Cold and Crowded - The Early Childhood Education Environments Study

Background In recent decades New Zealand has seen a growth in the use of childcare as a weekday living environment for children under five years old, with an increasing proportion of children attending, and children attending for longer hours. For children in early education or care, New Zealand has one of the lower allocations of indoor activity space per child in the OECD, at 2.5m2 per child. The New Zealand minimum indoor temperature requirement for these environments is 16oC, the lowest found in a search of English-language statutes and recommendations. With one exception, all other recommendations or requirements found were 18oC or more. New Zealand research has found a positive association between higher rates of respiratory and gastrointestinal infections, and colder temperatures and crowding in dwellings, while four studies outside New Zealand reported negative association between illness rates and greater area per child in childcare. Viral infectivity has been shown to decrease with higher environmental temperatures. Methods A 22-week observational cohort study was conducted in winter-spring 2017 measuring temperatures, humidity, child illness rates and rates of absence from childcare, and consequent parental absence from work. The study involved 22 full-day childcare centres, and a final cohort for statistical analysis of 221 children aged two to five years old. The study geographic area was the Hutt Valley and nearby suburbs, in the Wellington region of New Zealand. Indoor temperature and humidity were measured at 15-minute intervals, while activity space per child was calculated from floor area measurement and Ministry of Education daily attendance data. Symptomatic illness data and absence data were obtained from website-based reports entered by parents. Data were analysed by generalised linear mixed modelling to account for clustering by childcare centre, to generate rate ratios (RR) of child-days sick in relation to environmental variables.   Results The study found a significant negative relationship between increased indoor temperatures in childcare and child-days sick. For each degree increase in the median winter indoor temperatures, risk was reduced by 28%, RR = 0.721 (95% CI: 0.563 to 0.924). The association was significant across the second and third quartile temperature ranges, which were from 15.2oC to 20.8oC. For each percentage point of time spent under 18oC, risk of children being away sick increased 1.5% (95% CI: 0.6% to 2.4%). The modelling controlled for mould in the child’s home, ethnicity, use of a Community Services Card (a proxy for low income), and child age. The study also found high levels of non-compliance with minimum temperature and minimum area-per-child legal requirements. Surprisingly, the analysis indicated an association between increased risk of illness and more square metres of space per child: winter-spring RR 2.132 (95% CI:1.222 to 3.720). The result was affected by multicollinearity however, and potential confounding between space per child and temperature. After removing one environment that was an outlier for illness rates and space per child, the winter result became statistically insignificant (95% CI: 0.904 to 1.376), but there was little change in the winter-spring result. This result is contrary to the four studies mentioned above, while the only other comparable study found in the literature review found no association between area per child and illness rates. Conclusions The results support an increase in the minimum indoor temperature requirement to 18oC, in line with WHO recommendations. The study also indicates a need to improve compliance with environmental legal minima in the New Zealand childcare sector. The analysis suggested that more space per child is a risk for illness, but this result is inconsistent with other studies, and lacks a direct mechanism for causation. The area per child result may have arisen through use of daily attendance data to generate a proxy measurement for space per child, an approach that is unable to distinguish time spent outdoors from time spent outdoors at the childcare centre.

The similarity of the effect of carbohydrase or prebiotic supplementation in broilers aged 21 days, fed mixed cereal diets and challenged with coccidiosis infection

