There is growing evidence that optimising dietary quality and engaging in physical activity (PA) can reduce dementia and cognitive decline risk and improve psychosocial health and quality of life (QoL). Multimodal interventions focusing on diet and PA are recognised as significant strategies to tackle these behavioural risk factors; however, the cost-effectiveness of such interventions is seldom reported. A limited cost consequence based on a 12-month cluster-randomised Mediterranean diet (MedDiet) and walking controlled trial (MedWalk) was undertaken. In addition, QoL data were analysed. Programme costs ($AUD2024) covered staff to deliver the MedWalk programme and foods to support dietary behaviour change. The primary outcome measure of this study was change in QoL utility score, measured using the Assessment of Quality of Life (AQoL-8D). Change scores were compared for the groups using general linear models while controlling for demographic factors associated with baseline group differences and attrition. Change in QoL (decreased, maintained or improved) was determined using a cross-tabulation test. MedWalk programme costs were estimated at $2695 AUD per participant and control group cost at $165 per person – a differential cost of $2530. Mean change in utility scores from baseline to 12 months was not statistically significant between groups. Nevertheless, the MedWalk group was significantly less likely to experience a reduction in their QoL (20·3 % MedWalk v. 42·6 % control group) (P = 0·020). A MedDiet and walking intervention may have a role in preventing decline in QoL of older Australians; however, longer-term follow-up would be beneficial to see if this is maintained.

Human milk and direct breastfeeding provide the optimal, biologically normative nutrition for hospitalised infants, with well-established benefits for immune, gut, cardiac, brain, and maternal health. Despite these benefits, human milk and breastfeeding rates for infants with CHD in high-resource countries are typically low, and there are no formal guidelines to drive CHD breastfeeding practice. Our aim is to (1) summarise the evidence on breastfeeding for infants with CHD, (2) discuss key barriers to and facilitators of breastfeeding in this population, (3) identify critical research and practice gaps to improve breastfeeding care in CHD, and (4) provide recommendations for clinical practice and future research.

Primary breastfeeding barriers for infants with CHD include (1) concern for dysphagia/aspiration, (2) concerns related to weight gain, (3) clinical instability/sickness, (4) developmental considerations, (5) general breastfeeding challenges, and (6) workflow and implementation issues, with racism and health disparities also contributing. The evidence to support these barriers is limited and often conflicting. Breastfeeding facilitators for preterm infants are well described, but facilitators may require modification for infants with CHD. Most lactation interventions have not been tested in CHD populations. Current evidence does not support automatic withholding of breastfeeding from infants with CHD; rather, the benefits of breastfeeding likely outweigh many potential concerns. There is a critical need for research and quality improvement to identify interventions that equitably and effectively support breastfeeding for infants with CHD and to evaluate the effect of breastfeeding on short- and long-term physical, psychological, and developmental outcomes for infants and families.

The dhole Cuon alpinus is a large canid that is categorized as Endangered on the IUCN Red List and at risk of global extinction. Information on the spatial distribution of suitable habitat is important for conservation planning but is largely unavailable. We quantified the spatial distribution of potential range as well as the relative probability of dhole occurrence across large parts of the species’ global range. We used the MaxEnt algorithm to produce a multi-scale environmental niche model based on 24 environmental variables and dhole occurrence data from 12 countries. We identified three regions where dhole conservation should be focused: western India, central India, and across the Himalayan foothills through Southeast Asia. Connectivity between suitable areas was poor, so coordinated action among these regions should be a priority. For instance, transboundary dhole conservation initiatives across the Himalayas from southern China, Myanmar, north-east India, Nepal and Bhutan need to be initiated. We also highlight the value of improving dhole population viability on unprotected land and increasing monitoring in the northern parts of its historic distribution, in particular in areas within mainland China.

