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BACKGROUND: The chicken body louse is an obligate ectoparasite of domestic chickens. Chicken body lice feed on feathers, and infestation with this louse is linked to decreases in egg production, hen weight, and feed conversion efficiency. However, it is unknown how chicken body lice impact egg-laying chickens in cage-free environments. Welfare and behavior metrics were collected from flocks of egg-laying chickens either infested with chicken body lice or left uninfested. METHODS: In two trials, two flocks of cage-free commercial egg-laying chickens were infested with chicken body lice or maintained as uninfested controls. At three timepoints, behavior and welfare of all chickens was measured. On-animal sensors were used to quantify pecking, preening, and dustbathing behavior. Other animal-based welfare metrics included recording comb wounds and skin lesions. RESULTS: Birds infested with chicken body lice exhibited significantly more preening behaviors than uninfested birds, even at low louse levels. Moderate or severe skin lesions were detected on birds that were moderately infested with chicken body lice while skin lesions were never detected on uninfested birds. CONCLUSIONS: The welfare of chickens was impacted by the chicken body louse, a chewing louse that primarily feather feeds. Evidence of skin lesions on infested birds suggests that lice may cause more damage to birds than previously thought, and further evaluation of louse economic damage is necessary.

Spatial abilities of hens are particularly sensitive to development during early life. Experiences in pullet housing may have lasting consequences on adult hens movements in cage-free environments. We tested whether opportunities to access elevated spaces during rearing improved hens use of a multitiered aviary. Female Dekalb White pullets were reared in either floor pens (FL), single-tiered aviaries (ST), or 2-tiered aviaries (TT; n = 5 pens/environment) through 16 wk of age. Rearing structures were replaced with identical multitiered aviaries at 17 wk. The distribution of the flock within the aviary and the vertical transitions of 10 focal hens/pen across the aviary were determined from videos recorded during their first (D1) and seventh (D7) day of aviary access, as well as at 19, 23, and 27 wk of age. Prevalence of floor eggs was recorded weekly from 17 to 28 wk of age. On D1, more ST and TT hens utilized the aviary during the daytime (P = 0.0077), made more vertical transitions when searching for a roosting spot in the evening (P = 0.0021), and maintained a consistent distance traveled during transitions compared to FL hens (P = 0.02). These differences disappeared by D7, except that ST and TT hens continued to roost on the highest perches of the aviary more (P < 0.0001) than FL hens through 27 wk of age. FL hens laid more floor eggs than ST and TT hens for the first 2 wk of lay (P < 0.0001). The majority (97.9%) of vertical transitions was controlled. Uncontrolled transitions were highest at D1 and decreased by D7 (P = 0.0009) and were not affected by rearing (P = 0.33). The results suggest that hens reared with minimal height are hesitant to use the laying hen aviaries when they are first transferred. They acclimate within 1 to 2 wk, but continue to roost less in the highest accessible level.

Breaktimes are ubiquitous in English schools. Research suggests they have social value for children, but school staff often have a range of concerns about breaktimes and tend to undervalue them. However, there is little understanding about these times, not least because data are not collected about their organisation and characteristics. This paper brings together data from three national surveys undertaken in 1995, 2006 and 2017 of head teachers of primary and secondary schools to provide an understanding of the nature, organisation and staff attitudes towards breaktimes and how they have changed over 25 years. At each survey point, completed questionnaires were received from representative random samples of over 1000 primary and secondary schools. Results showed marked reductions in the average total amount of time for breaks, the virtual abolition of afternoon breaks and a decline in time available for lunchtime breaks. The reductions were largely for behavioural reasons and to increase time for learning. Results also show variations in the length of breaktimes across school types and in relation to socioeconomic disadvantage, and changes to the amount of supervision provided by schools. Attitudes towards breaks varied across primary and secondary phases, and the withholding of breaks was used by schools to address poor pupil behaviour and disengagement. Schools continued to have concerns about the management of behaviour during breaktimes, even when breaks had already been shortened. It is suggested that staff undervalue the potential contribution that breaktimes afford the development and wellbeing of children and young people in school.

Abstract Background The chicken body louse is an obligate ectoparasite of domestic chickens. Chicken body lice feed on feathers, and infestation with this louse is linked to decreases in egg production, hen weight, and feed conversion efficiency. However, it is unknown how chicken body lice impact egg-laying chickens in cage-free environments. Welfare and behavior metrics were collected from flocks of egg-laying chickens either infested with chicken body lice or left uninfested. Methods In two trials, two flocks of cage-free commercial egg-laying chickens were infested with chicken body lice or maintained as uninfested controls. At three timepoints, behavior and welfare of all chickens was measured. On-animal sensors were used to quantify pecking, preening, and dustbathing behavior. Other animal-based welfare metrics included recording comb wounds and skin lesions. Results Birds infested with chicken body lice exhibited significantly more preening behaviors than uninfested birds, even at low louse levels. Moderate or severe skin lesions were detected on birds that were moderately infested with chicken body lice while skin lesions were never detected on uninfested birds. Conclusions The welfare of chickens was impacted by the chicken body louse, a chewing louse that primarily feather feeds. Evidence of skin lesions on infested birds suggests that lice may cause more damage to birds than previously thought, and further evaluation of louse economic damage is necessary. Graphical Abstract

Providing environmental enrichments that increase environmental complexity can benefit poultry welfare. This Poultry Science Association symposium paper is structured around four themes on 1) poultry preferences and affective states 2) species-specific behavior, including play behavior and the relationship between behavior, activity level and walking ability, 3) environmental enrichment and its relationship with indicators of welfare, and 4) a case study focusing on the application of enrichments in commercial broiler chicken production. For effective enrichment strategies, the birds' perspective matters most, and we need to consider individual variation, social dynamics, and previous experience when assessing these strategies. Play behavior can be a valuable indicator of positive affect, and while we do not yet know how much play would be optimal, absence of play suggests a welfare deficit. Activity levels and behavior can be improved by environmental modifications and prior research has shown that the activity level of broilers can be increased, at least temporarily, by increasing the environmental complexity. However, more research on impacts of enrichments on birds' resilience, on birds in commercial conditions, and on slow(er)-growing strains is needed. Finally, incorporating farmers' expertise can greatly benefit enrichment design and implementation on commercial farms.

ABSTRACT: The skeletal health of laying hens improves when birds are given opportunities to perform load-bearing movements with elevated structures, such as perches. We investigated how early access to elevated structures varying in complexity and height would affect bone quality and subsequent keel bone fractures in a layer multitiered aviary. Female Dekalb White pullets were reared in floor pens furnished with floor perches (FL), single-tiered aviaries (ST), or 2-tiered aviaries (TT; n = 5 pens/treatment) through 16 wk of age. At 17 wks, all structures were replaced with identical multitiered layer aviaries. The keel, both tibiae, and both humeri were collected from 60 euthanized birds from each rearing treatment at 8, 16 and 30 wk of age, and analyzed with dual X-ray absorptiometry (DEXA) for bone mineral density and length. At 18, 26, 28, and 30 wk of age, 10 focal hens/pen were radiographed repeatedly and the presence, severity of keel bone fractures were assessed with a tagged visual analogue scale. The number of fractures was also recorded. At 16 wk of age, FL pullets had lower BMD of the tibia (P = 0.003), keel (P = 0.013), and humerus (P = 0.004) compared to ST and TT pullets. Most of the observed treatment differences disappeared after pullets were transferred to the aviary. BMD continued to increase for all hens through 30 wk of age. Pullet rearing did not affect the presence or severity of keel bone fractures, or number of new fractures incurred between ages (P > 0.05). The prevalence and severity of keel bone fractures increased between 26 to 28 wk and remained high to 30 wk of age (P < 0.0001). Hens experienced more new fractures between 26 to 30 wk than between 18 to 26 wk of age (P = 0.0046). The effects of pullet housing on bone quality were short-term when hens had access to adult housing with multiple opportunities for load-bearing movements. Keel fractures with minor severity were high in prevalence reflecting the use of radiography to assess this injury.

