduced-fat varieties of foods deliberately to reduce their risk of CVD. Red meat and deep-fried fatty foods were the most common foods that most participants thought they should avoid; however, some were not sure. Foods that participants considered heart-healthy were green vegetables, lentils and ghee in moderation. Most meat-consuming participants were unaware of healthy cuts of meat with only 38% reporting always choosing low-fat cuts of meat. Most participants believed that they could take some measures to reduce their risk of heart disease. Nevertheless, their health beliefs were not consistent with knowledge of or behaviours concerning heart-healthy measures. Substantial knowledge gaps evident in the reported dietary behaviours need to be addressed to reduce the risk of CVD among at-risk South Asians.