Advertising of Human Milk Substitutes in United Kingdom Healthcare Professional Publications: An Observational Study.

BACKGROUND: Inappropriate marketing of human milk substitutes negatively influences efforts to protect breastfeeding. Although healthcare professionals can positively influence infant feeding decisions, government regulations permit manufacturers to communicate messages to them through advertising. RESEARCH AIMS: (1) To identify the extent of human milk substitute advertising in publications aimed at United Kingdom healthcare professionals and (2) to describe compliance with the International Code of Marketing of Breast-Milk Substitutes and United Kingdom Formula and Follow-on Formula Regulations. METHODS: This was a cross-sectional observational study. We reviewed publications targeting healthcare professionals working with families in the United Kingdom (N = 19). Quantity and type of human milk substitute advertisements, as a proportion of all advertising, in each publication were recorded. All unique advertisements were double assessed for compliance. RESULTS: Human milk substitute advertising was found in nine (47%) of the 19 publications (four affiliated with professional associations), making up 10.3% (n = 196) of these publications' total advertising. Of human milk substitute advertisements found, 65.4% (n = 110) were for products used to manage cows' milk protein allergy. Of the 32 unique human milk substitute advertisements found, none complied with the International Code of Marketing of Breast Milk Substitutes or United Kingdom Formula and Follow-on Formula Regulations. CONCLUSIONS: Many healthcare professionals' publications had non-compliant human milk substitute advertisements. There is an urgent need to ensure full compliance with international and local regulation in future advertisements and to consider whether advertisements are justified at all

Palliative care interventions and end-of-life care as reported by patients' post-stroke and their families: a systematic review

Aims: Internationally, there is an urgent need to implement guidelines supporting integration of palliative care into stroke clinical practice. Despite considerable advances in acute stroke management, ∼20% of all acute stroke patients die within the first 30 days. Palliative care is well established in diseases such as cancer or advanced heart failure, but evidence-based interventions of high quality are limited in stroke populations. This systematic review aims to identify and evaluate quantitative studies that describe palliative care interventions and end-of-life care as reported by patient's post-stroke and their families. Methods: and results: A systematic review following Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines was conducted in Cumulative Index to Nursing and Allied Health Literature, PubMed, Cochrane, Embase, Ovid, Proquest, and Scopus from 1990 to April 2021. The National Heart, Lung and Blood Institute standardized quality rating tools for quality assessment were used. Seven studies were identified, and all used descriptive quantitative designs. There were no interventional studies. The results were synthesized narratively according to the elements of palliative care interventions and end-of-life care: symptom burden and satisfaction, loss of autonomy at the end of life, and acknowledging uncertainty. Conclusion: This review highlights the limited empirical evidence that describes palliative care interventions and end-of-life care as reported by patient's post-stroke and their families. Most of the current evidence focuses on the provision of care during the final days and hours of life, or end-of-life care, with little evidence to guide the integration of palliative care into post-stroke clinical care, especially for patients with an uncertain prognosis. Acute stroke is sudden, unexpected, and life-changing, and patients and families would benefit from well-designed targeted interventions to determine strategies that address the diverse palliative needs of this patient population.</p

Review of CO₂ as a Euthanasia Agent for Laboratory Rats and Mice.

Selecting an appropriate, effective euthanasia agent is controversial. Several recent publications provide clarity on the use of CO2 in laboratory rats and mice. This review examines previous studies on CO2 euthanasia and presents the current body of knowledge on the subject. Potential areas for further investigation and recommendations are provided. J Am Assoc Lab Anim Sci 2017 Sep 1; 56(5):491-499

Modelling a risk classification of aneuploidy in human embryos using non-invasive morphokinetics

This study determined whether morphokinetic variables between aneuploid and euploid embryos differ as a potential aid to select euploid embryos for transfer. Following insemination, EmbryoScope time-lapse images from 98 blastocysts were collected and analysed blinded to ploidy. The morphokinetic variables were retrospectively compared with ploidy, which was determined following trophectoderm biopsy and analysis by array comparative genomic hybridization or single-nucleotide polymorphic array. Multiple aneuploid embryos were delayed at the initiation of compaction (tSC; median 85.1 hours post insemination (hpi); P = 0.02) and the time to reach full blastocyst stage (tB; median 110.9 hpi, P = 0.01) compared with euploid embryos (tSC median 79.7 hpi, tB median 105.9 hpi). Embryos having single or multiple aneuploidy (median 103.4 hpi, P = 0.004 and 101.9 hpi, P = 0.006, respectively) had delayed initiation of blastulation compared with euploid embryos (median 95.1 hpi). No significant differences were observed in first or second cell-cycle length, synchrony of the second or third cell cycles, duration of blastulation, multinucleation at the 2-cell stage and irregular division patterns between euploid and aneuploid embryos. This non-invasive model for ploidy classification may be used to avoid selecting embryos with high risk of aneuploidy while selecting those with reduced risk. Chromosome anomalies (aneuploidy) are prevalent in human embryos and result in either IVF failure, miscarriage or the birth of children with chromosome disorders. After IVF, it is imperative to try to detect aneuploid embryos in order to transfer an embryo with a normal chromosome copy number (euploid) to maximize the chances of a successful and healthy live birth. Currently, the only option is to biopsy a cell (or cells) from the embryo and analyse these using complex and expensive genetic technology. Novel uninterrupted culturing methods using the EmbryoScope now enables detailed observation of the each embryo via time-lapse photography during the whole culture period, for up to 6 days. This new technology has permitted us to observe the development of human embryos in detail after IVF, providing analysis of complex patterns of cell division and cell movement (morphokinetics). As far as is known for the first time, we have demonstrated differences between aneuploid and euploid embryos based on their morphokinetic patterns, whereby aneuploid embryos are significantly delayed in reaching the later stages of development, during days 4 and 5 in culture. We postulate that, by using the unique, non-invasive and specifically designed models or algorithms developed in this study, embryologists can make more informed choices on the most viable embryo to select for transfer and reduce the risk of selecting an aneuploid embryo