The Early Years

Policy concentration on the early years is of vital importance for the wellbeing of children now and for their future health outcomes and life chances. Evidence-based research points to the need for a focus that is properly holistic and to precipitate intervention to promote a healthy diet, regular patterns of activity and rest and give children the best start in life. In 2005, The United Nations Committee on the Rights of the Child (General Comment No. 7) acknowledged the need for a fresh strategy, pinpointing research findings indicating that a failure to prioritise early years’ welfare exposes children to the ills of ‘malnutrition, disease, poverty, neglect, social exclusion and a range of other adversities.’ Professor Dame Sally Davies, Chief Medical Officer of the United Kingdom, considers that robust early years’ policies make both social and economic sense: ‘Too many children and young people do not have the start in life they need, leading to high costs for society, and too many affected lives’ (Forward to ‘The 1001 Critical Days’, June 16th 2014). This observation is significant because there remains much to do. In 2012, the NSPCC reviewed the United Kingdom policy scenario for babies and very young children and concluded that identifiable advances in maternity and early years’ provision did not detract from the fact that: ‘babies are still particularly vulnerable’ and ‘their rights are not always recognised or realised’. (‘All Babies Count – But what about their rights?’ Sally Knock and Lorriann Robinson, January 2012). Knock and Robinson highlight glaring gaps of support and provision – especially in maternity services whereby the fostering of a strong parent-child bond is invariably sacrificed to a concentration upon purely medical practicalities such as labour, birth and the immunisation programme. The All Party Group on a Fit and Healthy Childhood aims, in this report, to offer the incoming Government recommendations for an early years’ strategy that are credible, feasible and evidence-based and will enable the United Kingdom to set the standard in a crucial policy field both at home and abroad. In defining ‘early childhood’, we follow the example of The United Nations (2005) Convention on the Right of the Child by examining the period of 0-8 including, as it does, the vital transition phase from pre-school to primary school. We consider the antenatal period and maternal physical and mental health, methods of feeding the newborn, parental support services both hospital and home-based and infant nutrition and socioeconomic factors that may impact upon the health and wellbeing of young children. The report examines the optimum balance between sleep, rest and activity, the need for freely-chosen play, safeguarding measures and the importance of respecting cultural diversity in all early years’ settings. Above all, we analyse the relationship between young families and the professionals whose role it is to ensure that babies have the very best start in life, supported by parents who have confidence in the choices that they make and the advice that they are given. Just as new families require mentoring so that they can act in the best interests of their children, so the early years’ workforce needs training and continuous professional development to ensure that the advice given is of the highest possible quality and specifically tailored to the individual family. Early Years’ students from The University of Northampton (interviewed) explain what a positive difference their newly acquired knowledge has made to their performance in the settings and Government recognition of The Early Years as a developmental stage in its own right and the creation of the new posts of Early Years Teacher and Early Years Educator have been positive. Yet as the Ilkeston ‘Mums Group’ (interviewed) makes clear, there is still no guarantee of uniform excellence in the delivery of services nationwide and no assurance of continuity between, for example, advice on feeding from the midwife and the health visitor, or the emphasis put on freely-chosen play in an early years’ setting and a primary school. If young children are to thrive, we believe it is essential that there is a national consensus and political will behind multi-disciplinary working in the early years. We see the early years as a window of opportunity and make no apology for the fact that each section of this report is accompanied by many policy recommendations. It has not been possible to produce a uniform handful of ‘asks’, just as the early years itself is a rich, complex and multifarious developmental phase. However, neither do we consider it to be feasible to achieve everything that we recommend in the lifespan of a single Government. This is a two, even three term journey. However, if the nation’s families and the early years workforce are to embark upon it, the Government must be prepared to provide the resources; the Cabinet Minister for Children and Families, the commitment to multi-disciplinary co-operation to achieve an early years workforce that is truly ‘joined up’ and, above all, the finance to make well–intentioned aspiration a reality. In an age of austerity, by spending early, the later savings to education, health, social or criminal justice services will be immense. Investing in the children of today is not a gambl

Use of axial tomography to follow temporal changes of benthic communities in an unstable sedimentary environment (Baie des Ha! Ha!, Saguenay Fjord)

In the upper layer of the sediment column, organic matter recycling is greatly influenced by bioturbation. However, there are many physical changes in the nature of the sediment that may disturb benthic communities and create a biogeochemical imbalance. Following a very heavy rainfall between 26 and 29 July 1996, an intense flash flood in the Saguenay Fjord caused discharges of 6 million cubic metres of sediments into Baie des Ha! Ha!. Unstable sediment deposits located at the top of the delta of the Rivie`re des Ha! Ha! were sporadically exported to the deep basin. After this physical disturbance, meiobenthic and macrobenthic organisms progressively re-colonised the sediment column. To determine the impacts of such sedimentary depositions on benthic fauna, two stations, one at the head and one at the mouth of the Baie des Ha! Ha!, have been monitored since 1996. During this survey, we developed a new method for the quantification of biogenic structures using computer axial tomography (CAT-Scan). Benthic fauna analysis showed that the two stations were characterised by different temporal changes in the benthic dynamics according to their geographic location. Using CAT-Scan analysis of sediment cores, we were able to characterise the stability of the sediment column for the two stations in 1999 and 2000. Scan results suggest that colonisation processes were closely linked with the stability of the sediment column. Erosion and redeposition of surficial sediments caused a succession in the formation of biogenic structures. These variations were characterised for the first time using CAT-Scan, which is a nondestructive, rapid, and precise method. Tomographic analysis showed the importance of the production and destruction rates of biogenic structures and the sedimentation rate for the preservation of burrows and potentially reactive components. This study finally demonstrated that each erosional event could be followed by a rapid formation of biogenic structures, allowing the re-oxidation of old deposits

