The food pyramid meets the regulatory pyramid - responsive regulation of food advertising to children

Obesity poses an urgent threat to children’s health. The causes of obesity are many and varied, but evidence suggests that the food industry makes a significant contribution. Multinational companies use a range of communication channels and marketing techniques to promote unhealthy foods and beverages to children. This promotion has a small but significant effect on children’s food preferences and choices, their consumption patterns and diet-related health. While public health advocates call for statutory regulation of unhealthy food advertising, the food industry has mobilised government support for voluntary action. In Australia, there is significant debate over the success of two self-regulatory codes that address food advertising to children. In this thesis I evaluate the food industry’s initiatives using a new approach. Although I consider evidence of the codes’ outcomes, I focus on whether they establish the building blocks of an effective self-regulatory regime. I use regulatory studies and public health law to create a framework for evaluation, drawing particularly on the idea of responsive regulation. I also compare food, tobacco and alcohol advertising regulation to predict whether statutory regulation of food advertising is practical and politically feasible. I find that food and alcohol advertising codes contain a series of ‘escape clauses’ that permit companies to continue with most of their marketing practices. As a result, the codes do not significantly reduce children’s exposure to food and alcohol advertising, or moderate the persuasive techniques used by marketers. Food industry self-regulation lacks the features of a well-designed voluntary scheme, including clear objectives, independent administration and monitoring, effective enforcement and systematic review. Further, regulatory processes are almost entirely industry based, meaning that the scheme is not accountable to external stakeholders. The difficulty of conducting research in this area underscores this conclusion. Food and alcohol companies report high levels of compliance with the codes, and an ethical commitment to responsible marketing practices. However, the initiatives do not place demanding requirements on participants; they only codify existing best practice in advertising to children. Further, industry initiatives exclude some of the main food and alcohol advertisers. In comparison to tobacco, food and alcohol products are highly varied, making regulation a more complex exercise. More fundamentally, these industries have an economic interest in advertising unhealthy products to a wide range of age groups. Accordingly, they are unlikely to accept any tighter restrictions on advertising to children, which might impact on their communication with adult audiences. One way of strengthening self-regulation is to include external stakeholders in regulatory processes. Public health actors engage with the food and alcohol industry (unlike the tobacco industry), creating the potential for more collaborative arrangements. However, experience with the ‘quasi-regulation’ of alcohol advertising illustrates that public health participation may not create a more transparent and accountable scheme. Also, external participation in industry schemes is highly contentious, and public health actors risk their credibility and reputation in doing so. Accordingly, government action is required to broaden the reach of self-regulation and improve its functioning. Given the strong case for government action, the question becomes what form it should take. There are significant political barriers to legislation, including the power of the food industry, and neo-liberal ideologies that favour minimal regulation. Accordingly, I consider options outside of ‘command-and-control’ regulation. Through co-regulation, the government could set clear objectives for the codes to achieve, establish an independent body for monitoring and enforcement, and formalise its oversight of the scheme. It must also threaten the industry with more intrusive regulation, should the improved scheme fail to reduce children’s exposure to unhealthy food advertising. This strategy implicitly endorses a responsive regulatory approach that begins with voluntary action by the food industry itself. However, it also recognises the central role of the state in regulation, and describes new ways for governments to protect public health

Contributions to the theory of factorized groups

In chapter 1 we begin by describing certain group theoretical concepts which appear during the course of this thesis. We also supply a brief survey of results concerning factorized groups, relating them to our investigations. In chapter 2, section 2.2, we consider groups which possess a triple factorization. We show that if a Cernikov group is factorized by three nilpotent subgroups it is itself nilpotent. It is then possible to generalize this result to a wider class of infinite groups, denoted by Ǽ In section 2.3 we continue this theme by examining groups which have a triple factorization by three abelian subgroups. If such a group has finite abelian total rank then it must be nilpotent. In section 2.4 we investigate the circumstances under which a subgroup inherits the factorization of the group. We show that if a Cernikov group is factorized by two abelian subgroups, then its Fitting subgroup factorizes. Once again this result holds for the class Ǽ, furthermore we are able to show that the Hirsch-Plotkiu radical also factorizes. Chapter 3 examines this question in relation to the formation subgroups of a group. Let § denote a formation of finite soluble groups as defined in section 3.1. We begin by reviewing the existence and behaviour of the L§ -covering subgroups and L§ -normalizers of a periodic (LŊ)Ø-group. Then, by taking § to be the formation of finite nilpotent groups, we prove that, if such a group is factorized by two nilpotent subgroups, then there is an L§ -covering subgroup which also factorizes. By specializing to Cernikov groups we are able to show that the above holds for an arbitrary saturated formation §. In the final chapter of this thesis we consider the situation where the product of two abelian subgroups of a group G is not itself a group. We then examine a subgroup M of G which lies in the product set. By imposing extra conditions we are able to produce some bounds on the exponent of M in terms of those of the factors. Lastly we show that if the torsion-free nilpotent group G is generated by two infinite cyclic subgroups then a subgroup which lies in their product is abelian