The aim of this study was to investigate the effect on growth performance and nutrient utilisation when supplementing diets deficient in energy and protein with carbohydrase enzymes or xylo-oligosaccharide in broilers challenged with coccidia. 960 Ross 308 broilers were used in this 21-day study. The treatments were arranged into a 2×4 factorial with 2 challenge states (challenged and non-challenged) and 4 different additive types (control, xylanase alone, xylanase and β-glucanase mixture and xylo-oligosaccharide). On day 14, the challenged group received 12× the recommended dose of coccidiosis vaccine while the non-challenged group received a sham treatment of water only. The birds and feed were weighed on days 0, 14 and 21. On day 21, two birds per pen were euthanized, the caeca were removed and the contents collected for short chain fatty acid analysis. Six more birds per pen were euthanized and ileal digesta were collected and pooled per pen for nutrient digestibility analysis. Feed intake was greater (P < 0.05) on days 14 and 21 when xylo-oligosaccharide was included in the diet compared to the xylanase and β-glucanase mixture in birds challenged with coccidiosis. Including xylo-oligosaccharide in the diet improved (P < 0.05) the digestibility of nitrogen and supplementing diets with the xylanase and β-glucanase mixture improved (P < 0.05) the digestibility of several amino acids. The concentration of arabinose and xylose was (P < 0.001) greater when broiler diets were supplemented with carbohydrase enzymes or xylo-oligosaccharide compared to the control. Although there was an increase in short chain fatty acid production due to the addition of carbohydrase enzymes or xylo-oligosaccharide, there was no additive effect on the %G+C profile of caecal bacteria however there was a negative effect of coccidiosis. In conclusion, the similarity in the response to carbohydrase enzymes or xylo-oligosaccharide supplementation illustrates that the hydrolysis products from carbohydrase activity may have prebiotic like effects

The effect of carbohydrases or prebiotic oligosaccharides on growth performance, nutrient utilisation and the development of the small intestine and immune organs in broilers fed nutrient-adequate diets based on either wheat or barley

BACKGROUND: Non‐starch polysaccharides are large complex molecules and are found in cereal grains. This study was conducted to investigate the effect of carbohydrase enzymes or prebiotic oligosaccharides on growth performance, nutrient utilisation and weight of organs associated with the immune system in broilers fed wheat‐ or barley‐based diets. RESULTS: In wheat‐based diets, feed intake was lower (P < 0.05) following xylo‐oligosaccharide supplementation, whereas in barley‐based diets feed intake was greater (P < 0.05) following β‐glucanase supplementation. Gross energy digestibility was improved (P < 0.01) when either level of xylanase was added to wheat diets. Ileal digestible energy was greater (P < 0.01) in wheat diets including an additive compared with the control diet. In wheat diets, bursa weight was lower (P < 0.05) following xylo‐oligosaccharide supplementation compared with the control treatment. CONCLUSIONS: The current study showed that supplemented carbohydrases or prebiotic oligosaccharides could alter the development of immune organs or small intestine without any significant effect on growth performance in broilers receiving nutrient‐adequate diets

Facilitating the participation of children with disabilities in early childhood development centres in Malawi: Developing a sustainable staff training programme

This article explores the development of a sustainable training programme supporting the inclusion of children with disabilities in early childhood, education and care (ECEC) centres in Malawi. This programme is based on a review of literature of curriculum, pedagogy and teaching approaches in ECEC in sub-Saharan Africa, alongside a review of national policy documents. The training was designed to enable staff to value the inclusion of children with disabilities in ECEC centres, as well as suggesting practical ways to do so. We set out our response to the gap in training of ECEC staff through the development of a supplementary integrated training programme, which, whilst respectful of the curriculum, policy and practice of Malawi, challenged staff to consider ways of including children with disabilities (CWD) and their families. We suggest this is a pragmatic and sustainable model that could be applied to training in other ECEC settings across the region in sub-Saharan Africa. It concludes with guiding principles for training those working in ECEC with young children with disabilities in low-income countries.`

Snapshots during the catalytic cycle of a histidine acid phytase reveal an induced fit structural mechanism