ABSTRACT: Spatial abilities of hens are particularly sensitive to development during early life. Experiences in pullet housing may have lasting consequences on adult hens’ movements in cage-free environments. We tested whether opportunities to access elevated spaces during rearing improved hens’ use of a multitiered aviary. Female Dekalb White pullets were reared in either floor pens (FL), single-tiered aviaries (ST), or 2-tiered aviaries (TT; n = 5 pens/environment) through 16 wk of age. Rearing structures were replaced with identical multitiered aviaries at 17 wk. The distribution of the flock within the aviary and the vertical transitions of 10 focal hens/pen across the aviary were determined from videos recorded during their first (D1) and seventh (D7) day of aviary access, as well as at 19, 23, and 27 wk of age. Prevalence of floor eggs was recorded weekly from 17 to 28 wk of age. On D1, more ST and TT hens utilized the aviary during the daytime (P = 0.0077), made more vertical transitions when searching for a roosting spot in the evening (P = 0.0021), and maintained a consistent distance traveled during transitions compared to FL hens (P = 0.02). These differences disappeared by D7, except that ST and TT hens continued to roost on the highest perches of the aviary more (P < 0.0001) than FL hens through 27 wk of age. FL hens laid more floor eggs than ST and TT hens for the first 2 wk of lay (P < 0.0001). The majority (97.9%) of vertical transitions was controlled. Uncontrolled transitions were highest at D1 and decreased by D7 (P = 0.0009) and were not affected by rearing (P = 0.33). The results suggest that hens reared with minimal height are hesitant to use the laying hen aviaries when they are first transferred. They acclimate within 1 to 2 wk, but continue to roost less in the highest accessible level.