A three-year longitudinal study of retinal function and structure in patients with multiple sclerosis

BACKGROUND Researchers have in recent years begun to investigate ophthalmological manifestations of multiple sclerosis (MS) other than optic neuritis (ON), and it is now clear that changes to retinal function (measured using the electroretinogram, ERG) and structure (measured using optical coherence tomography, OCT) are found in MS patients irrespective of prior ON episodes. ERG results are consistent with dysfunctional bipolar cells, as in other autoimmune diseases. To date, studies have presented only cross-sectional data regarding ERG and OCT. We, therefore, studied the longitudinal course of ERG and OCT in patients with MS, as well as the effect of disability changes and non-ON clinical relapses on these functional and structural measures. METHODS MS patients (n = 23) participating in an ongoing longitudinal observational study were invited to take part in a 3-year ophthalmological substudy. ERG and OCT were performed, and measures of MS-related disability and relapse history were obtained. Study visits were repeated annually. ERG peak times, rod b-wave amplitude, mixed rod/cone and cone b-/a-wave amplitude ratios, thickness of the peripapillary retinal nerve fibre layer, and volumes of the segmented retinal layers/complexes were analysed. Using generalised estimating equation models adjusted for age, ON, and MS treatment status, we assessed changes to ERG and OCT over the study duration, the effect of changes in disability and recent non-ON MS relapses on ERG and OCT, and the effect of selected OCT parameters on corresponding ERG parameters. RESULTS At the group level, small fluctuations of several ERG peak times were recorded, with OCT values remaining stable. Increased disability between visits was associated with significant prolongation of mixed rod-cone ERG b-wave peak times. No evidence of associations between OCT and ERG parameters was observed. CONCLUSIONS Retinal bipolar cell function may be affected by changes in disability in patients with MS; however, recent non-ON MS clinical relapses appear not to affect ERG or OCT results. As ERG changes in MS patients over 3 years are likely to be small and of uncertain clinical relevance, longitudinal studies of retinal function in MS should be planned over an extended period

Worldwide experience with a totally subcutaneous implantable defibrillator: Early results from the EFFORTLESS S-ICD registry

Aims The totally subcutaneous implantable-defibrillator (S-ICD) is a new alternative to the conventional transveno

Effects of Renal Denervation vs Sham in Resistant Hypertension after Medication Escalation:Prespecified Analysis at 6 Months of the RADIANCE-HTN TRIO Randomized Clinical Trial