Highly engineered phytases, which sequentially hydrolyze the hexakisphosphate ester of inositol known as phytic acid, are routinely added to the feeds of monogastric animals to improve phosphate bioavailability. New phytases are sought as starting points to further optimize the rate and extent of dephosphorylation of phytate in the animal digestive tract. Multiple inositol polyphosphate phosphatases (MINPPs) are clade 2 histidine phosphatases (HP2P) able to carry out the stepwise hydrolysis of phytate. MINPPs are not restricted by a strong positional specificity making them attractive targets for development as feed enzymes. Here, we describe the characterization of a MINPP from the Gram-positive bacterium Bifidobacterium longum (BlMINPP). BlMINPP has a typical HP2P-fold but, unusually, possesses a large a-domain polypeptide insertion relative to other MINPPs. This insertion, termed the U-loop, spans the active site and contributes to substrate specificity pockets underpopulated in other HP2Ps. Mutagenesis of U-loop residues reveals its contribution to enzyme kinetics and thermostability. Moreover, four crystal structures of the protein along the catalytic cycle capture, for the first time in an HP2P, a large ligand-driven a-domain motion essential to allow substrate access to the active site. This motion recruits residues both downstream of a molecular hinge and on the U-loop to participate in specificity subsites, and mutagenesis identified a mobile lysine residue as a key determinant of positional specificity of the enzyme. Taken together, these data provide important new insights to the factors determining stability, substrate recognition, and the structural mechanism of hydrolysis in this industrially important group of enzymes

Effect of phytase on intestinal phytate breakdown, plasma inositol concentrations and glucose transporter type 4 abundance in muscle membranes of weanling pigs

The objective of this current study was to determine the effects of phytase dosing on growth performance, mineral digestibility, phytate breakdown and the level of glucose transporter type 4 (GLUT4) in muscle plasma membranes of weanling pigs. A total of 160 barrows were used in a randomized completely block design and assigned to four treatments for a 7-week study. Depending on the feeding phase, diets differed in dietary calcium (Ca) and phosphorus (P) levels (PC:8 to 6.8g/kg Ca; 7.3 to 6.3 g/kg P; negative control (NC):5.5 to 5.2 g/kg Ca; 5.4 to 4.7 g/kg P). NC diets were supplemented with phytase at 0 (NC); 500 (NC+500 FTU) or 2000 FTU/kg (NC+2000 FTU) phytase units/kg. Blood was collected after fasting (d 48) or feeding (d 49) for measurement of plasma inositol concentrations. On d 49, two pigs per pen were euthanized, duodenal and ileal digesta samples were collected to determine inositol phosphates (InsP6-2) concentrations. High phytase supplementation increased body weight (BW) on d 21, 35 and 49 (P <0.05). Over the entire feeding period, average daily gain (ADG), average daily feed intake (ADFI) and feed efficiency were increased by NC+2000 FTU compared to the other treatments (P <0.05). Postprandial plasma inositol concentration was increased in NC+2000 (P < 0.01), but there was only a tendency (P = 0.06) of a higher fasting plasma inositol concentration in this group. Inositol concentrations in the portal vein plasma (d 49) were not different among treatments. Duodenal digesta InsP5 and InsP6 concentrations were similar in PC and NC, but higher in these two treatments (P < 0.05) than those supplemented with phytase. Phytase supplementation decreased InsP6-4, resulting in increased InsP3-2 and myo-inositol concentrations. Similar effects were found in ileal contents. Compared to NC, phytase supplementation resulted in greater cumulative InsP6-2 disappearance (93.6% vs. 72.8% vs. 25.0%, for NC+2000 FTU, NC +500 FTU and NC, respectively, P < 0.01) till the the distal ileum. Longissimus dorsi muscle plasma membrane GLUT4 concentration was increased by NC+2000 FTU (P < 0.01) compared to NC. In summary, high phytase supplementation increased growth performance of nursery pigs. The higher myo-inositol release from phytate could contribute to the increased expression of GLUT4 in muscle plasma membranes. Further investigation is needed to determine if this is associated with enhanced cellular glucose uptake and utilization

Association between a genetic index for digital dermatitis resistance and the presence of digital dermatitis, heel horn erosion and interdigital hyperplasia in Holstein cows

