Head-to-head trials of antibiotics for bronchiectasis

Background The diagnosis of bronchiectasis is defined by abnormal dilation of the airways related to a pathological mechanism of progressive airway destruction that is due to a 'vicious cycle' of recurrent bacterial infection, inflammatory mediator release, airway damage, and subsequent further infection. Antibiotics are the main treatment option for reducing bacterial burden in people with exacerbations of bronchiectasis and for longer‐term eradication, but their use is tempered against potential adverse effects and concerns regarding antibiotic resistance. The comparative effectiveness, cost‐effectiveness, and safety of different antibiotics have been highlighted as important issues, but currently little evidence is available to help resolve uncertainty on these questions. Objectives To evaluate the comparative effects of different antibiotics in the treatment of adults and children with bronchiectasis. Search methods We identified randomised controlled trials (RCTs) through searches of the Cochrane Airways Group Register of trials and online trials registries, run 30 April 2018. We augmented these with searches of the reference lists of published studies. Selection criteria We included RCTs reported as full‐text articles, those published as abstracts only, and unpublished data. We included adults and children (younger than 18 years) with a diagnosis of bronchiectasis by bronchography or high‐resolution computed tomography who reported daily signs and symptoms, such as cough, sputum production, or haemoptysis, and those with recurrent episodes of chest infection; we included studies that compared one antibiotic versus another when they were administered by the same delivery method. Data collection and analysis Two review authors independently assessed trial selection, data extraction, and risk of bias. We assessed overall quality of the evidence using GRADE criteria. We made efforts to collect missing data from trial authors. We have presented results with their 95% confidence intervals (CIs) as mean differences (MDs) or odds ratios (ORs). Main results Four randomised trials were eligible for inclusion in this systematic review ‐ two studies with 83 adults comparing fluoroquinolones with β‐lactams and two studies with 55 adults comparing aminoglycosides with polymyxins. None of the included studies reported information on exacerbations ‐ one of our primary outcomes. Included studies reported no serious adverse events ‐ another of our primary outcomes ‐ and no deaths. We graded this evidence as low or very low quality. Included studies did not report quality of life. Comparison between fluoroquinolones and β‐lactams (amoxicillin) showed fewer treatment failures in the fluoroquinolone group than in the amoxicillin group (OR 0.07, 95% CI 0.01 to 0.32; low‐quality evidence) after 7 to 10 days of therapy. Researchers reported that Pseudomonas aeruginosa infection was eradicated in more participants treated with fluoroquinolones (Peto OR 20.09, 95% CI 2.83 to 142.59; low‐quality evidence) but provided no evidence of differences in the numbers of participants showing improvement in sputum purulence (OR 2.35, 95% CI 0.96 to 5.72; very low‐quality evidence). Study authors presented no evidence of benefit in relation to forced expiratory volume in one second (FEV₁). The two studies that compared polymyxins versus aminoglycosides described no clear differences between groups in the proportion of participants with P aeruginosa eradication (OR 1.40. 95% CI 0.36 to 5.35; very low‐quality evidence) or improvement in sputum purulence (OR 0.16, 95% CI 0.01 to 3.85; very low‐quality evidence). The evidence for changes in FEV₁ was inconclusive. Two of three trials reported adverse events but did not report the proportion of participants experiencing one or more adverse events, so we were unable to interpret the information. Authors' conclusions Limited low‐quality evidence favours short‐term oral fluoroquinolones over beta‐lactam antibiotics for patients hospitalised with exacerbations. Very low‐quality evidence suggests no benefit from inhaled aminoglycosides verus polymyxins. RCTs have presented no evidence comparing other modes of delivery for each of these comparisons, and no RCTs have included children. Overall, current evidence from a limited number of head‐to‐head trials in adults or children with bronchiectasis is insufficient to guide the selection of antibiotics for short‐term or long‐term therapy. More research on this topic is needed

A Tutoring Framework to Support Computer Science Programmes in Higher Education

Computing Support is the provision of academic supports such as individual tutoring and support classes to students studying computing at third level. Students can struggle with computing as it requires practice involving trial and error. This work proposes a research informed tutoring framework to support computer science students at third level. The tutoring framework combines three pillars; staff and training, pedagogies and activities. Support is put in place to help students develop technical and programming skills. Essential tutoring is provided for those who might otherwise drop out of college. The framework was applied to first and second-year undergraduate programmes and to the first semester in Higher Diploma conversion programmes. Results demonstrate that students\u27 attendance has increased by 14%. In addition, student feedback shows that the framework supports students in computer science. This framework is a useful resource for academic managers that wish to implement computing support at third level

Investigation into the safety, and serological responses elicited by delivery of live intranasal vaccines for bovine herpes virus type 1, bovine respiratory syncytial virus, and parainfluenza type 3 in pre-weaned calves

