Dual bronchodilators in Bronchiectasis study (DIBS): protocol for a pragmatic, multicentre, placebo-controlled, three-arm, double-blinded, randomised controlled trial studying bronchodilators in preventing exacerbations of bronchiectasis

INTRODUCTION: Bronchiectasis is a long-term lung condition, with dilated bronchi, chronic inflammation, chronic infection and acute exacerbations. Recurrent exacerbations are associated with poorer clinical outcomes such as increased severity of lung disease, further exacerbations, hospitalisations, reduced quality of life and increased risk of death. Despite an increasing prevalence of bronchiectasis, there is a critical lack of high-quality studies into the disease and no treatments specifically approved for its treatment. This trial aims to establish whether inhaled dual bronchodilators (long acting beta agonist (LABA) and long acting muscarinic antagonist (LAMA)) taken as either a stand-alone therapy or in combination with inhaled corticosteroid (ICS) reduce the number of exacerbations of bronchiectasis requiring treatment with antibiotics during a 12 month treatment period. METHODS: This is a multicentre, pragmatic, double-blind, randomised controlled trial, incorporating an internal pilot and embedded economic evaluation. 600 adult patients (≥18 years) with CT confirmed bronchiectasis will be recruited and randomised to either inhaled dual therapy (LABA+LAMA), triple therapy (LABA+LAMA+ICS) or matched placebo, in a 2:2:1 ratio (respectively). The primary outcome is the number of protocol defined exacerbations requiring treatment with antibiotics during the 12 month treatment period. ETHICS AND DISSEMINATION: Favourable ethical opinion was received from the North East-Newcastle and North Tyneside 2 Research Ethics Committee (reference: 21/NE/0020). Results will be disseminated in peer-reviewed publications, at national and international conferences, in the NIHR Health Technology Assessments journal and to participants and the public (using lay language). TRIAL REGISTRATION NUMBER: ISRCTN15988757

Dual bronchodilators in Bronchiectasis study (DIBS): protocol for a pragmatic, multicentre, placebo-controlled, three-arm, double-blinded, randomised controlled trial studying bronchodilators in preventing exacerbations of bronchiectasis

Introduction: Bronchiectasis is a long-term lung condition, with dilated bronchi, chronic inflammation, chronic infection and acute exacerbations. Recurrent exacerbations are associated with poorer clinical outcomes such as increased severity of lung disease, further exacerbations, hospitalisations, reduced quality of life and increased risk of death. Despite an increasing prevalence of bronchiectasis, there is a critical lack of high-quality studies into the disease and no treatments specifically approved for its treatment. This trial aims to establish whether inhaled dual bronchodilators (long acting beta agonist (LABA) and long acting muscarinic antagonist (LAMA)) taken as either a stand-alone therapy or in combination with inhaled corticosteroid (ICS) reduce the number of exacerbations of bronchiectasis requiring treatment with antibiotics during a 12 month treatment period. Methods: This is a multicentre, pragmatic, double-blind, randomised controlled trial, incorporating an internal pilot and embedded economic evaluation. 600 adult patients (≥18 years) with CT confirmed bronchiectasis will be recruited and randomised to either inhaled dual therapy (LABA+LAMA), triple therapy (LABA+LAMA+ICS) or matched placebo, in a 2:2:1 ratio (respectively). The primary outcome is the number of protocol defined exacerbations requiring treatment with antibiotics during the 12 month treatment period. Ethics and dissemination: Favourable ethical opinion was received from the North East—Newcastle and North Tyneside 2 Research Ethics Committee (reference: 21/NE/0020). Results will be disseminated in peer-reviewed publications, at national and international conferences, in the NIHR Health Technology Assessments journal and to participants and the public (using lay language). Trial registration number: ISRCTN15988757

Spatial language and landmark use: Can 3-, 4-, and 5-year-olds find the middle

Abstract Evidence suggests that (a) young children have difficulty reasoning about spatial relations, and that (b) spatial language can facilitate their performanc