Accelerated glacier mass loss across the Antarctic Peninsula has consequences for sea level rise and local ecology. However, there are few direct glaciological observations available from this region. Here, we reveal glacier changes on the James Ross Archipelago between 2010 and 2023. The median rate of glacier area loss (remote-sensing derived) increased over the study period, with the most significant changes observed in smaller glaciers. In situ measurements show that ablation has prevailed since 2019/20 with the most negative point surface mass balance change measured as −1.39 ± 0.12 m water equivalent at Davies Dome and Lookalike Glacier in 2022/23 (200–300 m a.s.l.). We identified a tripling of the frontal velocity of Kotick Glacier in 2015, which, combined with terminus surface elevation gains (bulging), suggests that this is the first surge-type glacier identified in Antarctica from velocity and surface elevation change observations. We contend that the glacier recession rate has increased due to increased air temperatures (0.24 ± 0.08°C yr−1, 2010–23), decreased albedo and glacier elevation change feedbacks. These processes could decrease glacier longevity on the archipelago. Future research should prioritise monitoring albedo and rising equilibrium-line altitudes and identify glaciers most vulnerable to rapid future mass loss.

The treatment recommendation based on a network meta-analysis (NMA) is usually the single treatment with the highest expected value (EV) on an evaluative function. We explore approaches that recommend multiple treatments and that penalise uncertainty, making them suitable for risk-averse decision-makers. We introduce loss-adjusted EV (LaEV) and compare it to GRADE and three probability-based rankings. We define properties of a valid ranking under uncertainty and other desirable properties of ranking systems. A two-stage process is proposed: the first identifies treatments superior to the reference treatment; the second identifies those that are also within a minimal clinically important difference (MCID) of the best treatment. Decision rules and ranking systems are compared on stylised examples and 10 NMAs used in NICE (National Institute of Health and Care Excellence) guidelines. Only LaEV reliably delivers valid rankings under uncertainty and has all the desirable properties. In 10 NMAs comparing between 5 and 41 treatments, an EV decision maker would recommend 4–14 treatments, and LaEV 0–3 (median 2) fewer. GRADE rules give rise to anomalies, and, like the probability-based rankings, the number of treatments recommended depends on arbitrary probability cutoffs. Among treatments that are superior to the reference, GRADE privileges the more uncertain ones, and in 3/10 cases, GRADE failed to recommend the treatment with the highest EV and LaEV. A two-stage approach based on MCID ensures that EV- and LaEV-based rules recommend a clinically appropriate number of treatments. For a risk-averse decision maker, LaEV is conservative, simple to implement, and has an independent theoretical foundation.

Precision or “Personalized Medicine” and “Big Data” are growing trends in the biomedical research community and highlight an increased focus on access to larger datasets to effectively explore disease processes at the molecular level versus the previously common one-size-fits all approach. This focus necessitated a local transition from independent lab and siloed projects to a single software application utilizing a common ontology to create access to data from multiple repositories. Use of a common system has allowed for increased ease of collaboration and access to quality biospecimens that are extensively annotated with clinical, molecular, and patient associated data. The software needed to function at an enterprise level while continuing to allow investigators the autonomy and security access they desire. To identify a solution, a working group comprised of representation from independent repositories and areas of research focus across departments was established and responsible for review and implementation of an enterprise-wide biospecimen management system. Central to this process was the creation of a unified vocabulary across all repositories, including consensus around source of truth, standardized field definitions, and shared terminology.

This article replicates and “stress tests” a recent finding by Eckel and Grossman (2003) that matching subsidies generate substantially higher Charity Receipts than theoretically comparable rebate subsidies. In a first replication treatment, we show that most choices are consist with a “constant (gross) contribution” rule, suggesting that inattention to the subsidies’ differing net consequences may explain the higher revenues elicited with matching subsidies. Results of additional treatments suggest that (a) the charity dimension of the decision problems has little to do with the result, and (b) extra information regarding the net consequences of decisions reduces but does not eliminate the result.

