Background: Prebiotic soluble fibers are fermented by beneficial bacteria in the colon to produce short-chain fatty acids (SCFAs), which are proposed to have systemic anti-inflammatory effects. Objective: This review examines the effect of SCFAs, prebiotics, and pre-and probiotic combinations (synbiotics) on systemic inflammation. Design: Relevant English language studies from 1947 to May 2017 were identified with the use of online databases. Studies were considered eligible if they examined the effects of SCFAs, prebiotics, or synbiotics; were delivered orally, intravenously, or per rectum; were on biomarkers of systemic inflammation in humans; and performed meta-analysis where possible. Results: Sixty-eight studies were included. Fourteen of 29 prebiotic studies and 13 of 26 synbiotic studies reported a significant decrease in $1 marker of systemic inflammation. Eight studies compared prebiotic and synbiotic supplementation, 2 of which reported a decrease in inflammation with synbiotics only, with 1 reporting a greater anti-inflammatory effect with synbiotics than with prebiotics alone. Meta-analyses indicated that prebiotics reduce C-reactive protein ( Conclusions: There is significant heterogeneity of outcomes in studies examining the effect of prebiotics and synbiotics on systemic inflammation. Approximately 50% of included studies reported a decrease in $1 inflammatory biomarker. The inconsistency in reported outcomes may be due to heterogeneity in study design, supplement formulation, dosage, duration, and subject population. Nonetheless, meta-analyses provide evidence to support the systemic anti-inflammatory effects of prebiotic and synbiotic supplementation.Am J Clin Nutr 2017;106:930-45.

Summary Background Soluble fibre modulates airway inflammation in animal models. The aim of this study was to investigate the effects of soluble fibre supplementation, with and without a probiotic, on plasma short chain fatty acids (SCFA), airway inflammation, asthma control and gut microbiome in adults with asthma. Methods A randomised, double-blinded, placebo controlled 3-way cross-over trial in 17 subjects with stable asthma at the Hunter Medical Research Institute, Newcastle, Australia. Subjects received 3 × 7 day oral interventions in random order; soluble fibre (inulin 12 g/day), soluble fibre + probiotic (inulin 12 g/day + multi-strain probiotic >25 billion CFU) and placebo. Plasma SCFA, sputum cell counts and inflammatory gene expression, asthma control gut microbiota, adverse events including gastrointestinal symptoms were measured. Findings There was no difference in change in total plasma SCFA levels (μmol/L) in the placebo versus soluble fibre (Δmedian [95% CI] 16·3 [−16·9, 49·5], p = 0·335) or soluble fibre+probiotic (18·7 [−14·5, 51·9], p = 0·325) group. Following the soluble fibre intervention there was an improvement in the asthma control questionnaire (ACQ6) (∆median (IQR) -0·35 (−0·5, −0·13), p = 0·006), sputum %eosinophils decreased (−1.0 (−2·5, 0), p = 0·006) and sputum histone deacetylase 9 (HDAC9) gene expression decreased (−0.49 (−0.83, −0.27) 2 -ΔCt , p = .008). Individual bacterial operational taxonomic units changed following both inulin and inulin+probiotic arms. Interpretation Soluble fibre supplementation for 7 days in adults with asthma did not change SCFA levels. Within group analysis showed improvements in airway inflammation, asthma control and gut microbiome composition following inulin supplementation and these changes warrant further investigation, in order to evaluate the potential of soluble fibre as a non-pharmacological addition to asthma management. Fund John Hunter Hospital Charitable Trust.

11 Objectives: Psychologically informed practice (PIP) is advocated for physiotherapists to help 12 people with chronic pain. There is little research observing how PIP is delivered in clinical 13 practice. This study describes behaviours and techniques used by experienced physiotherapists 14 working with groups of people with chronic pain. 15 16 Setting and Participants: Experienced physiotherapists (n=4) were observed working with 17 groups of people with chronic pain in out-patient pain management, and physiotherapy 18 departments, in a large UK city centre teaching hospital. 19 20 Design: We observed the clinical behaviours and interpersonal skills of experienced 21 psychologically informed physiotherapists, enriched by their accounts of intentions. The 22 physiotherapists were audio and video recorded delivering group movement sessions. 23 Recordings were reviewed with the physiotherapists for elaboration of intentions, then 24 thematically analysed for comparison with defined CBT competencies. 25 26 Results: Four themes representing physiotherapist intentions when working with people with 27 chronic pain were identified; building a therapeutic alliance, reducing perceived threat, 28 reconceptualising beliefs and somatic experience, and fostering self-efficacy. The 29 physiotherapists also reflected on challenges including engaging patients in self-management, 30 encouraging activity and reinforcing rather than correcting movement. Considerable overlap 31 existed between the observed behaviours in this study and existing CBT competencies. 32 Conclusions: This paper complements current recommendations for delivering psychologically 33 informed physiotherapy by providing examples of these skills being used in clinical practice. 34 Further research supporting the development of training for, and mentoring of, 35 physiotherapists, to promote competence and confidence in delivering psychologically informed 36 interventions is recommended. 37 38 Key words: 39 Chronic pain, Psychologically informed, Cognitive Behavioural Therapy, Qualitative 40 41 Contribution of paper 42  This study describes behaviours and techniques used by experienced physiotherapists 43 working with groups of patients with chronic pain. 44  This paper complements current recommendations for delivering psychologically 45 informed physiotherapy by providing examples of these skills being used in clinical 46 practice. 47 48 49 50 51 Background: 52 53Chronic pain is difficult to treat and poses a major healthcare challenge, affecting up to half the 54 UK population [1]. Its management requires a biopsychosocial model prioritising self-55 management [2], since treatment of even the most severely affected 1% requires more 56 resources than could ever be available [3]. Psychological approaches to extend and enhance the 57 skills of physiotherapists, and promote self management with patients, have been advocated for 58 over twenty years [4]. Delivering these psychological approaches and promoting patient self-59 management necessitates changes in us...

COPD is complex and heterogeneous with respect to its aetiology, clinical presentation, phenotypes and biological mechanisms. Despite this, COPD is still diagnosed and treated according to simple clinical measures, including airflow limitation, symptoms and exacerbation frequency, leading to failure to recognise the disease's heterogeneity and/or to provide targeted interventions. COPD continues to have a very large burden of disease with suboptimal outcomes for people with the disease, including frequent hospitalisation with exacerbations, rapid lung function decline, multimorbidity and death from respiratory failure. In light of this, there have been increasing calls for a renewed taxonomy with better characterisation of COPD phenotypes and endotypes. This would allow the unravelling of COPD's complexity and heterogeneity, the implementation of targeted interventions and improved patient outcomes. The treatable traits strategy is a proposed vehicle for the implementation of precision medicine in chronic airway diseases. In this review, in addition to summarising the key knowledge on the heterogeneity of COPD, we refer to the existing evidence pertaining to the treatable traits strategy as applied in COPD and discuss implementation in different settings.