The effect of a novel, digital physical activity and emotional well-being intervention on health-related quality of life in people with chronic kidney disease: trial design and baseline data from a multicentre prospective, wait-list randomised controlled trial (kidney BEAM).

BACKGROUND: Physical activity and emotional self-management has the potential to enhance health-related quality of life (HRQoL), but few people with chronic kidney disease (CKD) have access to resources and support. The Kidney BEAM trial aims to evaluate whether an evidence-based physical activity and emotional wellbeing self-management programme (Kidney BEAM) leads to improvements in HRQoL in people with CKD. METHODS: This was a prospective, multicentre, randomised waitlist-controlled trial, with health economic analysis and nested qualitative studies. In total, three hundred and four adults with established CKD were recruited from 11 UK kidney units. Participants were randomly assigned to the intervention (Kidney BEAM) or a wait list control group (1:1). The primary outcome was the between-group difference in Kidney Disease Quality of Life (KDQoL) mental component summary score (MCS) at 12 weeks. Secondary outcomes included the KDQoL physical component summary score, kidney-specific scores, fatigue, life participation, depression and anxiety, physical function, clinical chemistry, healthcare utilisation and harms. All outcomes were measured at baseline and 12 weeks, with long-term HRQoL and adherence also collected at six months follow-up. A nested qualitative study explored experience and impact of using Kidney BEAM. RESULTS: 340 participants were randomised to Kidney BEAM (n = 173) and waiting list (n = 167) groups. There were 96 (55%) and 89 (53%) males in the intervention and waiting list groups respectively, and the mean (SD) age was 53 (14) years in both groups. Ethnicity, body mass, CKD stage, and history of diabetes and hypertension were comparable across groups. The mean (SD) of the MCS was similar in both groups, 44.7 (10.8) and 45.9 (10.6) in the intervention and waiting list groups respectively. CONCLUSION: Results from this trial will establish whether the Kidney BEAM self management programme is a cost-effective method of enhancing mental and physical wellbeing of people with CKD. TRIAL REGISTRATION: NCT04872933. Registered 5th May 2021.

Varying apparent metabolizable energy concentrations and protease supplementation affected broiler performance and jejunal and ileal nutrient digestibility from 1 to 35 d of age.

An experiment was conducted to evaluate the effects of varying AME concentrations and protease supplementation on broiler performance and jejunal and ileal nutrient digestibility from 1 to 35 d of age. Ross × Ross 308 male broilers (n = 1,008) were equally distributed into 48 floor pens and offered 1 of 6 dietary treatments (8 replicate pens/treatment). Dietary treatments consisted of a factorial arrangement with AME concentration (low-, moderate-, or high-AME) and supplemental protease (without or with) as the main factors. Birds and feed were weighed on 1, 15, 29, and 35 d of age to determine body BW, BW gain (BWG), feed intake (FI) and feed conversion ratio (FCR). At 15 and 29 d of age, jejunal and ileal digesta contents were collected to determine nutrient digestibility. From 1 to 15 d of age, broilers offered moderate-AME diets (P < 0.05) had 6.7, 7.1, 4.8% higher BW, BWG, FI, respectively, and a 2.1% lower FCR compared with those offered low-AME diets. Likewise, protease increased (P < 0.05) BW and BWG by 4.3 and 4.7%, respectively, and decreased (P < 0.05) FCR by 3.4%, compared with those offered the diets without protease. From 1 to 29 d of age, broilers offered high-AME diets had 2.9% lower (P < 0.05) FCR compared with those offered low-AME diets. Protease increased (P < 0.05) BW, BWG, and FI by 3.1, 3.2, and 4.2%, respectively, compared with the unsupplemented diets. From 1 to 35 d of age, broilers receiving high-AME diets had 2.9% lower (P < 0.05) FCR compared with those offered low-AME diets. Protease increased (P < 0.05) FCR by 1.0% compared with those offered unsupplemented diets. Jejunal (15 and 29 d of age) and ileal (29 d of age) starch digestibility and jejunal nitrogen digestibility (29 d of age) were lower (P < 0.05) in broilers offered high-AME diets compared with those offered low-AME diets. Both AME concentration and supplemental protease independently affected broiler performance, with responses being most apparent during early growth phases whereas digestibility measures were mainly influenced by AME concentration.

Effects of protease supplementation and diet type on jejunal and ileal digestibility and total tract metabolisability of nitrogen, starch, and energy in broilers.

1. A study was conducted to assess the effects of supplemental protease (0 or 15,000 units/kg) and diet type (maize- or wheat-based) on apparent jejunal and ileal digestibility and apparent total tract metabolisability of nutrients in Cobb 500 mixed-sex broilers from 6 to 31 d of age.2. Birds were randomly distributed into 56 metabolism cages (6 birds/cage; 14 replicates/treatment). At 22 d of age, jejunal and ileal digesta contents were collected and pooled from 4 birds/cage to determine apparent digestibility coefficients (DC) and digestible energy (DE). Feed intake was measured, and total excreta were collected from 8 to 11 and 18 to 21 d of age to determine apparent metabolisable energy (AME) and total tract nitrogen and starch metabolisability coefficients.3. Broilers offered the maize-based diet with protease had greater (P < 0.05) jejunal nitrogen DC, starch DC, and DE (8.2, 6.5, and 14.9%, respectively) and ileal nitrogen DC and DE (5.1 and 6.8%, respectively) than those offered the maize-based diet without protease. Ileal starch DC was increased (P < 0.05) by 1.1% with protease supplementation.4. Broilers offered maize-based diets had greater (P < 0.05) nitrogen (7.3%) and starch (0.6%) metabolisability coefficients and AME (4.7%) from 8 to 11 d of age, and nitrogen (4.3%) metabolisability coefficients and AME (2.0%) from 18 to 21 d of age compared with those offered wheat-based diets.5. Thus, protease supplementation and diet type can affect digestive dynamics and nutrient utilisation in broilers.