Digital dermatitis (DD) is a polybacterial disease endemic to most UK dairy farms. It poses a major financial and welfare threat and is characterized by high incidence and recurrence rates. We aimed to investigate the association between the UK estimated breeding value for resistance to digital dermatitis, the Digital Dermatitis Index (DDI) and the frequency of DD, heel horn erosion (HHE), and interdigital hyperplasia (IH) in a population of Holstein dairy cows. We enrolled and genotyped 2,352 cows from 4 farms in a prospective cohort study. Foot lesion records were recorded by veterinary surgeons for each animal at 4 time points during a production cycle, starting at approximately 2 mo before calving and ending in late lactation. Importantly, these records were not used in the calculation of the DDI. Lesion records were matched to the animal's own DDI (n = 2,101) and their sire's DDI (n = 1,812). Digital Dermatitis Index values in our study population ranged from -1.41 to +1.2 and were transformed to represent distance from the mean expressed in standard deviations. The relationship between the DDI and the presence of DD was investigated using a logistic regression model, with farm, parity, and a farm-parity interaction fitted as covariates. A multivariable logistic regression model was fitted to evaluate the relationship between HHE and DDI with farm fitted as a covariate. Finally, a univariable logistic regression model with DDI as explanatory variable was used to investigate the relationship between IH and DDI. The odds ratio of an animal being affected by DD was 0.69 for one standard deviation (SD) increase in the animal's DDI (95% confidence interval (CI) = 0.63-0.76). The odds of HHE and IH were 0.69 (95%CI = 0.62-0.76) and 0.58 (95%CI = 0.49-0.68) respectively for one SD increase in DDI. The adjusted probability of DD was 32% (95% CI = 27-36%) for cows with mean DDI value of 0 while it was 24% (95% CI = 20-29%) in cows with a DDI value of +1. Sire DDI breeding values were standardized in the same way and then binned into terciles creating an ordinal variable representing bulls of high, medium, and low genetic merit for DD resistance. The daughters of low genetic merit bulls were at 2.05 (95% CI = 1.60-2.64), 1.96 (95% CI = 1.53-2.50), and 2.85 (95% CI = 1.64-5.16) times greater odds of being affected by DD, HHE, and IH respectively compared with the daughters of high genetic merit bulls. The results of this study highlight the potential of digital dermatitis genetic indexes to aid herd management of DD, and suggest that breeding for resistance to DD, alongside environmental and management control practices, could reduce the prevalence of the disease.</p

Effect of phytase supplementation on plasma and organ myo-inositol content and erythrocyte inositol phosphates in chickens

‘Woody breast’ (WB) and ‘white striping’ in broiler meat is a global problem. With unknown etiology, WB negatively impacts bird health, welfare and is a significant economic burden to the poultry industry. New evidence has shown that WB is associated with dysregulation in systemic and breast muscle-oxygen homeostasis, resulting in hypoxia and anaemia. However, it has been observed that phytase (Quantum Blue (QB) a modified, E. coli-derived 6-phytase) super dosing can reverse dysregulation of muscle-oxygen homeostasis and reduces WB severity by ~5%. The objective of this study was to assess whether levels of Ins(1,3,4,5,6)P5, the main allosteric regulator of haemoglobin, are influenced by changes in plasma myo-inositol arising from super dosing with phytase. To enable this, methods suitable for measurement of myo-inositol in tissues and inositol phosphates in blood were developed. Data were collected from independent trials, including male Ross 308 broilers fed low and adequate calcium/available phosphate (Ca/AvP) diets supplemented with QB at 1,500 phytase units (FTU)/kg, which simultaneously decreased gizzard InsP6 (P<0.001) and increased gizzard myo-inositol (P<0.001). Similarly, male Cobb 500 broiler chicks fed a negative control (NC) diet deficient in AvP, Ca and sodium or diet supplemented with the QB phytase at 500, 1000 or 2,000 FTU/kg increased plasma (P<0.001) and liver (P=0.007) myo-inositol of 18d-old birds at 2,000 FTU/kg. Finally, QB supplementation of Cobb 500 breeder flock diet at 1,250 FTU/kg increased blood myo-inositol (P<0.001) and erythrocyte Ins(1,3,4,5,6)P5 (P=0.011) of their 1d-old hatchlings. These data confirmed the ability of phytase to modulate inositol phosphate pathways by provision of metabolic precursors of important signalling molecules. The ameliorations of WB afforded by super doses of phytase may include modulation of hypoxia pathways that also involve inositol signalling molecules. Elevations of erythrocyte Ins(1,3,4,5,6)P5 by phytase supplementation may enhance systemic oxygen carrying capacity, an important factor in the amelioration of WB and WS myopathy