Relational language helps children reason analogically

This paper explores the role of relational language in the development of children’s analogical reasoning ability. In two experiments, children were asked to make a relational mapping between two pictures while ignoring a competing object match. Three-and-a-half-year-olds, 5-year-olds, and 7-year-olds were all more successful at this task when they heard relational language. Experiment 2 further demonstrated that children were as good at finding the relational match with an object match present if they heard relational language as they were when there was no compelling object match present at all. These results suggest that relational language may be important in instilling the ability to reason analogically

Spatial Alignment Enhances Comparison of Complex Educational Visuals

Grasping relational concepts is facilitated by comparing their representations. Previously, Matlen et al (2014; underreview) found that for simple visual figures, the comparison process was optimized when the visuals were placed in directspatial alignment, such that the main axes of the visuals run perpendicular to their placement (e.g., horizontal figures placedvertically), relative to impeded spatial alignment, when the axes run parallel to their placement. In the present work,we tested this spatial alignment effect using complex naturalistic stimuli, consisting of skeletal structures. Participantsidentified anomalous bones by comparing a correct skeleton with a skeleton that had an incorrect bone. Participants weremore accurate when skeletal structures were placed in direct (M=.90) relative to impeded (M=.84) alignment (p¡.01).Given the relevance of these findings to education, we are formally coding visuals in middle-school science textbooksbased on their spatial alignment and will present these results at the conference

Spatial alignment supports comparison of life science visuals for 7th graders

Visual comparisons are ubiquitous in STEM education. We suggest that visual comparisons are carried out by a structuralalignment process that draws correspondences between analogs based on relational structure (Sagi, Gentner, & Lovett,2012). The spatial arrangement of images can influence visual comparisons by increasing or decreasing competitionfrom incorrect correspondences (Matlen, Gentner, & Franconeri, 2020). The present study tested whether this could beleveraged to help children compare complex STEM-related images. Seventh graders were shown drawings of skeletonscontaining an anomalous bone, either solo or paired with a correct standard. Children were more accurate at finding theanomaly when given a correct standard to compare to. On especially difficult trials in which skeletons were shown innon-canonical orientations (e.g., a cow oriented vertically), performance was enhanced when the spatial placement of thetwo skeletons was direct, minimizing competing correspondences. Thus, direct placement may help students comparecomplex unfamiliar images

Supports for Visual Comparison in STEM textbooks

Many science and mathematics concepts involve complex relationships. Educational materials, such as textbooks, oftenconvey these systems through visualizations (e.g., Jee et al., 2010; Mayer, 1993). To abstract the key relationships,students must compare corresponding elements of these visualizations-parts of a structure, steps in a process, etc. Yet,little is known about the ways in which visual comparisons are presented in textbooks. The present study evaluated imagesin science and mathematics textbooks from top U.S. publishers with respect to the support for visual comparisons. Theresearch team identified several factors that could help vs. hinder visual comparison based on prior research on visualcomparison and analogy, including the spatial arrangement of corresponding elements (Matlen, Gentner, & Franconeri,2014), the number intervening elements between them, and the ways in which comparisons are formally encouragedthrough both verbal and non-verbal cues

When do Children Pass the Relational-Match-To-Sample Task?

Relational ability—the ability to compare situations or ideas and discover common relations – is a key process in higher-order cognition that underlies transfer in learning and creative problem solving. For this reason, it has generated intense interest both among developmentalist and in cross-species comparative studies. The gold standard for evaluating relational ability is the Relational-Match-to-Sample (RMTS) task (Premack, 1983). Current work in cognitive development has produced inconsistent results as to when children are able to pass the RMTS, with Christie and Gentner (2014) finding earlier success than Hochmann et al. (2017) and Kroupin and Carey (2022). In this research, we attempt to resolve this issue. We first describe two studies that bear out and extend Christie and Gentner’s (2014) findings. We then discuss factors that might explain the discrepancy between the findings