Background It is recognised that longer-term needs after stroke may not be well addressed by current services. The aim of this programme of research was to develop a novel primary care model to address these needs and to evaluate this new approach. Objectives The work was divided into three workstreams: development of a primary care model development of a ‘Managing Life After Stroke’ programme (including self-management) for people with stroke evaluation of the effectiveness and cost effectiveness of these interventions. Design The development of the primary care model involved information gathering in the form of literature reviews, patient and public involvement workshops, qualitative studies (interviews and focus groups), a consensus study and a pilot study, all feeding into a multidisciplinary intervention development group that approved the final primary care model. In parallel, a further literature review, consultation workshops with healthcare professionals and patients and public involvement fed into the iterative development of the ‘My Life After Stroke’ programme. In the final phase of the programme, the two interventions were evaluated in a cluster randomised controlled trial, which included a process evaluation and within-trial cost-effectiveness analysis. Setting General practices in the East of England and East Midlands. Participants People with a history of stroke identified from general practice stroke registers. Interventions The Improving Primary Care After Stroke model of primary care delivery. This comprised five components: a structured review; a direct point of contact; improving communication between primary and secondary care; local service mapping; and training of primary care professionals. The ‘My Life After Stroke’ self-management programme for people with stroke comprised an initial individual session, four weekly group-based sessions and a final individual session. Main outcome measures The coprimary end points for the trial were two subscales (emotion and participation) of the Stroke Impact Scale v3.0 at 12 months after randomisation. Secondary outcomes included the Stroke Impact Scale Short Form, the EuroQol-5 Dimension, five level questionnaire, the ICEpop CAPability measure for Adults, the Southampton Stroke Self-Management Questionnaire and the Health Literacy Questionnaire. Data sources General practice records for health economic costing data. Patient questionnaires for outcomes. Results Trial: 46 clusters (general practices) were randomised with 1040 participants. At 12 months, there was a 0.64 (97.5% confidence interval −1.7 to +2.8) improvement in the emotion outcome in the intervention arm compared to the control arm and a 1.3 (97.5% confidence interval −2.0 to +4.6) increase in the participation outcome in the intervention arm compared to control. There was also no evidence of effect of the intervention on short form Stroke Impact Scale, quality of life (EuroQol 5 Dimension 5 level questionnaire), well-being (ICEpop CAPability measure for Adults), Southampton Stroke Self-Management questionnaire or health literacy (Health Literacy Questionnaire). Process evaluation: over 80% of participants received a review. Only a third of patients attended the ‘My Life After Stroke’ course. The direct point of contact service was hardly used. The local directory of services had variable take-up by healthcare professionals. It did not prove possible to support improved communication between primary and secondary care as originally intended. Training fidelity was high. Cost-effectiveness analysis: the intervention increased primary care workload and was associated with a non-significant, higher quality-adjusted life-year at 12 months. The incremental cost per quality-adjusted life-year was £20,863. Limitations There were differences in age, sex and proportion of people from minority ethnic groups in the trial population as compared to a typical general practice stroke register. Uptake of the intervention was variable. Ceiling effects were observed in the primary outcome measure. Follow-up was limited to 12 months. Conclusions This programme of research has reaffirmed the importance of addressing longer-term needs of people after stroke in the community. The most commonly expressed need is fatigue. The primary care model that we developed was not effective at addressing these needs. Our qualitative findings suggest that an intervention focused on patients earlier after their stroke or one which is more intensive might be effective. There was a mismatch between the needs reported by stroke survivors and evidence available for how to address these needs. Future work Research to inform who should be offered poststroke assessment of needs in the community in the longer term (after 6 months). Development and evaluation of interventions to address fatigue, low mood and cognitive problems in people with stroke in the community. Study registration This study is registered as PROSPERO 2015 CRD42015026602. Trial registration This trial is registered as ISRCTNCT03353519. Funding This award was funded by the National Institute for Health and Care Research (NIHR) Programme Grants for Applied Research programme (NIHR award ref: PTC-RP-PG-0213-20001) and is published in full in Programme Grants for Applied Research; Vol. 12, No. 1. See the NIHR Funding and Awards website for further award information. Plain language summary What was the question? People tell us that their longer-term problems after a stroke are not always well dealt with. We wanted to develop a new way for general practice to look after their patients who have had a stroke in such a way that these problems are better addressed. What did we do? We looked at the evidence that already exists in terms of what problems people face after their stroke. Then we spoke to people with stroke and their carers and to healthcare professionals to understand how general practice might be better able to support people. A multiprofessional group, including patients, met to discuss our findings and propose a new way of working. The approach included: review of patient needs by a practice nurse using a checklist adapted for use in general practice group-based self-management course directory of relevant local services direct point of contact for people with stroke to use ways to improve communication between primary care and specialist staff training for practice nurses. Over 1 year, we followed up patients with stroke in 23 practices who tried out this new model of care and compared what happened to them and how they felt with patients from 23 practices that had not introduced this new model. What did we find? We found that the commonest problems that people reported included fatigue, difficulties in thinking and mood. We found that the new model did not change the impact of stroke on patients who received it. Some participants indicated that the approach might have been more helpful earlier in their stroke journey. What does this mean? The services developed in this research are not relevant to all people after stroke in the longer term. Research is needed on how to address the specific poststroke problems that patients report. Scientific summary Background There is evidence that stroke survivors and their carers have longer-term needs that are not well addressed by current services. This shortfall might be met by extending access to specialist services or enhancing generalist primary care services. This programme of research focuses on the latter approach. Objectives Develop a primary care-based model to optimise postdischarge longer-term care: Understand perspectives of stroke survivors and carers on experiences of health and care services since discharge from specialist services. Explore roles of specialist and primary care services for stroke aftercare and avenues of communication between specialist and primary care. Consider poststroke checklists for primary care. Establish criteria for rereferral from primary care to specialist care. Agree the components of the primary care model. Pilot the primary care model. Develop a ‘Managing Life After Stroke’ (MLAS) programme (including self-management) for people with stroke. Evaluate the effectiveness and cost-effectiveness of these interventions. Methods The primary care model was informed by: A systematic review and meta-ethnography of the literature We recorded themes identified by authors of the included studies and grouped these into issues relating to continuity of care, access to services, information and quality of communication. We then developed our own overarching explanation of why stroke survivors and caregivers had the experiences that they did. Qualitative interviews with patients and carers Semistructured interviews were carried out with 22 stroke survivors and their caregivers (n = 14), recruited from general practice stroke registers. Interviews were audio-recorded, transcribed and analysed using a framework approach. Focus groups with healthcare professionals and patients Six focus groups were run involving healthcare professionals (HCPs) from primary care and from six NHS acute trusts in the East of England and East Midlands in order to better understand communication processes between generalists and specialists with regard to stroke care. Focus groups were carried out to explore the use of checklists to support management of healthcare needs of people with stroke in primary care. Focus groups with HCPs and with patients and their carers were held separately. Modified Research And Development Corporation Appropriateness Consensus Study The purpose of this study was to understand when referrals to specialist services are appropriate from the perspective of HCPs. Fictional scenarios were devised covering all the areas of need that had been identified in our work on checklists. In the first round, panellists representing both secondary and primary care were asked to rate online the appropriateness of referral decisions in these scenarios. In the second round, the panellists met face to face to discuss each referral decision. Scoping review The aim was to give an overview of interventions delivered in the community that were effective at addressing long-term outcomes after stroke. We conducted a systematic search to identify reviews of randomised controlled trials (RCTs), reviews of observational studies, and single trials published in the last 5 years. Pilot study A 6-month single arm (i.e. no control group) feasibility study was carried out in a single practice in Cambridgeshire. The Managing Life After Stroke programme The MLAS programme was informed by a literature review; a consultation phase with a multidisciplinary healthcare professional group and stroke survivors; an iterative phase in two cycles and a feasibility study. The evaluation phase involved three components: Cluster randomised controlled trial Forty-six general practices were randomised to usual care or the new model of care. Participants were people with stroke on the practice stroke registers. The coprimary outcomes were two subscales (emotion and participation) of the stroke impact scale. Follow-up was by postal questionnaire at 6 and 12 months. Process evaluation A mixed-methods design was used to assess fidelity of design, training, delivery and engagement. Methods included questionnaires sent to practices (to ascertain ‘usual care’); video-recording and audio-recording of training sessions of staff; direct observations; and interviews with staff and participants. Cost-effectiveness analysis The evaluation takes a ‘within-trial’ approach and assesses only those costs and benefits that fall within the first 12 months following the evaluation. Costs were measured from the perspective of the UK NHS. Resources to implement the intervention were costed using a micro-costing approach that took into account the time spent by healthcare staff on training and intervention delivery. Health service use was assessed through patient questionnaires and primary care electronic health records. Quality-adjusted life-years (QALYs) were estimated from the EuroQol-5 Dimension, five level questionnaire (EQ-5D-5L) questionnaire. We calculated incremental cost-effectiveness ratios to represent the incremental cost required to obtain one additional QALY when moving from usual care to the new intervention. Results A systematic review and meta-ethnography of the literature Key themes were lack of proactive follow-up; premature withdrawal of services; lack of support in specific areas; lack of information about local services and realistic timescales for recovery; and poor communication both between patients and HCPs and between different HCPs. Our overarching narrative was of marginalisation of stroke survivors and caregivers by the healthcare system, characterised by passivity of both patients and health services and fluidity of needs. Qualitative interviews with patients and carers Patients talked about many different needs, including physical (e.g. fatigue), psychological (e.g. fear of another stroke; loss of confidence) and informational (e.g. feeling unprepared; lack of prognosis). They noted a lack of continuity and advance planning from health services. Caregivers added the impact on themselves, such as the loss of the physical/emotional side of a relationship. General practice was the first point of contact with health services to raise any of these needs. Focus groups with healthcare professionals and patients Roles of generalist and specialist overlapped, but they tended to work in silos. Referral decision-making was associated with quality of communication, which was variable. Barriers to communication included different information technology systems, different technical languages and lack of knowledge of roles. Both HCPs and patients were supportive of the idea of using a checklist, though healthcare professionals emphasised the importance of having a pathway to address identified needs. Some needs were added to the 11 in the published checklist that was used as a starting point. Modified Research And Development Corporation Appropriateness Consensus Study For most referral decisions (59 out of 69, 86%), there was agreement as to whether or not referral was indicated. Lack of consensus tended to be where it was questioned if specialist input would lead to patient benefit. This lack of consensus was not related to professional background. Scoping review Rehabilitation and physiotherapy interventions to address activities of daily living were most common. Cognitive problems, fatigue and specific mental health outcomes were not addressed. Pilot study Out of 48 stroke survivors invited, 13 (27%) took part. All attended a stroke review with a practice nurse. Action plans were generated for 10 (77%) patients. The Improving Primary Care After Stroke (IPCAS) model The final model included five elements: a structured review; a direct point of contact (DPoC); improving communication between primary and secondary care; local service mapping; and training of primary care professionals. Managing Life After Stroke development work The feasibility study involved 17 stroke survivors and 7 carers in three courses. Fifteen (88%) patients completed the course and 5 (71%) carers. Fourteen of 15 (93%) participants who completed a follow-up questionnaire said they would recommend the course to someone else. The final MLAS self-management programme for people with stroke comprised an initial individual session, four weekly group-based sessions and a final individual session. Cluster randomised controlled trial One thousand and forty patients with a mean age of 70.6, 63% male, were recruited from 46 general practices (range per practice: 8–36). Median time since last stroke was 5 years. Primary outcome data were available for 76% of those still alive at 12 months. There was a 0.64 [97.5% confidence interval (CI) −1.7 to +2.8] improvement in the emotion outcome in the intervention arm compared to the control arm and a 1.3 (97.5% CI −2.0 to +4.6) increase in the participation outcome in the intervention arm compared to control. There was no evidence of effect of the intervention on short form Stroke Impact Scale, quality of life (QoL) (EQ-5D-5L), well-being ICEpop CAPability measure for Adults, Southampton Stroke Self-Management questionnaire or Health Literacy Questionnaire (HLQ). One hundred and seventy (43%) patients in the intervention arm identified fatigue as a need. Mobility (153, 39%), mood (130, 33%) and cognition (128, 33%) were the next most commonly identified needs. Process evaluation With regard to the different components of IPCAS, delivery of the structured review had the most uptake, with 421 (81%) of 522 participants receiving a review and action plans being generated. These included follow-up appointments (29%), referrals (25%) and provision of advice (45%). Only 139 patients attended an MLAS course, but those who did appeared to value it. Practice staff perceived that a lot of effort was put into setting up the DPoC service, but this was hardly used. The local directory of services had variable take-ups by HCPs. It did not prove possible to support improved communication between primary and secondary care as originally intended. Instead, we needed to rely on videos of specialist staff explaining what they did and how to access their service. Training fidelity was high. Cost-effectiveness analysis There was a non-significant mean QALY difference of 0.013 (95% CI −0.024 to 0.048) in favour of the intervention. The intervention was associated with an incremental cost to the NHS of £267.07 per person. This equated to an incremental cost per QALY of £20,863. Conclusions Implications for health care We found no evidence that structured stroke reviews offered in primary care to all stroke survivors in the community are effective at addressing stroke-related needs. Such reviews should perhaps therefore be time-limited after stroke and only continued in selected patients. The 15-item checklist that we developed is perceived to be useful and practicable in primary care. Greater attention needs to be paid to services that can address the prevalent long-term needs of stroke survivors, namely fatigue, low mood and cognitive issues. From the evidence in the wider literature, self-management programmes have a role in improving QoL of stroke survivors in the community. Our findings suggest that such programmes are likely to be of greatest value if offered early after discharge from hospital. Research recommendations Research to inform who should be offered poststroke assessment of needs in the community in the longer term (after 6 months). Development and evaluation of interventions to address fatigue, low mood and cognitive problems in people with stroke in the community. Study registrations This study is registered as PROSPERO 2015 CRD42015026602. Trial registration This trial is registered as ISRCTNCT03353519. Funding This award was funded by the National Institute for Health and Care Research (NIHR) Programme Grants for Applied Research programme (NIHR award ref: PTC-RP-PG-0213-20001) and is published in full in Programme Grants for Applied Research; Vol. 12, No. 1. See the NIHR Funding and Awards website for further award information.

