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Multiple reports from international organisations and expert groups call for reductions in production and consumption of red and processed meat (RPM) to attenuate associated health and environmental harms. Policymakers have given limited attention to the issue and public discourse on the topic is contentious. The framing of RPM as a policy issue by influential actors may be contributing to inertia and confusion. We investigate the political challenge of RPM reduction by analyzing how relevant actors interpret and portray the issue. Thirty-two participants from academia, civil society, intergovernmental organisations, and industry were interviewed. We find that food systems stakeholders do see value in continued RPM production and consumption in the food system, but that the current status-quo is untenable. RPM reduction was perceived as a polarising concept. Participants cited a lack of nuance in public discourse, with framings on harms and benefits of RPM being over-simplified and lacking context. Some participants noted that intensive RPM production and high consumption levels reflected corporatized/globalised supply chains, and power relations were the most critical factor to address the harms of RPM. Participants also viewed the preference for technology-driven responses (i.e., novel proteins) as reinforcing corporate power in the food system. This study shows that despite polarised public discourse, more convergence on the issue across food systems stakeholders exists. Furthermore, powerful actors such as the meat and 'novel protein' industries are perceived to be a driving influence in maintaining the market-driven status-quo and are a likely obstacle in achieving healthy and sustainable consumption of RPM.

OBJECTIVE: Diets high in red and processed meat (RPM) contribute substantially to environmental degradation, greenhouse gas emissions and the global burden of chronic disease. High-profile reports have called for significant global RPM reduction, especially in high-income settings. Despite this, policy attention and political priority for the issue are low. DESIGN: The study used a theoretically guided framing analysis to identify frames used by various interest groups in relation to reducing RPM in online news media articles published in the months around the release of four high-profile reports by authoritative organisations that included a focus on the impacts of high RPM production and/or consumption. SETTING: Four major RPM producing and consuming countries - USA, United Kingdom, Australia and New Zealand. PARTICIPANTS: None. RESULTS: Hundred and fifty news media articles were included. Articles reported the views of academics, policymakers, industry representatives and the article authors themselves. RPM reduction was remarkably polarising. Industry frequently framed RPM reduction as part of a 'Vegan Agenda' or as advocated by an elite minority. Reducing RPM was also depicted as an infringement on personal choice and traditional values. Many interest groups attempted to discredit the reports by citing a lack of consensus on the evidence, or that only certain forms of farming and processing were harmful. Academics and nutrition experts were more likely to be cited in articles that were aligned with the findings of the reports. CONCLUSIONS: The polarisation of RPM reduction has led to a binary conflict between pro- and anti-meat reduction actors. This division may diminish the extent to which political leaders will prioritise this in policy agendas. Using nuanced and context-dependent messaging could ensure the narratives around meat are less conflicting and more effective in addressing health and environmental harms associated with RPM.

BACKGROUND: The global milk formula market has 'boomed' in recent decades, raising serious concerns for breastfeeding, and child and maternal health. Despite these developments, few studies have investigated the global expansion of the baby food industry, nor the market and political practices corporations have used to grow and sustain their markets. In this paper, our aim is to understand the strategies used by the baby food industry to shape 'first-foods systems' across its diverse markets, and in doing so, drive milk formula consumption on a global scale. We used a theoretically guided synthesis review method, which integrated diverse qualitative and quantitative data sources. RESULTS: Global milk formula sales grew from ~US$1.5 billion in 1978 to US$55.6 billion in 2019. This remarkable expansion has occurred along two main historical axes. First, the widening geographical reach of the baby food industry and its marketing practices, both globally and within countries, as corporations have pursued new growth opportunities, especially in the Global South. Second, the broadening of product ranges beyond infant formula, to include an array of follow-up, toddler and specialized formulas for a wider range of age groups and conditions, thereby widening the scope of mother-child populations subject to commodification. Sophisticated marketing techniques have been used to grow and sustain milk formula consumption, including marketing through health systems, mass-media and digital advertising, and novel product innovations backed by corporate science. To enable and sustain this marketing, the industry has engaged in diverse political practices to foster favourable policy, regulatory and knowledge environments. This has included lobbying international and national policy-makers, generating and deploying favourable science, leveraging global trade rules and adopting corporate policies to counter regulatory action by governments. CONCLUSION: The baby food industry uses integr