Sport and transgender people: a systematic review of the literature relating to sport participation and competitive sport policies

Background Whether transgender people should be able to compete in sport in accordance with their gender identity is a widely contested question within the literature and among sport organisations, fellow competitors and spectators. Owing to concerns surrounding transgender people (especially transgender female individuals) having an athletic advantage, several sport organisations place restrictions on transgender competitors (e.g. must have undergone gender-confirming surgery). In addition, some transgender people who engage in sport, both competitively and for leisure, report discrimination and victimisation. Objective To the authors’ knowledge, there has been no systematic review of the literature pertaining to sport participation or competitive sport policies in transgender people. Therefore, this review aimed to address this gap in the literature. Method Eight research articles and 31 sport policies were reviewed. Results In relation to sport-related physical activity, this review found the lack of inclusive and comfortable environments to be the primary barrier to participation for transgender people. This review also found transgender people had a mostly negative experience in competitive sports because of the restrictions the sport’s policy placed on them. The majority of transgender competitive sport policies that were reviewed were not evidence based. Conclusion Currently, there is no direct or consistent research suggesting transgender female individuals (or male individuals) have an athletic advantage at any stage of their transition (e.g. cross-sex hormones, gender-confirming surgery) and, therefore, competitive sport policies that place restrictions on transgender people need to be considered and potentially revised

Networked T Cell Death following Macrophage Infection by Mycobacterium tuberculosis

<div><h3>Background</h3><p>Depletion of T cells following infection by <em>Mycobacterium tuberculosis</em> (Mtb) impairs disease resolution, and interferes with clinical test performance that relies on cell-mediated immunity. A number of mechanisms contribute to this T cell suppression, such as activation-induced death and trafficking of T cells out of the peripheral circulation and into the diseased lungs. The extent to which Mtb infection of human macrophages affects T cell viability however, is not well characterised.</p> <h3>Methodology/Principal Findings</h3><p>We found that lymphopenia (<1.5×10⁹ cells/l) was prevalent among culture-positive tuberculosis patients, and lymphocyte counts significantly improved post-therapy. We previously reported that Mtb-infected human macrophages resulted in death of infected and uninfected bystander macrophages. In the current study, we sought to examine the influence of infected human alveolar macrophages on T cells. We infected primary human alveolar macrophages (the primary host cell for Mtb) or PMA-differentiated THP-1 cells with Mtb H37Ra, then prepared cell-free supernatants. The supernatants of Mtb-infected macrophages caused dose-dependent, caspase-dependent, T cell apoptosis. This toxic effect of infected macrophage secreted factors did not require TNF-α or Fas. The supernatant cytotoxic signal(s) were heat-labile and greater than 50 kDa in molecular size. Although ESAT-6 was toxic to T cells, other Mtb-secreted factors tested did not influence T cell viability; nor did macrophage-free Mtb bacilli or broth from Mtb cultures. Furthermore, supernatants from <em>Mycobacterium bovis</em> Bacille de Calmette et Guerin (BCG)- infected macrophages also elicited T cell death suggesting that ESAT-6 itself, although cytotoxic, was not the principal mediator of T cell death in our system.</p> <h3>Conclusions</h3><p>Mtb-Infected macrophages secrete heat-labile factors that are toxic to T cells, and may contribute to the immunosuppression seen in tuberculosis as well as interfere with microbial eradication in the granuloma.</p> </div

Community pharmacies mood intervention Study (CHEMIST) Feasibility and External Pilot randomised controlled trial protocol