BACKGROUND: Interventions targeting psychosocial factors may improve rehabilitation outcomes for prosthesis users after lower-limb amputation (LLA), but there is a need to identify targeted factors for minimizing disability. OBJECTIVE: To identify psychosocial factors related to disability for prosthesis users after LLA in middle age or later. DESIGN: Cross-sectional study. SETTING: General community. PARTICIPANTS: Participants with LLA (N = 122) were included in this cross-sectional study if their most recent LLA was at least 1 year prior, they were ambulating independently with a prosthesis, and they were between 45 and 88 years old. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Disability, the primary outcome, was measured using the World Health Organization Disability Assessment Schedule 2.0 (WHODAS). Candidate psychosocial variables included self-efficacy, social support, and motivation, measured using the Self-Efficacy of Managing Chronic Disease questionnaire (SEMCD), Multidimensional Scale of Perceived Social Support questionnaire (MSPSS), and modified contemplation ladder (mCL), respectively. The hypothesis was that greater self-efficacy, social support, and motivation would be associated with lower disability when controlling for covariates. RESULTS: The covariate model, including etiology, age, sex, U.S. military veteran status, LLA characteristics, time since LLA, medical complexity, and perceived functional capacity, explained 66.1% of disability variability (WHODAS 2.0). Backward elimination of candidate psychosocial variables stopped after removal of motivation (P = .10), with self-efficacy (P

The associations between objective measures of sleep duration and bone outcomes in older men are unknown. No consistent, significant association was identified between sleep duration and bone mineral density (BMD) in the current analysis. However, future research should determine if vitamin D status modifies this relationship.IntroductionPrior studies, predominantly in women, reported that long and short self-reported sleep duration are associated with lower BMD. Associations between actigraphy-determined sleep duration and BMD or bone turnover markers (BTMs) in older men are unknown.MethodsMen in The Osteoporotic Fractures in Men (MrOS) Study with wrist actigraphy and concurrent BMD assessment but without comorbidities affecting bone health were included. Sleep duration was considered as a continuous (N = 1926) and dichotomized variable where men were classified as getting the recommended (7-8 h/night; N = 478) or short (< 6 h/night; N = 577) sleep. The cross-sectional association between BMD, BTMs, and sleep duration was examined using a t test or linear regression, where appropriate, in unadjusted and adjusted models.ResultsThere were no clinically or statistically significant differences in BMD at the L-spine, total hip, or femoral neck between men getting the recommended vs. short sleep duration, using actigraphy or self-reported sleep duration (all p ≥ 0.07). When sleep duration was considered as a continuous variable, femoral neck BMD was higher in men with longer self-reported sleep duration (β = 0.006 ±0.003, p = 0.02), but this was not significant after further adjustment. In men with low 25OHD (< 20 ng/mL), longer actigraphy-determined sleep duration was associated with higher total hip BMD (β = 0.016 ± 0.008; p = 0.04). Sleep duration and BTMs were not associated.ConclusionSleep duration was not associated with hip or L-spine BMD or BTMs in older men. Future research should determine if vitamin D status or other factors modify this relationship.

In recent years, welfare certification companies have encouraged the use of scatter feeding as enrichment material, though there is little scientific evidence to support a scatter feeding program. This study aimed to understand the impact of scatter feeding on the foraging behavior of broilers. One hundred eighty Ross 308 chicks were allocated into six treatment groups (six replicates/treatment). Broilers were scatter fed dried mealworms, whole wheat, shredded cabbage, alfalfa pellets, wood shavings, or no scatter feeding, respectively. Enrichment was provided on the first three days of each week. Total foraging, active foraging, and feeding were observed for one-hour periods immediately after scattering, 2 h later, and 6 h later. In all groups, broilers increased both total (p = 0.001) and active (p = 0.001) foraging, though this was most pronounced in the dried mealworm group. Across all groups, active foraging decreased with age (p = 0.001). The mealworm group also showed a corresponding decrease in feeding during hour one compared to the later hours (p = 0.001). These results did not provide evidence that scatter feeding encourages foraging behavior, except for a short-term effect of a high value feed item. This finding suggests that the item scattered and the delivery method should be studied further.

