Drug-microbiota interactions and treatment response: Relevance to rheumatoid arthritis

Knowledge about associations between changes in the structure and/or function of intestinal microbes (the microbiota) and the pathogenesis of various diseases is expanding. However, interactions between the intestinal microbiota and different pharmaceuticals and the impact of these on responses to treatment are less well studied. Several mechanisms are known by which drug-microbiota interactions can influence drug bioavailability, efficacy, and/or toxicity. This includes direct activation or inactivation of drugs by microbial enzymes which can enhance or reduce drug effectiveness. The extensive metabolic capabilities of the intestinal microbiota make it a hotspot for drug modification. However, drugs can also influence the microbiota profoundly and change the outcome of interactions with the host. Additionally, individual microbiota signatures are unique, leading to substantial variation in host responses to particular drugs. In this review, we describe several known and emerging examples of how drug-microbiota interactions influence the responses of patients to treatment for various diseases, including inflammatory bowel disease, type 2 diabetes and cancer. Focussing on rheumatoid arthritis (RA), a chronic inflammatory disease of the joints which has been linked with microbial dysbiosis, we propose mechanisms by which the intestinal microbiota may affect responses to treatment with methotrexate which are highly variable. Furthering our knowledge of this subject will eventually lead to the adoption of new treatment strategies incorporating microbiota signatures to predict or improve treatment outcomes

Expert consensus document: The International Scientific Association for Probiotics and Prebiotics (ISAPP) consensus statement on the definition and scope of prebiotics

In December 2016, a panel of experts in microbiology, nutrition and clinical research was convened by the International Scientific Association for Probiotics and Prebiotics to review the definition and scope of prebiotics. Consistent with the original embodiment of prebiotics, but aware of the latest scientific and clinical developments, the panel updated the definition of a prebiotic: a substrate that is selectively utilized by host microorganisms conferring a health benefit. This definition expands the concept of prebiotics to possibly include non-carbohydrate substances, applications to body sites other than the gastrointestinal tract, and diverse categories other than food. The requirement for selective microbiota-mediated mechanisms was retained. Beneficial health effects must be documented for a substance to be considered a prebiotic. The consensus definition applies also to prebiotics for use by animals, in which microbiota-focused strategies to maintain health and prevent disease is as relevant as for humans. Ultimately, the goal of this Consensus Statement is to engender appropriate use of the term ‘prebiotic’ by relevant stakeholders so that consistency and clarity can be achieved in research reports, product marketing and regulatory oversight of the category. To this end, we have reviewed several aspects of prebiotic science including its development, health benefits and legislation

The impact of 'achievement for all' on school leadership

The Achievement for All (AfA) pilot initiative, delivered in partnership by the Department for Education (DfE), (formerly the Department for Children, Schools and Families [DCSF]), National Strategies and the National College (NCSL), aims to increase the attainment and progress of children in schools with special educational needs and disabilities (SEND); improve the engagement of their parents with the school and improve wider outcomes for this group of children. Introduced in September 2009 as a two year pilot in 454 primary, secondary and special schools and Pupil Referral Units across 10 Local Authorities in England, AfA, with a particular focus on inclusive leadership practice, takes a whole school approach to school improvement. The population included pupils in Years 1, 2, 5, 6, 7, 8, 10 and 11 identified with SEND on School Action, School Action Plus or holding Statements; 85 per cent of the participating schools are primary. Guided by government documentation (DCSF, 2009a) and local authority advisers, schools have implemented the initiative around three distinct but integrated strands: assessment, tracking and interventions; structured conversations with parents and provision for developing wider outcomes. By considering focus group data evidence from headteachers/school project leaders across the participating local authorities, this article will explore the impact of AfA on inclusive leadership practices in schools. Findings suggest that although vision, commitment, collaboration and communication remain self evident for the majority of leaders, within the context of AfA, these characteristics of effective inclusive leadership along with pupil learning have been enhanced

Do complainants appreciate overcompensation? A meta-analysis on the effect of simple compensation vs. overcompensation on post-complaint satisfaction

Service recovery, Compensation, Meta-analysis, Consumer behavior, Consumer satisfaction, Complaint management,