Feasibility study: Objectives:Refine a bespoke enhanced support intervention (ESI) (including self-help materials, intervention manual and training) for implementation by community pharmacy (CP) staff to people with sub-threshold depression and long-term conditions (LTCs) based upon evidence-supported interventions in primary careDevelop and refine study procedures (recruitment strategies and set up, screening, participant recruitment, assessment, suitability of outcome measures and data collection procedures) for testing in the pilot study phaseDesign: A case series/qualitative studySetting: UK community pharmacyPopulation: Adults with long-term health conditions who screen-positive for depression but who do not reach the threshold for DSM IV Moderate Depressive disorderIntervention: Enhanced support intervention (ESI) delivered by an appropriately trained community pharmacy team member involving four to six sessions over four months. ESI is a modified form of an intervention within the collaborative care framework for sub-threshold depression validated in previous studies in UK primary care which appears suitable for implementation in community settings.Sample size: 20-30 participantsOutcomes: Study implementation (recruitment and attrition rates), quality of data collection at baseline and 4 months and ESI adherence (number of contacts, DNA and drop out) as per objectives 1a/bQualitative evaluation: Semi-structured interviews with up to 10 participants and ESI facilitators and focus group(s) (range of pharmacy staff n = 8-10) will be conducted to explore the acceptability of the intervention and feasibility of the study, training and study procedures. External pilot study: Objectives:Quantify the flow of participants (eligibility, recruitment and follow-up rate)Evaluate proposed recruitment, assessment and outcome measure collection methodsExamine the delivery of the enhanced support intervention in a community pharmacy setting (intervention uptake, retention and dose) to inform process evaluationProcess evaluation, using semi-structured interviews with participants across a range of socio-economic settings, and pharmacy staff to explore the acceptability of the ESI within community pharmacy, elements of the intervention that were considered useful (or not) and appropriateness of study proceduresDesign: Pilot randomised controlled trial, including a prospective economic and qualitative evaluationSetting: As abovePopulation: As aboveIntervention: As above with adaptations post feasibility studyComparator: Usual careSample size: 100 participantsOutcomes: Data will be used to estimate recruitment, intervention delivery and study completion rates as per objectives 2a-d. Definitive estimates of the effectiveness of ESI will not be made.Primary outcome: Depression severity (Patient Health Questionnaire 9) at four months.Secondary outcomes: Patient acceptance, uptake and attrition. ICD10 depression status, anxiety (GAD 7), health-related quality of life (SF-12v2) and health-state utility (EQ5D 3L) will be measured at four months.Economic evaluation: The incremental cost per QALY will be calculated from both the NHS and societal perspective.Process evaluation: Using mixed methods, potential mediators/moderators of the intervention, the acceptability (to participants and pharmacy staff), barriers and facilitators to the use of ESI in community pharmacy, and impact on usual practice will be examined. Semi-structured interviews with approximately 30 study participants, 20 pharmacy staff and eight GPs near participating pharmacies will be conducted. Trial registration: ISRCTN: ISRCTN11290592Protocol version number: Version 4.1 (dated 16th January 2018)Study Sponsor Tees Esk and Wear Valleys NHS Foundation Trust

Adjunctive rifampicin for Staphylococcus aureus bacteraemia (ARREST): a multicentre, randomised, double-blind, placebo-controlled trial.

BACKGROUND: Staphylococcus aureus bacteraemia is a common cause of severe community-acquired and hospital-acquired infection worldwide. We tested the hypothesis that adjunctive rifampicin would reduce bacteriologically confirmed treatment failure or disease recurrence, or death, by enhancing early S aureus killing, sterilising infected foci and blood faster, and reducing risks of dissemination and metastatic infection. METHODS: In this multicentre, randomised, double-blind, placebo-controlled trial, adults (≥18 years) with S aureus bacteraemia who had received ≤96 h of active antibiotic therapy were recruited from 29 UK hospitals. Patients were randomly assigned (1:1) via a computer-generated sequential randomisation list to receive 2 weeks of adjunctive rifampicin (600 mg or 900 mg per day according to weight, oral or intravenous) versus identical placebo, together with standard antibiotic therapy. Randomisation was stratified by centre. Patients, investigators, and those caring for the patients were masked to group allocation. The primary outcome was time to bacteriologically confirmed treatment failure or disease recurrence, or death (all-cause), from randomisation to 12 weeks, adjudicated by an independent review committee masked to the treatment. Analysis was intention to treat. This trial was registered, number ISRCTN37666216, and is closed to new participants. FINDINGS: Between Dec 10, 2012, and Oct 25, 2016, 758 eligible participants were randomly assigned: 370 to rifampicin and 388 to placebo. 485 (64%) participants had community-acquired S aureus infections, and 132 (17%) had nosocomial S aureus infections. 47 (6%) had meticillin-resistant infections. 301 (40%) participants had an initial deep infection focus. Standard antibiotics were given for 29 (IQR 18-45) days; 619 (82%) participants received flucloxacillin. By week 12, 62 (17%) of participants who received rifampicin versus 71 (18%) who received placebo experienced treatment failure or disease recurrence, or died (absolute risk difference -1·4%, 95% CI -7·0 to 4·3; hazard ratio 0·96, 0·68-1·35, p=0·81). From randomisation to 12 weeks, no evidence of differences in serious (p=0·17) or grade 3-4 (p=0·36) adverse events were observed; however, 63 (17%) participants in the rifampicin group versus 39 (10%) in the placebo group had antibiotic or trial drug-modifying adverse events (p=0·004), and 24 (6%) versus six (2%) had drug interactions (p=0·0005). INTERPRETATION: Adjunctive rifampicin provided no overall benefit over standard antibiotic therapy in adults with S aureus bacteraemia. FUNDING: UK National Institute for Health Research Health Technology Assessment