BACKGROUND: Lower-limb amputation (LLA) due to non-traumatic vascular etiology is linked to extremely low physical activity and high disability. OBJECTIVE: To test the feasibility of a biobehavioral intervention designed to promote physical activity. DESIGN: A randomized, single-blind feasibility trial with a crossover design. SETTING: Veterans Administration Medical Center. PARTICIPANTS: Military veterans (age: 65.7 [7.8] years; mean [standard deviation]) with nontraumatic lower-limb amputation (LLA), randomized to two groups: GROUP1 (n = 16) and GROUP2 (n = 15). Both groups had similar baseline amputation characteristics (level of amputation and time since amputation). INTERVENTIONS: Twelve weekly, 30-minute telehealth sessions of physical activity behavior-change intervention, with GROUP1 participating in weeks 1-12 and GROUP2 in weeks 13-24. GROUP1 noncontact phase in weeks 13-24 and GROUP2 attention control telehealth phase in weeks 1-12. MAIN OUTCOME MEASURES: Feasibility (participant retention, dose goal attainment, intervention acceptability [Intrinsic Motivation Inventory [IMI] Interest and Enjoyment scale], safety) and signal of efficacy (free-living physical activity [accelerometer-based average daily step count], Late Life Function and Disability Index - Disability Scale [LLFDI-DS]). RESULTS: Participant retention rate was high (90%), with three participants lost to follow-up during the intervention period. Dose goal attainment was low, with only 10% of participants achieving an a priori walking dose goal. Intervention was rated as acceptable, with mean IMI Interest and Enjoyment score (5.8) statistically higher than the null value of 5.0 (P = .002). There were no between-group differences in adverse event rates (falls: P = .19, lower extremity wounds: P = .60). There was no signal of efficacy for change in average daily step count (d = -0.15) or LLFDI-DS (d = -0.22 and 0.17 for frequency and limitations scales, respectively). CONCLUSIONS: Telehealth delivered biobehavioral intervention resulted in acceptable participant retention, low dose goal attainment, high participant acceptability, and low safety risk, while having no signal of efficacy (physical activity, disability) for people with nontraumatic LLA.

The northern fowl mite, Ornithonyssus sylviarum, is one of the most common and damaging ectoparasites of poultry. As an obligate blood feeding mite, the northern fowl mite can cause anaemia, slower growth, and decreased egg production of parasitized birds. However, the impact of mites or other ectoparasites on hen behaviour or welfare is not well studied. Here, we use activity sensors (three-axis accelerometers) affixed to individual birds to continuously record hen movement before, during, and after infestation with mites. Movements recorded by sensors were identified to specific bird behaviours through a previously trained algorithm, with frequency of these behaviours recorded for individual birds. Hen welfare was also determined before, during, and after mite infestation of hens using animal-based welfare metrics. Northern fowl mites significantly increased hen preening behaviour and resulted in increased skin lesions of infested birds.

Hens reared in aviaries (AVI) as pullets have improved spatial abilities compared to hens reared in non-enriched cages (CON). However, this effect on behavior has been shown only to 23 weeks of age. Lohmann LSL-Lite hens were reared in either CON or AVI until 19 weeks of age and then moved into enriched colony cages (ECC) containing two elevated perches of different heights (n = 6 ECC/treatment). Focal hens (3 per ECC) were fitted with tri-axial accelerometers to record acceleration events at 21, 35, and 49 weeks of age. Video recordings from each age were used to identify behaviors associated with acceleration events as well as the proportion of hens utilizing perches. CON hens experienced more acceleration events (p = 0.008) and more collisions (p = 0.04) than AVI hens during the day at 21 and 35 weeks of age. The total proportion of hens perching at night was similar between treatments across most time points, but fewer CON hens used the high perch compared to AVI hens throughout the study (p = < 0.001). Rearing in aviaries influences hen behavior out to peak lay for collisions and out to mid-lay for perch height preference in ECC.

Methodological limitations preclude determination of the association between sleep duration and bone mineral density (BMD) from existing literature. This was the first study to use objective sleep duration to determine its association with BMD. Nocturnal sleep duration, assessed objectively (actigraphy) or subjectively (questionnaire), was not independently associated with BMD in postmenopausal women.IntroductionBoth long and short self-reported sleep durations are associated with low bone mineral density (BMD) in men and women. The association between sleep duration measured by actigraphy and BMD in postmenopausal women is unknown.MethodsThe Study of Osteoporotic Fractures (SOF) ancillary sleep study was used to determine the association between sleep duration and BMD at the total hip and femoral neck in postmenopausal women ≥ 75 years old. Sleep duration was assessed by wrist actigraphy (average 4 nights) and questionnaire. BMD was compared between postmenopausal women with short (

A significant increase in the paraprofessional workforce has occurred internationally, aimed at facilitating inclusive education. Within Ireland, this is evidenced in the SNA scheme for pupils with significant care needs. This paper focuses on the constructs of SNA support and pupil independence, as based on large-scale research across 20 Irish mainstream primary classes. The study was modelled on Strand 2 Wave 1 of the UK's 'Deployment and Impact of Support Staff' project, involving systematic observations and case studies. Following qualitative and quantitative analysis, findings serve to expand the construct of pupil independence beyond adaptive behaviour to include themes of pupil voice and psychological empowerment. The research also highlights both positive and negative educational practices to support pupil independence including SNA rotation, SNA-pupil proximity and prompting. Results are discussed in light of previous national and international research. Future directions of the SNA scheme are presented, including the potential of scaffolding theory to advance applied practices. Limitations of the research are acknowledged, including implications for research, theory, policy and practice. This research presents as the first Irish study to examine the SNA role using systematic observations, serving to extend existing research on the complex relationship between paraprofessional support and pupil independence.

The issue of class size is a complex and contested topic that has divided opinion for many years. Whilst many teachers believe that smaller class sizes assist in enhancing outcomes, a number of policy influencers, policy makers and researchers argue that it has little influence on success in learning and that decreasing class sizes is not cost-effective. This article reports on over 20 years of research on this topic that is embodied in a recent text entitled "Rethinking Class Size: The Complex Story of Impact on Teaching and Learning" by Peter Blatchford and Anthony Russell of the University College London Institute of Education. The book offers an extended exploration of how class size affects key classroom processes including teaching, classroom management, peer relations, groups in the class, marking and other administrative teacher activities, as well effects on teachers themselves. The article is based on a question and answer session between one of the authors of the text, Professor Peter Blatchford, and his colleague at the UCL Institute of Education, Matt Somerville.

Palpation is the most popular method of measuring keel bone damage on live birds, although it has been criticized for being subjective and inaccurate. The goals of this study were to examine intra- and inter-rater reliability when trained with feedback of accuracy, as well as determine the accuracy of portable radiography and sonography. Four evaluators palpated 50 103-week old Lohmann LSL-lite hens immediately following euthanasia. Of those birds, 34 were then radiographed, sonographed, and all 50 were re-palpated. Lastly, the keels were dissected and scored. The presence of deviations (DEV), fractures (FR), and tip fractures (TFR) was scored for each method. Reliability of palpation was analyzed using Cronbach's Alpha (intra) and Fleiss' Kappa (inter) tests. Radiography and Sonography scores were further compared with dissection scores to determine sensitivity and specificity. Initial inter-observer reliability was 0.39 DEV, 0.53 FR, and 0.12 TFR, with similar scores for the second round of palpation. Scores for intra-observer reliability ranged from 0.58-0.79 DEV, 0.66-0.90 FR, and 0.37-0.87 TFR. A high prevalence of TFR, but low assessor agreement, warrants the development of specialized training for the palpation of this area. Both radiography and sonography showed relatively high sensitivity for FR and TFR, but low for DEV. On the other hand, specificity was generally high across all damage types. Even with feedback, palpation reliability was poor. However, portable radiography and sonography show promise for detecting keel fractures.