Despite the fact that pneumonia remains a leading cause of mortality and morbidity in pre-weaned calves, relatively little is known regarding the effects of the concurrent administration of intranasal pneumonia virus vaccines, particularly in calves with high levels of maternally derived antibodies. The objective of this study was to use a cohort of 40 dairy and dairy-beef female and male calves (27 females and 13 males) to determine serological responses to concurrent administration at 3 weeks of age (22 ± 4.85 days) of two commercially available intranasal (IN) vaccines for the viruses: bovine respiratory syncytial virus (BRSV), bovine herpes virus 1 (BoHV-1), and parainfluenza-3-virus (PI3-V). The study groups were as follows: (i) Bovilis IBR Marker Live only® (IO), (ii) Bovilis INtranasal RSP Live® only (RPO), (iii) Concurrent vaccination with Bovilis IBR Marker Live® & Bovilis Intranasal RSP Live® (CV), and (iv) a control group of non-vaccinated calves (CONT). The calves’ serological response post-IN vaccination, clinical health scores, rectal temperatures, and weights were measured. Data were analyzed in SAS using mixed models and logistic regression. The CV calves had an average daily weight gain (ADG) of 0.74 (±0.02) kg, which was similar to CONT (0.77 ± 0.02 kg). Despite no significant differences in the antibody levels between study groups 3 weeks post-IN vaccination, following the administration of subsequent parenteral injections in the form of Bovilis Bovipast RSP®(antigens; inactivated BRSV, inactivated PI3-V, inactivated Mannheimia haemolytica) and Bovilis IBR Marker Live®, the antibody levels of the BRSV and PI3-V increased in both the CV and RPO study groups. Concurrent vaccination resulted in no increase in fever and no difference in health scores when compared to CONT

Alginate/Chitosan Particle-Based Drug Delivery Systems for Pulmonary Applications

Cystic fibrosis (CF) is a complex, potentially life-threatening disease that is most effectively treated through the administration of antibiotics (e.g., colistimethate sodium). Chronic infection with Pseudomonas aeruginosa is one of the most significant events in the pathogenesis of cystic fibrosis, and tobramycin is the treatment of choice for those patients with chronic P. aeruginosa infection who are deteriorating despite regular administration of colistimethate sodium. Effective treatment can be challenging due to the accumulation of thickened mucus in the pulmonary environment, and here we describe the results of our investigation into the development of alginate/chitosan particles prepared via precipitation for such environments. Tobramycin loading and release from the alginate/chitosan particles was investigated, with evidence of both uptake and release of sufficient tobramycin to inhibit P. aeruginosa in vitro. Functionalisation of the alginate/chitosan particles with secretory leukocyte protease inhibitor (SLPI) was shown to help inhibit the inflammatory response associated with lung infections (via inhibition of neutrophil elastase activity) and enhance their interaction with cystic fibrosis mucus (assayed via reduction of the depth of particle penetration into the mucus) in vitro, which have prospects to enhance their efficacy in vivo

Prevalence, profiles and policy: a case study of drug use in north inner city Dublin.

Research for this project was carried out by the Isis Research Group in the Centre for Womenís Studies, Trinity College, Dublin, in partnership with the Inter-Agency Drugs Project/North Inner City Drugs Task Force. The project was funded by Enterprise Ireland (Science and Technology Against Drugs Programme) and the Combat Poverty Agency. Both qualitative and quantitative data were collected over a 10-month period on the prevalence of heroin use and the experiences of heroin users. After describing the background to the study, the report detailed the findings of the prevalence survey, including patterns of use found amongst clients of drug treatment agencies, multiple users and waiting lists, and data from the street survey. Profiles of heroin users are presented, including information on the social settings of heroin use, supply issues, experiences of seeking treatment, treatment needs, and prevention. Case studies of two heroin users are presented. The report concluded with a discussion of research and policy perspectives on the heroin problem

Research Trends in Plant-Derived Oligomers for Health Applications

Objective: Epidemiological data illustrates that there is a strong relationship between dietary intake of natural bioactive compounds and their beneficial properties against various diseases, and this stimulates academic and industrial interest in using plant-derived compounds for health and medicine. For this reason, recent health related studies in the literature have focused on a variety of many plant-derived bioactive compounds. Even though the bioactivities of such compounds have widely been investigated, there are few studies about oligomeric species and their activities. Methods: In this review, extraction and isolation methods of the plant-derived oligomers and the use of such oligomers in health applications is summarised. Results: In the literature, many studies state that oligomeric compounds have beneficial to human health. To maximize these beneficial properties, various ways to use oligomeric compounds have been examined and summarised. Conclusion: A better understanding of the specific activities of distinct components of plant-derived oligomers is expected to open new avenues for drug discovery. This review gives an overview of oligomers with health beneficial properties and their possible applications in healthcare

A Framework for Managing the Transition from Second Level to Higher Education in Response to the COVID19 Emergency Restrictions

This Research-to-Practice Full Paper looks at the transition from second level education to higher education and the challenges this presents in terms of students getting to know a new learning environment, identifying supports to assist with their learning and even getting to know new friends. This challenge is even more complicated with the move to an online learning environment in response to the COVID19 emergency restrictions. This research introduces a higher education transition framework (called S³F) that provides support and intervention activities to manage students transition from second level education to higher education, to reduce the impact of the online environment on students learning experience and to help to improve student mental health. The S³F framework uses ongoing student Feedback to inform activities across three pillars: Learning Environment Support, Academic Subject Support and Social Support. The research presented in this paper was conducted over the 2020/2021 academic year when 1 st year undergraduate Computing students from National College of Ireland, School of Computing participated in an innovative induction programme that consisted of a number of activities and support actions for the entire duration of the academic year that were part of the S³F framework. Students were surveyed during each induction session for live feedback to adapt the activities for the following sessions and to inform staff of other interventions required. Students initially have expressed feelings of nervousness at the start of the first semester however this changed to feelings of excitement midway through the induction programme. Results of the case study demonstrates that the activities and innovative actions introduced as part of S³F framework had a positive impact on student’s transition to higher education, especially around mental health, seen in the retention figures for those students. This paper discusses the results only in terms of students mental health This research is of benefit to higher education management and course directors involved in first year orientation that would like to reduce the impact of the online environment on student’s transition from second level to higher education