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IntroductionTrisomy 21, also known as Down syndrome (DS), is a clinical disorder where a third copy of chromosome 21 is present. Approximately 95% of DS are due to a meiotic nondisjunction, with the remaining 5% caused by chromosomal translocation or mosaicism. Children with DS are predisposed to recurrent respiratory infections due to a number of anatomical and immunological features. Our project investigated whether there is evidence supporting or refuting the use of antibiotic prophylaxis for recurrent respiratory infections in the DS population.MethodsA systematic literature review was conducted of published medical literature within the following databases: MEDLINE, Science Direct, and The Cochrane Library. A systematic search for ongoing clinical trials and guidelines/consensus statements was performed using various clinical trial registers and professional organisation websites. Search terms included ‘DS’, ‘Trisomy 21’, ‘paediatric’, ‘respiratory infections’, ‘recurrent respiratory infections’, ‘prophylaxis’ and ‘antibiotics’. Systematic reviews, meta-analyses, randomised controlled trials, case-control studies and case-series were considered.ResultsA systematic search revealed 0 published articles and 0 clinical trials meeting the necessary inclusion criteria. 1 guideline was found meeting our inclusion criteria; the Nottingham Guideline which outlines the role of prophylactic antibiotics in the DS population. Given the dearth of evidence in this area, we formulated a clinical trial to investigate the utility of prophylactic antibiotics for current respiratory infections in the DS population. Azithromycin was chosen as the antibiotic of choice for its anti-inflammatory and immunomodulatory properties. Primary endpoints would be the number of respiratory infections experienced over the course of the treatment period requiring a GP or ED attendance. Secondary endpoints include the severity of respiratory infections, both the number and severity of adverse events experienced over the period of the trial, along with the patient and parent/legal guardian self-reported quality of life.ConclusionThere is a current lack of evidence supporting or refuting the use of prophylactic antibiotics for recurrent respiratory infections in DS. Basic scientific studies need to be performed elucidating the role of anatomical and immunological features in predisposing children with DS to recurrent respiratory infections. Clinical trials are needed to elucidate whether prophylactic antibiotics are useful in this cohort and to investigate the optimal timing and combination of antibiotics. Guidelines are needed to support physicians in clinical decision making.

A pictorial of Michael Kenna's photographs of Hokkaido, the northernmost and least developed of Japan's four main islands, is presented.

More than twenty years after its initial publication, Michael Kenna's seminal collection of photographs of the Ford River Rouge industrial complex is now available in a new, revised, and expanded edition. One of the world s most acclaimed photographers working exclusively in black-and-white, Michael Kenna has traveled the world to create stunning, magical images of nature and manmade objects. Known for the ethereal tone and incredibly nuanced detail of his photographs, Kenna is also a chronicler of environmental degradation. His images of an auto plant outside of Detroit, Michigan, are some of his best-known works. Long out of print, Rouge has been brought back to life with a spectacular new design, an authoritative essay by art historian James Steward, and many previously unpublished images that were part of the original series. As the city of Detroit struggles to reclaim its heritage as an American commercial and artistic hub, these photographs resonate more than ever with the stark realities and hidden beauty of the industrial landscape. -- publisher's statement.

The origin of the late-time acceleration of the universe is one of the biggest questions in cosmology. We give the name dark energy to the substance which is responsible for this, highlighting our ignorance on its origin. The most widely accepted explanation is that of the cosmological constant. However the naturalness of the cosmological constant, and the theoretical inconsistency with the value expected from quantum field theory, poses a question over whether this is the true explanation of the late-time acceleration. In this thesis, we investigate models of massive gravity, which arise from modifying Einstein's theory of General Relativity, to tackle the late-time acceleration problem in a more natural way than the cosmological constant. The theories we will study are the bigravity and generalised massive gravity theories. In this work we are principally concerned with both the theoretical consistency and phenomenological implications of the aforementioned theories. To study the theoretical consistency we study cosmological perturbations and derive the stability conditions, whilst for the phenomenological study we investigate the background evolution and the effects on the large scale structure of the universe. We also investigate the screening mechanisms, which are important to allow the recovery of General Relativity on local, well tested, scales. The first part of the thesis is dedicated to the history of massive gravity. The timeline of the development of dRGT (de-Rham, Gabadadze, Tolley) massive gravity is discussed in detail in chapter 2. The second part of chapter 2 discusses the cosmological solutions in massive gravity, and the requirement to study extensions of the theory to find stable cosmologies. We also introduce other models of massive gravity which could explain the late-time acceleration. In chapter 3 we study the low energy limit model of bigravity. We study the linear scalar perturbations and investigate the modified Poisson's equation. To determine the details of the screening, we derive the non-linear equations and identify the Vainshtein radius. We conclude by discussing the viability of bigravity theories for dark energy. In chapter 4 we introduce the generalised massive gravity and study its stability at the level of the quadratic action for cosmological perturbations. To do so, we derive the stability conditions as a function of the model parameters. Imposing that we require late-time acceleration and the absence of instabilities, we identify a region of parameter space in which the theory is stable. Building upon the analysis in chapter 4, we study generalised massive gravity in more detail in chapter 5. We perform a full background analysis, identifying the expansion history and equation of state of dark energy for a concrete model. Later on in chapter 5 we study the linear scalar perturbations, focusing on the effects of generalised massive gravity on large scale structure. We finish the chapter by investigating the propagation of gravitational waves and conclude the thesis with future directions and open questions in the field.

Michael Kenna is internationally renowned for producing evocative black-and-white images of nature and the urban environment. Often photographing at night or in the early morning hours, the majority of his photographs involve long time exposures with the camera on a tripod. However, some of Kenna's more quirky, whimsical, and unpredictable images have been photographed with inexpensive, hand-held, plastic Holga cameras. These cameras generally produce relatively low- fidelity images, with marked vignetting. Precisely because of these attributes and its portability, Kenna often carries a Holga camera, even when he is not specifically photographing. For this beautifully produced book, Kenna has chosen his favorite Holga images, many never seen before, from his vast archive of negatives. Despite their low-tech origin, these refined and artful photographs bear the hallmarks of Kenna's brilliant work.

In this work we investigate the most general non-minimally coupled \\(\\mathbb{Z}_2\\) symmetric scalar-tensor effective field theory (EFT) of gravity up to dimension six in the operator expansion. The most general action is presented along with its equations of motion both in the covariant form and also in the coordinate form resulting from an FLRW analysis. The pressure and density of the scalar field are found as well as the equation of state parameter and some cosmological parameters. We analyse the background evolution of the scalar field within the framework of the slow-roll approximation and provide a brief discussion of \\(\\mathbb{Z}_2\\) symmetry breaking of the scalar field which gives an order of magnitude constraint on one of the coupling constants. To provide a concrete example we choose a couple of potentials for the scalar field and explore the cosmology. Some brief comments on the range of validity of the EFT are also offered as well as the connections between the general model and well-known examples in the literature.