A period of the life course where optimal nutrition and food security are crucial for the life-long health and wellbeing of women/birthing parents and infants is preconception, pregnancy, and infancy.(1) It is estimated that nearly one in every four households with pre-school children (0-4 years) experience food insecurity (FI) in the UK.(2) Yet, we lack an evidence-base exploring experiences of FI in this life course stage.(3,4) This study aimed to explore women’s experiences of food insecurity during and after pregnancy, including its influence on infant feeding decisions.

This study was ethically approved (Ref No: LRS/DP-23/24-39437) and pre-registered on OSF Registries (https://osf.io/9hn6r). Semi-structured mixed format individual interviews were conducted between November 2023 and February 2024. Pregnant individuals, those who had given birth ≤12 months ago, ≥18 years old, food insecure, residing in South London and with recourse to public funds were recruited through purposive sampling. The topic guide was informed by FI, pregnancy and postpartum related literature and piloted (n = 2). Interviews were audiorecorded and professionally transcribed. Demographic data was summarised using SPSS. Inductive thematic analysis was used to analyse the data and was completed using NVivo.

Eleven food insecure participants (2 pregnant, 9 new mothers; 2 White European, 9 Black African/Caribbean/British women) participated in the study. Six women were 0-6 months postpartum, and 3 women were between 6-12 months postpartum. The preliminary findings are represented by three themes: 1) A dichotomy: knowing vs affording, 2) Adaptive food coping strategies, and 3) Infant feeding practices. Participants shared detailed accounts of valuing a healthy diet and adapting food practices, yet they still were unable to meet their dietary needs and desires during and after pregnancy. Participants described worry around breastmilk supply; quality and quantity. Complimentary feeding was also identified as a source of worry. “She is still breastfeeding fully. I don’t want to change to milk, which maybe, sometimes, I might not be able to afford it…I won’t stop until she is 1.”Whilst the cost of formula feeding was a driver of a more severe experience of FI.

Policy and practice recommendations include enhancing local breastfeeding support to address FI specific concerns around breastmilk supply and at national level, advocating for greater support for adequate healthy food provision and for a price cap on infant formula. Future interventions must support maternal mental health given the high cognitive stress identified with living with FI during and after pregnancy. Further high-quality research is needed 1) amongst asylum seekers and refugees and non-English speakers who may also experience FI, and 2) exploring cultural influences on breastfeeding and the relationship with FI.

From early on, infants show a preference for infant-directed speech (IDS) over adult-directed speech (ADS), and exposure to IDS has been correlated with language outcome measures such as vocabulary. The present multi-laboratory study explores this issue by investigating whether there is a link between early preference for IDS and later vocabulary size. Infants’ preference for IDS was tested as part of the ManyBabies 1 project, and follow-up CDI data were collected from a subsample of this dataset at 18 and 24 months. A total of 341 (18 months) and 327 (24 months) infants were tested across 21 laboratories. In neither preregistered analyses with North American and UK English, nor exploratory analyses with a larger sample did we find evidence for a relation between IDS preference and later vocabulary. We discuss implications of this finding in light of recent work suggesting that IDS preference measured in the laboratory has low test-retest reliability.

This article examines the development, early operation and subsequent failure of the Tot-Kolowa Red Cross irrigation scheme in Kenya’s Kerio Valley. Initially conceived as a technical solution to address regional food insecurity, the scheme aimed to scale up food production through the implementation of a fixed pipe irrigation system and the provision of agricultural inputs for cash cropping. A series of unfolding circumstances, however, necessitated numerous modifications to the original design as the project became increasingly entangled with deep and complex histories of land use patterns, resource allocation and conflict. Failure to understand the complexity of these dynamics ultimately led to the project’s collapse as the region spiralled into a period of significant unrest. In tracing these events, we aim to foreground the lived realities of imposed development, including both positive and negative responses to the scheme’s participatory obligations and its wider impact on community resilience.