Abstract The consistency of reporting results for patient‐derived xenograft (PDX) studies is an area of concern. The PDX method commonly starts by implanting a derivative of a human tumor into a mouse, then comparing the tumor growth under different treatment conditions. Currently, a wide array of statistical methods (e.g., t‐test, regression, chi‐squared test) are used to analyze these data, which ultimately depend on the outcome chosen (e.g., tumor volume, relative growth, categorical growth). In this simulation study, we provide empirical evidence for the outcome selection process by comparing the performance of both commonly used outcomes and novel variations of common outcomes used in PDX studies. Data were simulated to mimic tumor growth under multiple scenarios, then each outcome of interest was evaluated for 10 000 iterations. Comparisons between different outcomes were made with respect to average bias, variance, type‐1 error, and power. A total of 18 continuous, categorical, and time‐to‐event outcomes were evaluated, with ultimately 2 outcomes outperforming the others: final tumor volume and change in tumor volume from baseline. Notably, the novel variations of the tumor growth inhibition index (TGII)—a commonly used outcome in PDX studies—was found to perform poorly in several scenarios with inflated type‐1 error rates and a relatively large bias. Finally, all outcomes of interest were applied to a real‐world dataset.

Purpose: Our goal was to evaluate the safety and toxicity of combining a PARP inhibitor, olaparib, with cetuximab and fractionated intensity-modulated radiotherapy for patients with locally advanced head and neck cancer and heavy smoking histories.Patients and Methods: Patients with ≥10 packs/year history of smoking were treated with olaparib at doses ranging from 25-200 mg orally twice daily beginning approximately 10 days prior to initiation of and with concurrent radiation (69.3 Gy in 33 fractions) using a time-to-event continual reassessment method model. Cetuximab was administered starting approximately 5 days prior to radiation per standard of care.Results: A total of 16 patients were entered onto the study, with 15 evaluable for acute toxicity. The most common treatment-related grade 3-4 side effects were radiation dermatitis and mucositis (38% and 69%, respectively). The MTD was determined to be 50 mg orally twice daily, but the recommended phase II dose was deemed to be 25 mg orally twice daily. At a median follow-up of 26 months, the actuarial median overall survival was 37 months, but was not reached for other endpoints. Two-year overall survival, progression-free survival, local control, and distant control rates were 72%, 63%, 72%, and 79%, respectively. Patients who continued to smoke during therapy experienced higher recurrence rates. MYC and KMT2A were identified as potential correlatives of response on gene amplification and mutational analysis.Conclusions: Olaparib at 25 mg orally twice daily with concurrent cetuximab and radiation was well tolerated with reduced dermatitis within the radiation field. Response rates were promising for this high-risk population. Clin Cancer Res; 24(20); 4949-59. ©2018 AACR.

ABSTRACT: Providing environmental enrichments that increase environmental complexity can benefit poultry welfare. This Poultry Science Association symposium paper is structured around four themes on 1) poultry preferences and affective states 2) species-specific behavior, including play behavior and the relationship between behavior, activity level and walking ability, 3) environmental enrichment and its relationship with indicators of welfare, and 4) a case study focusing on the application of enrichments in commercial broiler chicken production. For effective enrichment strategies, the birds’ perspective matters most, and we need to consider individual variation, social dynamics, and previous experience when assessing these strategies. Play behavior can be a valuable indicator of positive affect, and while we do not yet know how much play would be optimal, absence of play suggests a welfare deficit. Activity levels and behavior can be improved by environmental modifications and prior research has shown that the activity level of broilers can be increased, at least temporarily, by increasing the environmental complexity. However, more research on impacts of enrichments on birds’ resilience, on birds in commercial conditions, and on slow(er)-growing strains is needed. Finally, incorporating farmers’ expertise can greatly benefit enrichment design and implementation on commercial farms.

This article discusses the use of a smartphone application (‘app’) as a method for undertaking diary-based qualitative research with a group of participants with lived experience of multiple disadvantage (experience of two or more of homelessness, offending, mental ill-health and substance misuse). As part of a multi-method approach to the study, an app was designed for participants to capture rich, real-time qualitative data through a variety of media – text, audio, image and video – to make it accessible and interactive for participants. There is an identified gap in the use of apps to collect qualitative data with marginalised groups, and this paper reflects on our experience of designing and implementing an app as part of a wider multi-method research project. We argue that, particularly during the challenges of adapting research methods in light of the COVID-19 pandemic, the smartphone app has considerable potential for engaging participants in a flexible way to involve marginalised groups. Qualitative researchers in particular should consider the potential of this approach, and encourage others to share their reflections and learning.

Objective A self-management programme, My Life After Stroke (MLAS), was developed to support stroke survivors. This evaluation reports patients’ experience.Design Multimethod, involving interviews and questionnaires.Setting 23 general practices in the intervention arm of a cluster randomised controlled trial in East of England and East Midlands, UK.Participants People on the stroke registers of participating general practices were invited to attend an MLAS programme.Interventions MLAS comprises one-to-one and group-based sessions to promote independence, confidence and hope.Primary and secondary outcome measures The primary outcome was uptake of the programme. Participants who declined MLAS were sent a questionnaire to ascertain why. Attendees of four programmes completed evaluation forms. Attendees and non-attendees of MLAS were interviewed. Ad-hoc email conversations with the lead author were reviewed. Thematic analysis was used for qualitative data.Results 141/420 (34%) participants (mean age 71) attended an MLAS programme and 103 (73%) completed 1. 64/228 (28%) participants who declined MLAS gave reasons as: good recovery, ongoing health issues, logistical issues and inappropriate. Nearly all attendees who completed questionnaires felt that process criteria such as talking about their stroke and outcomes such as developing a strong understanding of stroke had been achieved.Conclusions MLAS was a positive experience for participants but many stroke survivors did not feel it was appropriate for them. Participation in self-management programmes after stroke might be improved by offering them sooner after the stroke and providing a range of delivery options beyond group-based, face-to-face learning.Trial registration number NCT03353519, NIH.

