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Intermittent prophylactic antibiotics for bronchiectasis
Get PDF© 2022 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.BACKGROUND: Bronchiectasis is a common but under-diagnosed chronic disorder characterised by permanent dilation of the airways arising from a cycle of recurrent infection and inflammation. Symptoms including chronic, persistent cough and productive phlegm are a significant burden for people with bronchiectasis, and the main aim of treatment is to reduce exacerbation frequency and improve quality of life. Prophylactic antibiotic therapy aims to break this infection cycle and is recommended by clinical guidelines for adults with three or more exacerbations a year, based on limited evidence. It is important to weigh the evidence for bacterial suppression against the prevention of antibiotic resistance and further evidence is required on the safety and efficacy of different regimens of intermittently administered antibiotic treatments for people with bronchiectasis.
OBJECTIVES: To evaluate the safety and efficacy of intermittent prophylactic antibiotics in the treatment of adults and children with bronchiectasis.
SEARCH METHODS: We identified trials from the Cochrane Airways Trials Register, which contains studies identified through multiple electronic searches and handsearches of other sources. We also searched trial registries and reference lists of primary studies. We conducted searches on 6 September 2021, with no restriction on language of publication.
SELECTION CRITERIA: We included randomised controlled trials (RCTs) of at least three months' duration comparing an intermittent regime of prophylactic antibiotics with placebo, usual care or an alternate intermittent regimen. Intermittent prophylactic administration was defined as repeated courses of antibiotics with on-treatment and off-treatment intervals of at least 14 days' duration. We included adults and children with a clinical diagnosis of bronchiectasis confirmed by high resolution computed tomography (HRCT), plain film chest radiograph, or bronchography and a documented history of recurrent chest infections. We excluded studies where participants received high dose antibiotics immediately prior to enrolment or those with a diagnosis of cystic fibrosis, allergic bronchopulmonary aspergillosis (ABPA), primary ciliary dyskinesia, hypogammaglobulinaemia, sarcoidosis, or a primary diagnosis of COPD. Our primary outcomes were exacerbation frequency and serious adverse events. We did not exclude studies on the basis of review outcomes.
DATA COLLECTION AND ANALYSIS: We analysed dichotomous data as odds ratios (ORs) or relative risk (RRs) and continuous data as mean differences (MDs) or standardised mean differences (SMDs). We used standard methodological procedures expected by Cochrane. We conducted GRADE assessments for the following primary outcomes: exacerbation frequency; serious adverse events and secondary outcomes: antibiotic resistance; hospital admissions; health-related quality of life.
MAIN RESULTS: We included eight RCTs, with interventions ranging from 16 to 48 weeks, involving 2180 adults. All evaluated one of three types of antibiotics over two to six cycles of 28 days on/off treatment: aminoglycosides, ß-lactams or fluoroquinolones. Two studies also included 12 cycles of 14 days on/off treatment with fluoroquinolones. Participants had a mean age of 63.6 years, 65% were women and approximately 85% Caucasian. Baseline FEV1 ranged from 55.5% to 62.6% predicted. None of the studies included children. Generally, there was a low risk of bias in the included studies. Antibiotic versus placebo: cycle of 14 days on/off. Ciprofloxacin reduced the frequency of exacerbations compared to placebo (RR 0.75, 95% CI 0.61 to 0.93; I2 = 65%; 2 studies, 469 participants; moderate-certainty evidence), with eight people (95% CI 6 to 28) needed to treat for an additional beneficial outcome. The intervention increased the risk of antibiotic resistance more than twofold (OR 2.14, 95% CI 1.36 to 3.35; I2 = 0%; 2 studies, 624 participants; high-certainty evidence). Serious adverse events, lung function (FEV1), health-related quality of life, and adverse effects did not differ between groups. Antibiotic versus placebo: cycle of 28 days on/off. Antibiotics did not reduce overall exacerbation frequency (RR 0.92, 95% CI 0.82 to 1.02; I2 = 0%; 8 studies, 1695 participants; high-certainty evidence) but there were fewer severe exacerbations (OR 0.59, 95% CI 0.37 to 0.93; I2 = 54%; 3 studies, 624 participants), though this should be interpreted with caution due to low event rates. The risk of antibiotic resistance was more than twofold higher based on a pooled analysis (OR 2.20, 95% CI 1.42 to 3.42; I2 = 0%; 3 studies, 685 participants; high-certainty evidence) and consistent with unpooled data from four further studies. Serious adverse events, time to first exacerbation, duration of exacerbation, respiratory-related hospital admissions, lung function, health-related quality of life and adverse effects did not differ between study groups. Antibiotic versus usual care. We did not find any studies that compared intermittent antibiotic regimens with usual care. Cycle of 14 days on/off versus cycle of 28 days on/off. Exacerbation frequency did not differ between the two treatment regimens (RR 1.02, 95% CI 0.84 to 1.24; I2 = 71%; 2 studies, 625 participants; moderate-certainty evidence) However, inconsistencies in the results from the two trials in this comparison indicate that the apparent aggregated similarities may not be reliable. There was no evidence of a difference in antibiotic resistance between groups (OR 1.00, 95% CI 0.68 to 1.48; I2 = 60%; 2 studies, 624 participants; moderate-certainty evidence). Serious adverse events, adverse effects, lung function and health-related quality of life did not differ between the two antibiotic regimens.
