Lactobacilli and bifidobacteria in the prevention of antibiotic-associated diarrhoea and Clostridium difficile diarrhoea in older inpatients (PLACIDE): a randomised, double-blind, placebo-controlled, multicentre trial

BACKGROUND: Antibiotic-associated diarrhoea (AAD) occurs most frequently in older (≥65 years) inpatients exposed to broad-spectrum antibiotics. When caused by Clostridium difficile, AAD can result in life-threatening illness. Although underlying disease mechanisms are not well understood, microbial preparations have been assessed in the prevention of AAD. However, studies have been mostly small single-centre trials with varying quality, providing insufficient data to reliably assess effectiveness. We aimed to do a pragmatic efficacy trial in older inpatients who would be representative of those admitted to National Health Service (NHS) and similar secondary care institutions and to recruit a sufficient number of patients to generate a definitive result. METHODS: We did a multicentre, randomised, double-blind, placebo-controlled, pragmatic, efficacy trial of inpatients aged 65 years and older and exposed to one or more oral or parenteral antibiotics. A computer-generated randomisation scheme was used to allocate participants (in a 1:1 ratio) to receive either a multistrain preparation of lactobacilli and bifidobacteria, with a total of 6 × 10(10) organisms, one per day for 21 days, or an identical placebo. Patients, study staff, and specimen and data analysts were masked to assignment. The primary outcomes were occurrence of AAD within 8 weeks and C difficile diarrhoea (CDD) within 12 weeks of recruitment. Analysis was by modified intention-to-treat. This trial is registered, number ISRCTN70017204. FINDINGS: Of 17,420 patients screened, 1493 were randomly assigned to the microbial preparation group and 1488 to the placebo group. 1470 and 1471, respectively, were included in the analyses of the primary endpoints. AAD (including CDD) occurred in 159 (10·8%) participants in the microbial preparation group and 153 (10·4%) participants in the placebo group (relative risk [RR] 1·04; 95% CI 0·84-1·28; p=0·71). CDD was an uncommon cause of AAD and occurred in 12 (0·8%) participants in the microbial preparation group and 17 (1·2%) participants in the placebo group (RR 0·71; 95% CI 0·34-1·47; p=0·35). 578 (19·7%) participants had one or more serious adverse event; the frequency of serious adverse events was much the same in the two study groups and none was attributed to participation in the trial. INTERPRETATION: We identified no evidence that a multistrain preparation of lactobacilli and bifidobacteria was effective in prevention of AAD or CDD. An improved understanding of the pathophysiology of AAD is needed to guide future studies. FUNDING: Health Technology Assessment programme; National Institute for Health Research, UK

The Masses of the Milky Way and Andromeda galaxies

We present a family of robust tracer mass estimators to compute the enclosed mass of galaxy haloes from samples of discrete positional and kinematical data of tracers, such as halo stars, globular clusters and dwarf satellites. The data may be projected positions, distances, line of sight velocities or proper motions. Forms of the estimator tailored for the Milky Way galaxy and for M31 are given. Monte Carlo simulations are used to quantify the uncertainty as a function of sample size. For the Milky Way, the satellite sample consists of 26 galaxies with line-of-sight velocities. We find that the mass of the Milky Way within 300 kpc is ~ 0.9 x 10^12 solar masses assuming velocity isotropy. However, the mass estimate is sensitive to the anisotropy and could plausibly lie between 0.7 - 3.4 x 10^12 solar masses. Incorporating the proper motions of 6 Milky Way satellites into the dataset, we find ~ 1.4 x 10^12 solar masses. The range here if plausible anisotropies are used is still broader, from 1.2 - 2.7 x 10^12 solar masses. For M31, there are 23 satellite galaxies with measured line-of-sight velocities, but only M33 and IC 10 have proper motions. We use the line of sight velocities and distances of the satellite galaxies to estimate the mass of M31 within 300 kpc as ~ 1.4 x 10^12 solar masses assuming isotropy. There is only a modest dependence on anisotropy, with the mass varying between 1.3 -1.6 x 10^12 solar masses. Given the uncertainties, we conclude that the satellite data by themselves yield no reliable insights into which of the two galaxies is actually the more massive.Comment: 15 pages, submitted to MNRA

OVERHEATED SECURITY? The Securitisation of Climate Change and the Governmentalisation of Security

Since the mid-2000s, climate change has become one of the defining security issues in political as well as academic debates and amongst others has repeatedly been discussed in the UN Security Council and countless high level government reports in various countries. Beyond the question whether the characterisation as ‘security issue’ is backed up by any robust empirical findings, this begs the question whether the ‘securitisation’ of climate change itself has had tangible political consequences. Moreover, within this research area there is still a lively discussion about which security conceptions apply, how to conceptualise (successful) securitisation and whether it is a (politically and normatively) desirable approach to deal with climate change. The aim of this dissertation is to shed light on these issues and particularly to contribute to a more thorough understanding of different forms or ‘discourses’ of securitisation and their political effects on a theoretical and empirical level. Theoretically, it conceptualises securitisation as resting on different forms of power, which are derived from Michel Foucault’s governmentality lectures. The main argument is that this framework allows me to better capture the ambiguous and diverse variants of securitisation and the ever-changing concept of security as well as to come to a more thorough understanding of the political consequences and powerful effects of constructing issues in terms of security. Empirically, the thesis looks at three country cases, namely the United States, Germany and Mexico. This comparative angle allows me to go beyond the existing literature on the securitisation of climate change that mostly looks at the global level, and to come to a more comprehensive and detailed understanding of different climate security discourses and their political consequences. Concerning the main results, the thesis finds that climate change has indeed been securitised very differently in the three countries and thus has facilitated diverse political consequences. These range from an incorporation of climate change into the defence sector in the US, the legitimisation of far-reaching climate policies in Germany, to the integration of climate change into several civil protection and agricultural insurance schemes in Mexico. Moreover, resting on different forms of power, the securitisation of climate change has played a key role in constructing specific actors and forms of knowledge as legitimate as well as in shaping certain identities in the face of the dangers of climate change. From a normative perspective, neither of these political consequences is purely good or bad but highly ambiguous and necessitates a careful, contextual assessment