Immune checkpoint inhibitors have been found to be effective in metastatic MSI-high colorectal cancers (CRC), however, have no efficacy in microsatellite stable (MSS) cancers, which comprise the majority of mCRC cases. Cabozantinib is a small molecule multi-tyrosine kinase inhibitor that is FDA approved in advanced renal cell, medullary thyroid, and hepatocellular carcinoma. Using Human Immune System (HIS) mice, we tested the ability of cabozantinib to prime MSS-CRC tumors to enhance the potency of immune checkpoint inhibitor nivolumab. In four independent experiments, we implanted distinct MSS-CRC patient-derived xenografts (PDXs) into the flanks of humanized BALB/c-Rag2nullIl2rγnullSirpαNOD (BRGS) mice that had been engrafted with human hematopoietic stem cells at birth. For each PDX, HIS-mice cohorts were treated with vehicle, nivolumab, cabozantinib, or the combination. In three out of the four models, the combination had a lower tumor growth rate compared to vehicle or nivolumab-treated groups. Furthermore, interrogation of the HIS in immune organs and tumors by flow cytometry revealed increased Granzyme B+, TNFα+ and IFNγ+ CD4+ T cells among the human tumor infiltrating leukocytes (TIL) that correlated with reduced tumor growth in the combination-treated HIS-mice. Notably, slower growth correlated with increased expression of the CD4+ T cell ligand, HLA-DR, on the tumor cells themselves. Finally, the cabozantinib/nivolumab combination was tested in comparison to cobimetinib/atezolizumab. Although both combinations showed tumor growth inhibition, cabozantinib/nivolumab had enhanced cytotoxic IFNγ and TNFα+ T cells. This pre-clinical in vivo data warrants testing the combination in clinical trials for patients with MSS-CRC.

Objective: The current study aimed to explore whether the subjective effects of microdosing psychedelics are comparable to those of yoga in relation to psychological wellbeing, depression, anxiety and stress. It also explored the relationship between yoga, microdosing and personality. Method: The sample comprised 339 participants, yoga (n = 131), microdose (n = 69), microdose and yoga (n = 54) and control (n = 85). All completed measures of personality (M5-50 and Tellegen Absorption Scale), mood (Depression, Anxiety and Stress Scale-21) and wellbeing (Ryff Scales of Psychological Wellbeing). Results: The yoga and microdosing groups scored significantly higher on psychological wellbeing and absorption than the control. The microdosing and yoga group had lower depression scores than the microdose only group, and lower anxiety scores than the yoga only group. Furthermore, the microdosing and yoga group had the highest absorption score. Openness was significantly lower in the control group than in all other groups. Conclusions: While we cannot infer that yoga and microdosing lead to increased wellbeing, openness and absorption, or to decreased depression and anxiety, the findings suggest that the subjective effects of microdosing psychedelics are comparable to those of yoga and that the combination of both might be beneficial. KEY POINTS What is already known about this topic: (1) Yoga often leads to improved psychological wellbeing, decreased depressive and anxiety symptoms, decreased neuroticism, and increased openness and absorption. (2) A small number of recent studies have found that taking subthreshold doses of psychedelic substances, known as microdosing, has improved psychological wellbeing, reduced depressive, anxiety and stress symptoms and increased the personality traits of openness and absorption. What this topic adds: (1) We are the first researchers to compare the effects of yoga with psychedelic microdosing on wellbeing and personality. (2) Our findings suggest the effects of microdosing psychedelic substances might be comparable to those of yoga. (3) Our study implies the combination of both yoga and microdosing has complementary effects on general wellbeing and absorption.

This paper reports on results from a descriptive study of the nature and quality of the day-to-day educational experiences of 49 13-14 year olds with special education needs and/or disabilities (SEND). All pupils had either an Education Health and Care Plan (EHCP) or a Statement, and attended in mainstream secondary school in England. Pupils involved in the SEN in Secondary Education study were shadowed for several days over a school week. Researchers prepared pupil-level case studies on the basis of data from qualitative observations and semi-structured interviews with pupils and key school staff involved in their learning and development. The case studies were subjected to a thematic analysis. Results are presented in terms of two inter-related themes -- (i) teaching and support; and (ii) differentiation -- which address approaches to, and expressions of, inclusive practice; the roles of teachers and teaching assistants; and the defining features of teaching and support for SEND. The results are considered in view of the inclusiveness, appropriateness and effectiveness of provision on offer to pupils with high-level SEND. We conclude there has been a systemic and long-standing failure to fully address the educational needs of such pupils, and suggest what schools could do to provide higher quality experiences.

ImportanceFor patients with limited prognosis, some medication risks may outweigh the benefits, particularly when benefits take years to accrue; statins are one example. Data are lacking regarding the risks and benefits of discontinuing statin therapy for patients with limited life expectancy.ObjectiveTo evaluate the safety, clinical, and cost impact of discontinuing statin medications for patients in the palliative care setting.Design, setting, and participantsThis was a multicenter, parallel-group, unblinded, pragmatic clinical trial. Eligibility included adults with an estimated life expectancy of between 1 month and 1 year, statin therapy for 3 months or more for primary or secondary prevention of cardiovascular disease, recent deterioration in functional status, and no recent active cardiovascular disease. Participants were randomized to either discontinue or continue statin therapy and were monitored monthly for up to 1 year. The study was conducted from June 3, 2011, to May 2, 2013. All analyses were performed using an intent-to-treat approach.InterventionsStatin therapy was withdrawn from eligible patients who were randomized to the discontinuation group. Patients in the continuation group continued to receive statins.Main outcomes and measuresOutcomes included death within 60 days (primary outcome), survival, cardiovascular events, performance status, quality of life (QOL), symptoms, number of nonstatin medications, and cost savings.ResultsA total of 381 patients were enrolled; 189 of these were randomized to discontinue statins, and 192 were randomized to continue therapy. Mean (SD) age was 74.1 (11.6) years, 22.0% of the participants were cognitively impaired, and 48.8% had cancer. The proportion of participants in the discontinuation vs continuation groups who died within 60 days was not significantly different (23.8% vs 20.3%; 90% CI, -3.5% to 10.5%; P=.36) and did not meet the noninferiority end point. Total QOL was better for the group discontinuing statin therapy (mean McGill QOL score, 7.11 vs 6.85; P=.04). Few participants experienced cardiovascular events (13 in the discontinuation group vs 11 in the continuation group). Mean cost savings were $3.37 per day and $716 per patient.Conclusions and relevanceThis pragmatic trial suggests that stopping statin medication therapy is safe and may be associated with benefits including improved QOL, use of fewer nonstatin medications, and a corresponding reduction in medication costs. Thoughtful patient-provider discussions regarding the uncertain benefit and potential decrement in QOL associated with statin continuation in this setting are warranted.Trial registrationclinicaltrials.gov Identifier: NCT01415934.

Antiangiogenic therapy is commonly used for the treatment of colorectal cancer (CRC). Although patients derive some clinical benefit, treatment resistance inevitably occurs. The MET signaling pathway has been proposed to be a major contributor of resistance to antiangiogenic therapy. MET is upregulated in response to vascular endothelial growth factor pathway inhibition and plays an essential role in tumorigenesis and progression of tumors. In this study, we set out to determine the efficacy of cabozantinib in a preclinical CRC patient-derived tumor xenograft model. We demonstrate potent inhibitory effects on tumor growth in 80% of tumors treated. The greatest antitumor effects were observed in tumors that possess a mutation in the PIK3CA gene. The underlying antitumor mechanisms of cabozantinib consisted of inhibition of angiogenesis and Akt activation and significantly decreased expression of genes involved in the PI3K pathway. These findings support further evaluation of cabozantinib in patients with CRC. PIK3CA mutation as a predictive biomarker of sensitivity is intriguing and warrants further elucidation. A clinical trial of cabozantinib in refractory metastatic CRC is being activated.