The Barts Health NHS Trust COVID-19 cohort: characteristics, outcomes and risk scoring of patients in East London.

BACKGROUND: Barts Health National Health Service Trust (BHNHST) serves a diverse population of 2.5 million people in London, UK. We undertook a health services assessment of factors used to evaluate the risk of severe acute respiratory coronavirus 2 (SARS-CoV-2) infection.METHODS: Patients with confirmed polymerase chain reaction (PCR) test results admitted between 1 March and 1 August 2020 were included, alongwith clinician-diagnosed suspected cases. Prognostic factors from the 4C Mortality score and 4C Deterioration scores were extracted from electronic health records and logistic regression was used to quantify the strength of association with 28-day mortality and clinical deterioration using national death registry linkage.RESULTS: Of 2783 patients, 1621 had a confirmed diagnosis, of whom 61% were male and 54% were from Black and Minority Ethnic groups; 26% died within 28 days of admission. Mortality was strongly associated with older age. The 4C mortality score had good stratification of risk with a calibration slope of 1.14 (95% CI 1.01-1.27). It may have under-estimated mortality risk in those with a high respiratory rate or requiring oxygen.CONCLUSION: Patients in this diverse patient cohort had similar mortality associated with prognostic factors to the 4C score derivation sample, but survival might be poorer in those with respiratory failure.

Effects of age and supplemental xylanase in corn- and wheat-based diets on cecal volatile fatty acid concentrations of broilers1.

An experiment was conducted to evaluate the effects of age and supplemental xylanase in corn- or wheat-based diets on cecal volatile fatty acid (VFA) concentrations of Ross × Ross 708 male broilers during weekly intervals from 14 to 42 d of age. Day-old chicks (1,500) were randomly distributed into 60 floor pens (25 chicks/pen; 0.078 m2/bird) and fed 1 of 4 dietary treatments (TRT) throughout the starter (1 to 14 d of age), grower (15 to 28 d of age), and finisher (29 to 42 d of age) phases with 15 replicates per TRT. Dietary TRT consisted of a 2 × 2 factorial arrangement with 2 diet types (corn- or wheat-based) and 2 xylanase inclusions (0 or 16,000 BXU/kg) as the main factors. At 14, 21, 28, 35, and 42 d of age, cecal contents were collected (4 birds/pen) for VFA analysis. Main effects of cereal grain source (P < 0.05) affected propionic, isobutyric, butyric, isovaleric, valeric, and isocaproic acid concentrations at 14, 21, 28, 35, and 42 d of age. Broilers fed corn-based diets had higher (P < 0.05) propionic, isobutyric, isovaleric, valeric, and isocaproic concentrations than those fed wheat-based diets from 14 to 42 d of age. However, broilers fed wheat-based diets had higher (P < 0.05) butyric acid concentrations at 28, 35, and 42 d of age compared with those fed corn-based diets. Individual and total VFA concentrations increased (P < 0.05) linearly from 14 to 42 d of age. Age and cereal grain interacted (P < 0.05) to affect propionic, isobutyric, butyric, isovaleric, and valeric acid concentrations. These results indicate that broiler cecal VFA concentrations are influenced by cereal grain source and age. In contrast, supplemental xylanase inconsistently influenced broiler cecal VFA concentrations. Therefore, future research evaluating factors affecting supplemental xylanase and cecal VFA production in broilers is warranted. Additionally, research investigating cereal grain source effects on cecal microflora development and fermentative patterns may be beneficial for optimizing cecal VFA production in broilers.

Effects of cereal grain source and supplemental xylanase concentrations on broiler growth performance and cecal volatile fatty acid concentrations from 1 to 40 d of age2.

An experiment was conducted to evaluate the effects of feeding diets varying in cereal grain source and supplemental xylanase concentrations on growth performance and cecal volatile fatty acid (VFA) concentrations of Ross × Ross 708 male broilers from 1 to 40 d of age. A total of 1,536 day-old chicks were randomly distributed into 64 floor pens (24 chicks/pen; 0.08 m2/bird) and fed 1 of 8 dietary treatments (TRT) with 8 replicates per TRT. Experimental TRT were of either corn- (TRT 1 to 4) or wheat-based (TRT 5 to 8) origins. The 4 dietary TRT for each cereal grain source consisted of a positive control (PC) reference diet and 3 reduced AMEn diets (AMEn reduced 66 kcal/kg below PC) with supplemental xylanase at either 0 (negative control), 12,000, or 24,000 BXU/kg. Birds and feed were weighed at 1, 14, 26, and 40 d of age to determine BW gain, feed intake, and feed conversion ratio. At 26 and 40 d of age, cecal contents were collected and pooled per pen (7 birds/pen; 5 replicate pens/TRT) for VFA concentrations. No TRT differences (P > 0.05) in cumulative growth performance were observed. Likewise, no TRT differences (P > 0.05) in acetic or total VFA concentrations were observed at 26 or 40 d of age. However, cereal grain source (P < 0.05) influenced propionic, isobutyric, butyric, and isovaleric concentrations at 26 and 40 d of age with birds receiving the corn-based diets having higher (P < 0.05) cecal propionic, isobutyric, and isovaleric concentrations, and lower (P < 0.05) butyric acid concentrations than those fed the wheat-based diets. These results indicate that dietary cereal grain source may influence individual cecal VFA concentrations. However, supplemental xylanase did not affect broiler growth performance or cecal VFA concentrations. Therefore, future research evaluating factors limiting xylanase responses on broiler growth performance and cecal VFA production is warranted.