AUTHORS' CONCLUSIONS: Overall, in adults who have frequent chest infections, long-term antibiotics given at 14-day on/off intervals slightly reduces the frequency of those infections and increases antibiotic resistance. Intermittent antibiotic regimens result in little to no difference in serious adverse events. The impact of intermittent antibiotic therapy on children with bronchiectasis is unknown due to an absence of evidence, and further research is needed to establish the potential risks and benefits.Unfunde
Island Tales: New Creative Interpretations of Robert Louis Stevenson’s Pacific Writing
No full textThis book chapter is not available on ChesterRepThe research explores the legacies of Robert Louis Stevenson's Pacific writing (c. 1893), investigating the relevance of his work to contemporary readers in Sāmoa, Scotland and Hawai'i. This is a written Introduction to an anthology of adaptations and creative responses to Stevenson’s Pacific writing by artists, scholar and artists/scholars Solomon Enos, Simon Grennan, Keao Nesmith, Lalovai Pesetā, Caroline Sinavaiana Gabbard and Selina Tusitala Marsh.Remediating Stevenson: Decolonising Robert Louis Stevenson's Pacific Fiction through Graphic Adaptation, Arts Education and Community Engagement | Funder: Arts and Humanities Research Council | Grant ID: AH/W007010/
‘Listen to students because they know more’: Physical education teachers’ views and experiences of teaching gender diverse students in England
Get PDF© 2025 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.Physical education (PE) is heteronormatively structured, which creates barriers for gender diverse students. An increasing body of literature focuses on LGBTQ+ issues in PE, but there has been less focus on gender diversity specifically. Adopting a Bourdieusian perspective, this paper explores PE teachers’ views and experiences of teaching gender diverse students in England. Semi-structured interviews were conducted with 12 PE teachers, and reflexive thematic analysis led to the construction of two themes: ‘the PE field: strongly entrenched “rules of the game”’ and ‘questioning the doxa: understanding and awareness of gender diversity in PE’. The first theme demonstrates that, similar to previous research, sex/gender-segregated changing rooms and lessons, and gendered kit were highlighted as particularly problematic features of the PE field. The second theme illustrates that participants had different levels of knowledge and understanding of gender diversity, and the extent to which they reported adapting their practice to meet gender diverse students’ needs varied. The results indicate that the PE field continues to marginalise gender diverse students, but teachers recognised a need to provide an inclusive environment. To do this, they emphasised building relationships with and listening to gender diverse students.Unfunde
Zoo Animal Welfare
No full textThis is an Accepted Manuscript of a book chapter published by CRC Press in [Zoo Animal Welfare] on [21/11/2025], available online: https://www.routledge.com/Zoo-Animal-Welfare/Rose-Newnham-Hickey/p/book/9781032547367One of the roles of a modern zoo is to provide insurance populations for threatened species, with an eventual aim of release back into the wild. To build a sustainable and genetically robust population, individuals are moved between different social groups and also mixed for breeding. These events can be highly stressful; there is a fine balance between individual welfare and successful population management, with a variety of methods available to reduce stress. Once populations have been deemed suitable for release, animals must become prepared for life in the wild; this includes learning to locate and compete for food and avoid predation. We consider the methods by which these survival skills can be taught to captive animals, through enrichment and training, and the challenges to welfare this process can present. We use the case study of headstarting in black-tailed godwits (Limosa limosa limosa) to illustrate the dynamic welfare assessment process employed throughout breeding programmes, considering the welfare implications for both adults and youngsters of human interventions. Throughout this chapter, we highlight that conservation programmes must sometimes balance short-term costs to individual welfare to achieve long-term population benefits but also highlight practices that can be put in place to optimise welfare wherever possible.Unfunde
Turing instability of a discrete competitive single diffusion-driven Lotka–Volterra model
Get PDFThis paper develops a discrete competitive Lotka–Volterra system with single diffusion under Neumann boundary conditions. It establishes the conditions for Turing instability and identifies the precise Turing bifurcation when the diffusion coefficient is used as a bifurcation parameter. Within Turing unstable regions, a variety of Turing patterns are explored via numerical simulations, encompassing lattice, nematode, auspicious cloud, spiral wave, polygon, and stripe patterns, as well as their combinations. The periodicity and complexity of these patterns are verified through bifurcation simulations, Lyapunov exponent analysis, trajectory or phase diagrams. These methods are also applicable to other single diffusion systems, including partial dissipation systems.Unfunde
Retrospective narratives of the cultural and linguistic brokering roles of migrant children following resettlement