The inclusion of pupils with special educational needs and disabilities (SEND) in mainstream schools can result in difficult decisions regarding classroom organisation and management. The premise of this article is that these are likely to be affected by the classroom context, specifically the number of pupils in the class, the size and composition of groups and classes, and the presence of additional adults, but that there is very little systematic information on these features. A systematic observation study was conducted involving 48 pupils at Year 5 (9-10 years) and 49 pupils at Year 9 (13-14 years) with Statements of SEND, along with 115 comparison pupils at Year 5 and 112 at Year 9 who were typically developing. There were nearly 70,000 observations (data points) in total. Results showed that pupils at Year 5 with SEN were being taught in larger classes than at Year 9, and that, compared with typically developing pupils, they were much more likely to be separately taught in small, low-attaining groups at Year 5 and small, low-attaining classes (sets) at secondary. The study raises worrying questions about the appropriateness of classroom contexts for pupils with SEND and the heavy reliance on teaching assistants.

Both Hayward (green) and SunGold (gold) kiwifruit varieties contain a proteolytic enzyme, actinidin, that has been reported to enhance the upper tract digestion of animal proteins. Unlike the other gold varieties, which do not contain any actinidin, the SunGold variety contains significantly higher actinidin activity, but its activity is still much lower than that present in the green (Hayward) fruit. The objective of this study was to determine the effectiveness of actinidin in Hayward and SunGold kiwifruit in digesting alternative proteins, including pea protein, almonds, tofu, and quinoa. The protein sources were digested using a three-stage in vitro oral-gastro-small intestinal digestion model. The findings showed that both kiwifruit extracts enhanced the breakdown (observed through SDS-PAGE) for all the studied protein sources, particularly during gastric digestion, possibly due to higher actinidin activity at gastric pH. The increase in the rate of protein breakdown was probably due to the broader specificity of actinidin compared to pepsin. For many protein sources, most of the intact proteins disappeared within the first few minutes of gastric digestion with added kiwifruit extract. Green kiwifruit extract, due to its higher actinidin activity, had a higher effect on protein breakdown than the SunGold extract. However, for some proteins and under certain digestion conditions, SunGold extract resulted in higher protein breakdown. The latter, in the absence of any digestive enzymes, also led to some protein breakdown during the small intestinal digestion phase, which was not the case for the green kiwifruit extract. The green kiwifruit extract led to the greater breakdown of polypeptide chains of Pru-du 6, a major allergen in almonds. The results, for the first time, suggest that both Hayward and SunGold kiwifruit can lead to improved breakdown and digestion of alternative proteins when consumed as part of a meal; and therefore, have the potential to be used as a digestive aid in population groups looking to achieve faster and greater protein digestion such as athletes, elderly and people with the impaired digestive system.

Lyon Playfair was a multi-talented man: a scientist, administrator and politician whose life and influence deserve further research. This article concentrates on the period between 1818 and 1858, from Playfair’s birth to his appointment as Professor of Chemistry at the University of Edinburgh. His biographer (Sir Thomas Wemyss Reid) described his life as a ‘story not of adventure, but work’ and yet his record was one of energetic enterprise that had considerable impact. He was a rising star in the then fashionable world of chemistry, a favoured student of the founder of organic chemistry, Justus Liebig, and a central figure in the promotion of new ideas in agricultural science.[1] A career in science and the state saw him connected to the leading figures of both, and he played a crucial role in the conceptual and financial success of the Great Exhibition, and its legacy. His brilliance has been overshadowed by the extrovert Henry Cole, and yet Playfair was essential to the major educational reforms of their time.

Over the past decade, immunotherapies have revolutionized the treatment of cancer. Although the success of immunotherapy is remarkable, it is still limited to a subset of patients. More than 1500 clinical trials are currently ongoing with a goal of improving the efficacy of immunotherapy through co-administration of other agents. Preclinical, small-animal models are strongly desired to increase the pace of scientific discovery, while reducing the cost of combination drug testing in humans. Human immune system (HIS) mice are highly immune-deficient mouse recipients rtpeconstituted with human hematopoietic stem cells. These HIS-mice are capable of growing human tumor cell lines and patient-derived tumor xenografts. This model allows rapid testing of multiple, immune-related therapeutics for tumors originating from unique clinical samples. Using a cord blood-derived HIS-BALB/c-Rag2nullIl2rγnullSIRPαNOD (BRGS) mouse model, we summarize our experiments testing immune checkpoint blockade combinations in these mice bearing a variety of human tumors, including breast, colorectal, pancreatic, lung, adrenocortical, melanoma and hematological malignancies. We present in-depth characterization of the kinetics and subsets of the HIS in lymph and non-lymph organs and relate these to protocol development and immune-related treatment responses. Furthermore, we compare the phenotype of the HIS in lymph tissues and tumors. We show that the immunotype and amount of tumor infiltrating leukocytes are widely-variable and that this phenotype is tumor-dependent in the HIS-BRGS model. We further present flow cytometric analyses of immune cell subsets, activation state, cytokine production and inhibitory receptor expression in peripheral lymph organs and tumors. We show that responding tumors bear human infiltrating T cells with a more inflammatory signature compared to non-responding tumors, similar to reports of “responding” patients in human immunotherapy clinical trials. Collectively these data support the use of HIS mice as a preclinical model to test combination immunotherapies for human cancers, if careful attention is taken to both protocol details and data analysis.

The validation of global remote sensing data comprises multiple methods including comparison to field measurements, cross-comparisons and verification of physical consistency. Physical consistency and cross-comparisons are typically assessed for all pixels of the entire product extent, which requires intensive computing. This paper proposes a statistically representative sampling approach to reduce time and efforts associated with validations of remote sensing data having big data volume. A progressive sampling approach, as typically applied in machine learning to train algorithms, combined with two performance measures, was applied to estimate the required sample size. The confidence interval (CI) and maximum entropy probability distribution were used as indicators to represent accuracy. The approach was tested on 8 continental remote sensing-based data products over the Middle East and Africa. Without the consideration of climate classes, a sample size of 10,000–100,000, dependent on the product, met the nominally set CI and entropy indicators. This corresponds to

In recent years, welfare certification companies have encouraged the use of scatter feeding as enrichment material, though there is little scientific evidence to support a scatter feeding program. This study aimed to understand the impact of scatter feeding on the foraging behavior of broilers. One hundred eighty Ross 308 chicks were allocated into six treatment groups (six replicates/treatment). Broilers were scatter fed dried mealworms, whole wheat, shredded cabbage, alfalfa pellets, wood shavings, or no scatter feeding, respectively. Enrichment was provided on the first three days of each week. Total foraging, active foraging, and feeding were observed for one-hour periods immediately after scattering, 2 h later, and 6 h later. In all groups, broilers increased both total (p = 0.001) and active (p = 0.001) foraging, though this was most pronounced in the dried mealworm group. Across all groups, active foraging decreased with age (p = 0.001). The mealworm group also showed a corresponding decrease in feeding during hour one compared to the later hours (p = 0.001). These results did not provide evidence that scatter feeding encourages foraging behavior, except for a short-term effect of a high value feed item. This finding suggests that the item scattered and the delivery method should be studied further.