Comparing Notes: Recording and Criticism

This chapter charts the ways in which recording has changed the nature of music criticism. It both provides an overview of the history of recording and music criticism, from the advent of Edison’s Phonograph to the present day, and examines the issues arising from this new technology and the consequent transformation of critical thought and practice

A multicentre randomised controlled trial evaluating lactobacilli and bifidobacteria in the prevention of antibiotic-associated diarrhoea in older people admitted to hospital: the PLACIDE study protocol

<p>Abstract</p> <p>Background</p> <p>Antibiotic associated diarrhoea complicates 5–39% of courses of antibiotic treatment. Major risk factors are increased age and admission to hospital. Of particular importance is <it>C. difficile</it> associated diarrhoea which occurs in about 4% of antibiotic courses and may result in severe illness, death and high healthcare costs. The emergence of the more virulent 027 strain of <it>C. difficile</it> has further heightened concerns. Probiotics may prevent antibiotic associated diarrhoea by several mechanisms including colonization resistance through maintaining a healthy gut flora.</p> <p>Methods</p> <p>This study aims to test the hypothesis that administration of a probiotic comprising two strains of lactobacilli and two strains of bifidobacteria alongside antibiotic treatment prevents antibiotic associated diarrhoea. We have designed a prospective, parallel group trial where people aged 65 years or more admitted to hospital and receiving one or more antibiotics are randomly allocated to receive either one capsule of the probiotic or a matching placebo daily for 21 days. The primary outcomes are the frequency of antibiotic associated and <it>C. difficile</it> diarrhoea during 8–12 weeks follow-up. To directly inform routine clinical practice, we will recruit a sufficient number of patients to demonstrate a 50% reduction in the frequency of <it>C. difficile</it> diarrhoea with a power of 80%. To maximize the generalizability of our findings and in view of the well-established safety record of probiotics, we will recruit a broad range of medical and surgical in-patients from two different health regions within the UK.</p> <p>Discussion</p> <p>Antibiotic associated diarrhoea constitutes a significant health burden. In particular, current measures to prevent and control <it>C. difficile</it> diarrhoea are expensive and disrupt clinical care. This trial may have considerable significance for the prevention of antibiotic associated diarrhoea in hospitals.</p> <p>Trial registration</p> <p>International Standard Randomised Controlled Trial Number Register ISRCTN70017204.</p

Wider Still and Wider: British Music Criticism since the Second World War

This chapter provides the first historical examination of music criticism in Britain since the Second World War. In the process, it also challenges the simplistic prevailing view of this being a period of decline from a golden age in music criticism

Young people's politics and the micro-territories of the local

In spite of the late modern interpellation of youth as mobile and globally oriented, and a perception of social and political issues as increasingly playing out in a transnational arena, young Australians exhibit strong local and individualised tendencies in expressing politics. They are bounded by the 'micro-territories of the local'; that is, their political thinking and acting takes place within the spaces of home, friendship groups, school and neighbourhood. This paper draws on an ARC project with nearly 1000 mainly 15-17-year-old Victorians to examine the relationship between young people's embeddedness in their local worlds and their views of themselves as efficacious political actors. It considers how their competency within such micro-territories opens up neglected sites and strategies for political expression and engagement while limiting their sense of sense of political efficacy, and it asserts the significance of considering this age group, not for what these young people will become in the future, but for their particular location, socially, physically and politically in the present

Youth Research in Australia and New Zealand

This article draws selectively on youth research in Australia and New Zealand to illustrate the distinctive nature of this emerging field. It reveals a vibrant, interdisciplinary field, which has developed rapidly from its derivative beginnings in the post-war period to a significant and distinctive field that is challenging theoretical and methodological traditions and providing new approaches to understanding youth, society and social change. The article highlights distinctive approaches to youth research that are characterized by two key elements. These are: (a) local conditions under which young people are growing up in Australia and New Zealand, including the ongoing shaping of meaning of indigeneity; and (b) active engagement with international debates on youth. The article first explores the traditions dominating the early conceptualization of youth in Australia and New Zealand, including the Birmingham school in the UK and psychological theories of development from the US. Next, the article describes how these traditions have resulted in a reconceptualization of youth in Australia and New Zealand. This is illustrated in discussions of the way in which discourses of youth and indigeneity and of health have been rethought. The paper also discusses emerging research traditions in the area of new identities and youth subjectivities, on young people’s participation in civic society and their engagement with global and virtual youth cultures

Young people and citizenship: an everyday perspective

This article addresses the changing nature of civic and political engagement for young people in Australia. It draws on recent research that explores youth engagement from the perspective of changing life patterns which see the current generation making adult choices in a highly individualised context. This approach is highly relevant for the study of youth engagement because it opens up the possibility of recognising new civic and political practices. If young people are no longer experiencing continuous, structured identities and predictable life trajectories, what does this mean for their participation in civic and political life? [Author abstract