Get PDFThe resettlement practices of (im)migrating communities into Global North countries has long been the focus of academic research. This thesis explores the pivotal role that children play in this resettlement process, through their roles as cultural and linguistic brokers, specifically the extent to which child brokers are exercising agency, and the factors which maximise or constrain this agency within the context of family hierarchies and other societal structures. Using Biographical Narrative Interpretive Method, (Chamberlayne, Rustin and Wengraf, 2002; Wengraf, 2004) the project elicits retrospective narratives from five adults who engaged in myriad brokering roles during their childhood. The research positions (Bio)ecological Systems Theory (Bronfenbrenner, 1979; Bronfenbrenner and Morris, 1998, 2006) as a sociological framework for identifying the macro and micro factors impacting upon children’s cultural and linguistic brokering roles. The alignment between the chosen theoretical framework and the BNIM methodology in the context of children’s cultural and linguistic brokering roles is a key feature of this research. The research findings indicate that brokering activities take place across a range of formal and informal contexts, with children deploying complex metalinguistic and cultural negotiation skills from an early age and into adulthood. Many of the brokering roles suggest children exercise varying degrees of agency in situational contexts, influencing family practices and contributing to the resettlement process. Retrospective perceptions of these roles reflect shifting interpretations of the challenges and benefits for their families and for the children themselves, mediated by such factors as their age, sense of efficacy, family expectations, duration, frequency and context of the brokering activities. Finally, I critique normative constructions of childhood, and analyse the significance of socio cultural factors on child brokering practices and their positioning within communities.
The application of Bioecological Systems Theory has revealed the importance of establishing conceptual frameworks for exploring child brokering roles which inform policy and practice across relevant academic and societal contexts
Beyond the Core Content Framework: Using experiential learning to develop agentic, creative and reflexive student teachers
No full textIn 2019, the Department for Education introduced the core content framework (CCF) in initial education in England. The framework, which has been criticised for being heavily shaped by research from cognitive science, has, inadvertently, become the baseline curriculum for initial teacher education. This article explores how experiential learning is being used on a history PGCE course to move beyond the limitations of the CCF and offer student teachers a mode of professional learning that is foregrounded in creativity and critical reflexivity.N/
Beat Soundtrack #33: Simon A. Morrison
No full textDr Simon A. Morrison is interviewed for Rock & The Beat Generation about the relationship between the Beat and Rave scenes.N/
Relationships between structure and properties in commercial lead zirconate titanate (PZT) piezoceramics
Get PDF© 2025 The Authors. Published by Elsevier B.V. on behalf of The Chinese Ceramic Society.Lead zirconate titanate (PZT) ceramics are the most widely used commercial piezoelectric ceramics. However, the relationships between structure and properties are still not completely clarified. In this work, a broad investigation is carried out on commercial PZT 5A, 5H and 4D ceramics. X-ray diffraction revealed that these compounds mainly contain a mixture of P4mm and C1m1 phases at room temperature, and poling induces an increased unit cell distortion in both phases and a higher content of the monoclinic phase. In the poled samples, the Curie point shifts towards lower temperatures, contradicting the Abrahams-Kurtz-Jamieson (AKJ) relation for distorted displacive ferroelectrics. The discordance in the phase transition behavior can be attributed to the decreased domain wall density in the PZT systems. Furthermore, the observed increase of the dielectric permittivity from radiofrequency to the THz range is explained by the increase of the ferroelectric distortion associated with the field-induced transitions and decreased domain wall density. A parameter ψ was introduced to characterize the asymmetry of ferroelectric hysteresis loops. The higher ψ value of the hard PZT 4D ceramic compared to that of soft PZT 5A and 5H is attributed to the pinning effect of oxygen vacancies on domain walls.This work was supported by the China Scholarship Council (No. 202006040021), the Royal Society grant (NAF∖R1∖201126), the National Natural Science Foundation of China (Grant No.12404116), the Postdoctoral Fellowship Program of CPSF (GZC20232832), the Grant Agency of the Slovak Academy of Sciences (Grant VEGA No 2/0034/23), and the Engineering and Physical Sciences Research Council (RC Grant reference: EP/Y027752/1). The Knut and Alice Wallenberg Foundation is gratefully acknowledged for an equipment grant (KAW 2003.0198) for the electron microscopy facilities at Stockholm University
Scouting and Guiding in Britain: The Ritual Socialisation of Young People
Get PDFThis is an Accepted Manuscript of an article (book review) published by Taylor & Francis in Folklore on 04/06/2025, available online: https://doi.org/10.1080/0015587X.2025.2501858.Review of Catherine Bannister's 2022 book, Scouting and Guiding in Britain: The Ritual Socialisation of Young People.N/
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