BACKGROUND: Diets high in red and processed meat (RPM) contribute substantially to environmental degradation, greenhouse gas (GHG) emissions, and the global burden of chronic disease. Recent high-profile reports from international expert bodies have called for a significant reduction in global dietary meat intake, particularly RPM, especially in high-income settings, while acknowledging the importance of animal-sourced foods to population nutrition in many lower-income countries. However, this presents a major yet under-investigated political challenge given strong cultural preferences for meat and the economic importance and power of the meat industry. METHODS: A theoretically-guided narrative review was undertaken. The theoretical framework used to guide the review considered the interests, ideas and institutions that constitute food systems in relation to meat reduction; and the instrumental, discursive and structural forms of power that actors deploy in relation to others within the food system. RESULTS: High production and consumption levels of RPM are promoted and sustained by a number of factors. Actors with an interest in RPM included business and industry groups, governments, intergovernmental organisations, and civil society. Asymmetries of power between these actors exist, with institutional barriers recognised in the form of government-industry dependence, trade agreement conflicts, and policy incoherence. Industry lobbying, shaping of evidence and knowledge, and highly concentrated markets are key issues. Furthermore, prevailing ideologies like carnism and neoliberalism present embedded difficulties for RPM reduction. The literature noted the power of actors to resist meat reduction efforts exists in varying forms, including the use of lobbying, shaping of evidence and knowledge, and highly concentrated markets. CONCLUSION: There are a number of political challenges related to RPM reduction that contribute to policy inertia, and hence are likely to impe

Background: Surgical aortic valve replacement and transcatheter aortic valve replacement (TAVR) are now both used to treat aortic stenosis in patients in whom life expectancy may exceed valve durability. The choice of initial bioprosthesis should therefore consider the relative safety and efficacy of potential subsequent interventions. Objectives: The aim of this study was to compare TAVR in failed transcatheter aortic valves (TAVs) versus surgical aortic valves (SAVs). Methods: Data were collected on 434 TAV-in-TAV and 624 TAV-in-SAV consecutive procedures performed at centers participating in the Redo-TAVR international registry. Propensity score matching was applied, and 330 matched (165:165) patients were analyzed. Principal endpoints were procedural success, procedural safety, and mortality at 30 days and 1 year. Results: For TAV-in-TAV versus TAV-in-SAV, procedural success was observed in 120 (72.7%) versus 103 (62.4%) patients (p = 0.045), driven by a numerically lower frequency of residual high valve gradient (p = 0.095), ectopic valve deployment (p = 0.081), coronary obstruction (p = 0.091), and conversion to open heart surgery (p = 0.082). Procedural safety was achieved in 116 (70.3%) versus 119 (72.1%) patients (p = 0.715). Mortality at 30 days was 5 (3%) after TAV-in-TAV and 7 (4.4%) after TAV-in-SAV (p = 0.570). At 1 year, mortality was 12 (11.9%) and 10 (10.2%), respectively (p = 0.633). Aortic valve area was larger (1.55 ± 0.5 cm2 vs. 1.37 ± 0.5 cm2; p = 0.040), and the mean residual gradient was lower (12.6 ± 5.2 mm Hg vs. 14.9 ± 5.2 mm Hg; p = 0.011) after TAV-in-TAV. The rate of moderate or greater residual aortic regurgitation was similar, but mild aortic regurgitation was more frequent after TAV-in-TAV (p = 0.003). Conclusions: In propensity score–matched cohorts of TAV-in-TAV versus TAV-in-SAV patients, TAV-in-TAV was associated with higher procedural success and similar procedural safety or mortality.