Fecal microbiota transplantation (FMT) has emerged as a highly effective therapy for refractory, recurrent Clostridium difficile infection (CDI), which develops following antibiotic treatments. Intestinal microbiota play a critical role in the metabolism of bile acids in the colon, which in turn have major effects on the lifecycle of C. difficile bacteria. We hypothesized that fecal bile acid composition is altered in patients with recurrent CDI and that FMT results in its normalization. General metabolomics and targeted bile acid analyses were performed on fecal extracts from patients with recurrent CDI treated with FMT and their donors. In addition, 16S rRNA gene sequencing was used to determine the bacterial composition of pre- and post-FMT fecal samples. Taxonomic bacterial composition of fecal samples from FMT recipients showed rapid change and became similar to the donor after the procedure. Pre-FMT fecal samples contained high concentrations of primary bile acids and bile salts, while secondary bile acids were nearly undetectable. In contrast, post-FMT fecal samples contained mostly secondary bile acids, as did non-CDI donor samples. Therefore, our analysis showed that FMT resulted in normalization of fecal bacterial community structure and metabolic composition. Importantly, metabolism of bile salts and primary bile acids to secondary bile acids is disrupted in patients with recurrent CDI, and FMT corrects this abnormality. Since individual bile salts and bile acids have pro-germinant and inhibitory activities, the changes suggest that correction of bile acid metabolism is likely a major mechanism by which FMT results in a cure and prevents recurrence of CDI.

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The significance of private standards and associated local level initiatives in agri-food value chains are increasingly recognised. However whilst issues related to compliance and impact at the smallholder or worker level have frequently been analysed, the governance implications in terms of how private standards affect national level institutions, public, private and non-governmental, have had less attention. This article applies an extended value chain framework for critical analysis of Private Standards Initiatives (PSIs) in agrifood chains, drawing on primary research on PSIs operating in Kenyan horticulture (Horticulture Ethical Business Initiative and KenyaGAP). The paper explores the legislative, executive and judicial aspects of governance in these southern PSIs highlighting how different stakeholders shape debates and act with agency. It is argued that governance is exercised ‘beyond the vertical’ in that one can identify wider horizontal processes of governance, including how the scope of key debates is constructed (especially in legislative governance) but analysis of executive governance emphasises the dominant role of the lead buyers

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BACKGROUND Early introduction of peanut is an effective strategy to prevent peanut allergy in high-risk infants; however, feasibility and effects on growth and nutritional intake are unknown. OBJECTIVE To evaluate the feasibility of introducing peanut in infancy and explore effects on growth and nutritional intake up to 60 months of age. METHODS In the Learning Early About Peanut Allergy (LEAP) trial, 640 atopic infants aged 4-11 months were randomly assigned to consume (6g peanut protein/week) or avoid peanut until 60 months of age. Peanut consumption and early feeding practices were assessed by questionnaire. Dietary intake was evaluated with prospective food diaries. Anthropometric measurements were taken at all study visits. RESULTS Peanut was successfully introduced and consumed until 60 months with median peanut protein intake of 7.5g/week (IQR 6.0-9.0) in the consumption group compared to 0g in the avoidance group. Introduction of peanut in breastfeeding infants did not affect the duration of breastfeeding. There were no differences in anthropometric measurements or energy intakes between groups at any visits. Regular peanut consumption led to differences in dietary intakes. Consumers had higher intakes of fat and avoiders had higher carbohydrate intakes; differences were greatest at the upper quartiles of peanut consumption. Protein intakes remained consistent between groups. CONCLUSIONS Introduction of peanut proved feasible in infants at high-risk of peanut allergy and did not affect the duration of breastfeeding nor impact negatively on growth or nutrition. Energy balance was achieved in both groups through variations in intakes from fat and carbohydrate while protein homeostasis was maintained.

The rise of private standards, including those involving multi-stakeholder processes, raises questions about whose interests are served and the kind of power that is exerted to maintain these interests. This paper critically examines the battle for ideas -the way competing factions assert their own narratives about value chain relations, the role of standards and related multi-stakeholder processes. Drawing on empirical research on the horticulture and floriculture value chains linking Kenya and the United Kingdom, the analysis explores the framing of sustainability issues, especially around labor issues and good agricultural practice, and the choice of response with respect to private standards and multi-stakeholder initiatives since the late 1990s. We identify four competing narratives currently in play: a dominant Global Sourcing narrative, a Pragmatic Development narrative, a Broader Development narrative and a narrative we term Potentially Transformative. This last narrative is currently emerging through the unpacking of narratives in relation to the framing of sustainability problems and solutions, and in terms of legislative, executive and judicial governance. The paper contributes to emerging understanding of power in value chains, moving beyond material power to a consideration of how ideational power is exerted and resisted.

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