The Perioperative Quality Improvement Programme (PQIP patient study): protocol for a UK multicentre, prospective cohort study to measure quality of care and outcomes after major surgery

INTRODUCTION: Major surgery accounts for a substantial proportion of health service activity, due not only to the primary procedure, but the longer-term health implications of poor short-term outcome. Data from small studies or from outside the UK indicate that rates of complications and failure to rescue vary between hospitals, as does compliance with best practice processes. Within the UK, there is currently no system for monitoring postoperative complications (other than short-term mortality) in major non-cardiac surgery. Further, there is variation between national audit programmes, in the emphasis placed on quality assurance versus quality improvement, and therefore the principles of measurement and reporting which are used to design such programmes. METHODS AND ANALYSIS: The PQIP patient study is a multi-centre prospective cohort study which recruits patients undergoing major surgery. Patient provide informed consent and contribute baseline and outcome data from their perspective using a suite of patient-reported outcome tools. Research and clinical staff complete data on patient risk factors and outcomes in-hospital, including two measures of complications. Longer-term outcome data are collected through patient feedback and linkage to national administrative datasets (mortality and readmissions). As well as providing a uniquely granular dataset for research, PQIP provides feedback to participating sites on their compliance with evidence-based processes and their patients' outcomes, with the aim of supporting local quality improvement. ETHICS AND DISSEMINATION: Ethical approval has been granted by the Health Research Authority in the UK. Dissemination of interim findings (non-inferential) will form a part of the improvement methodology and will be provided to participating centres at regular intervals, including near-real time feedback of key process measures. Inferential analyses will be published in the peer-reviewed literature, supported by a comprehensive multi-modal communications strategy including to patients, policy makers and academic audiences as well as clinicians

Lifeform indicators reveal large-scale shifts in plankton across the North-West European shelf

Increasing direct human pressures on the marine environment, coupled with climate-driven changes, is a concern to marine ecosystems globally. This requires the development and monitoring of ecosystem indicators for effective management and adaptation planning. Plankton lifeforms (broad functional groups) are sensitive indicators of marine environmental change and can provide a simplified view of plankton biodiversity, building an understanding of change in lower trophic levels. Here, we visualize regional-scale multi-decadal trends in six key plankton lifeforms as well as their correlative relationships with sea surface temperature (SST). For the first time, we collate trends across multiple disparate surveys, comparing the spatially and temporally extensive Continuous Plankton Recorder (CPR) survey (offshore) with multiple long-term fixed station-based time-series (inshore) from around the UK coastline. These analyses of plankton lifeforms showed profound long-term changes, which were coherent across large spatial scales. For example, ‘diatom’ and ‘meroplankton’ lifeforms showed strong alignment between surveys and coherent regional-scale trends, with the 1998–2017 decadal average abundance of meroplankton being 2.3 times that of 1958–1967 for CPR samples in the North Sea. This major, shelf-wide increase in meroplankton correlated with increasing SSTs, and contrasted with a general decrease in holoplankton (dominated by small copepods), indicating a changing balance of benthic and pelagic fauna. Likewise, inshore-offshore gradients in dinoflagellate trends, with contemporary increases inshore contrasting with multi-decadal decreases offshore (approx. 75% lower decadal mean abundance), urgently require the identification of causal mechanisms. Our lifeform approach allows the collation of many different data types and time-series across the NW European shelf, providing a crucial evidence base for informing ecosystem-based management, and the development of regional adaptation plans