IMPORTANCE: Although early trials of endovascular renal denervation (RDN) for patients with resistant hypertension (RHTN) reported inconsistent results, ultrasound RDN (uRDN) was found to decrease blood pressure (BP) vs sham at 2 months in patients with RHTN taking stable background medications in the Study of the ReCor Medical Paradise System in Clinical Hypertension (RADIANCE-HTN TRIO) trial. OBJECTIVES: To report the prespecified analysis of the persistence of the BP effects and safety of uRDN vs sham at 6 months in conjunction with escalating antihypertensive medications. DESIGN, SETTING, AND PARTICIPANTS: This randomized, sham-controlled, clinical trial with outcome assessors and patients blinded to treatment assignment, enrolled patients from March 11, 2016, to March 13, 2020. This was an international, multicenter study conducted in the US and Europe. Participants with daytime ambulatory BP of 135/85 mm Hg or higher after 4 weeks of single-pill triple-combination treatment (angiotensin-receptor blocker, calcium channel blocker, and thiazide diuretic) with estimated glomerular filtration rate (eGFR) of 40 mL/min/1.73 m(2 )or greater were randomly assigned to uRDN or sham with medications unchanged through 2 months. From 2 to 5 months, if monthly home BP was 135/85 mm Hg or higher, standardized stepped-care antihypertensive treatment starting with aldosterone antagonists was initiated under blinding to treatment assignment. INTERVENTIONS: uRDN vs sham procedure in conjunction with added medications to target BP control. MAIN OUTCOMES AND MEASURES: Six-month change in medications, change in daytime ambulatory systolic BP, change in home systolic BP adjusted for baseline BP and medications, and safety. RESULTS: A total of 65 of 69 participants in the uRDN group and 64 of 67 participants in the sham group (mean [SD] age, 52.4 [8.3] years; 104 male [80.6%]) with a mean (SD) eGFR of 81.5 (22.8) mL/min/1.73 m(2) had 6-month daytime ambulatory BP measurements. Fewer medications were added in the uRDN group (mean [SD], 0.7 [1.0] medications) vs sham (mean [SD], 1.1 [1.1] medications; P = .045) and fewer patients in the uRDN group received aldosterone antagonists at 6 months (26 of 65 [40.0%] vs 39 of 64 [60.9%]; P = .02). Despite less intensive standardized stepped-care antihypertensive treatment, mean (SD) daytime ambulatory BP at 6 months was 138.3 (15.1) mm Hg with uRDN vs 139.0 (14.3) mm Hg with sham (additional decreases of −2.4 [16.6] vs −7.0 [16.7] mm Hg from month 2, respectively), whereas home SBP was lowered to a greater extent with uRDN by 4.3 mm Hg (95% CI, 0.5-8.1 mm Hg; P = .03) in a mixed model adjusting for baseline and number of medications. Adverse events were infrequent and similar between groups. CONCLUSIONS AND RELEVANCE: In this study, in patients with RHTN initially randomly assigned to uRDN or a sham procedure and who had persistent elevation of BP at 2 months after the procedure, standardized stepped-care antihypertensive treatment escalation resulted in similar BP reduction in both groups at 6 months, with fewer additional medications required in the uRDN group. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT0264942

HCV activates somatic L1 retrotransposition–A potential hepatocarcinogenesis pathway

Hepatitis C virus (HCV) is a common cause of hepatocellular carcinoma (HCC). The activation and mutagenic consequences of L1 retrotransposons in virus-associated-HCC have been documented. However, the direct influence of HCV upon L1 elements is unclear, and is the focus of the present study. L1 transcript expression was evaluated in a publicly available liver tissue RNA-seq dataset from patients with chronic HCV hepatitis (CHC), as well as healthy controls. L1 transcript expression was significantly higher in CHC than in controls. L1orf1p (a L1 encoded protein) expression was observed in six out of 11 CHC livers by immunohistochemistry. To evaluate the influence of HCV on retrotransposition efficiency, in vitro engineered-L1 retrotransposition assays were employed in Huh7 cells in the presence and absence of an HCV replicon. An increased retrotransposition rate was observed in the presence of replicating HCV RNA, and persisted in cells after viral clearance due to sofosbuvir (PSI7977) treatment. Increased retrotransposition could be due to dysregulation of the DNA-damage repair response, including homologous recombination, due to HCV infection. Altogether these data suggest that L1 expression can be activated before oncogenic transformation in CHC patients, with HCV-upregulated retrotransposition potentially contributing to HCC genomic instability and a risk of transformation that persists post-viral clearance

High-coverage genomes to elucidate the evolution of penguins

Penguins (Sphenisciformes) are a remarkable order of flightless wing-propelled diving seabirds distributed widely across the southern hemisphere. They share a volant common ancestor with Procellariiformes close to the Cretaceous-Paleogene boundary (66 million years ago) and subsequently lost the ability to fly but enhanced their diving capabilities. With ∼20 species among 6 genera, penguins range from the tropical Galápagos Islands to the oceanic temperate forests of New Zealand, the rocky coastlines of the sub-Antarctic islands, and the sea ice around Antarctica. To inhabit such diverse and extreme environments, penguins evolved many physiological and morphological adaptations. However, they are also highly sensitive to climate change. Therefore, penguins provide an exciting target system for understanding the evolutionary processes of speciation, adaptation, and demography. Genomic data are an emerging resource for addressing questions about such processes