From legacy rhetoric to business benefits: A case study of the Gold Coast 2018 Commonwealth games

Bids for large-scale sporting events and the accompanying political rhetoric typically include promises of economic development and gains for host business communities over the short and long term. Although conceptual models for economic leverage of large-scale sport events have been developed, our knowledge of the practical experiences of private enterprise converting opportunities presented by large-scale sport events is limited. In this article, the authors address this gap through a case study of the Gold Coast 2018 Commonwealth Games. The article investigates the opportunities and challenges perceived by private enterprises across the host city and explores the implementation of existing strategies to leverage benefits for business. Although participants identify the general benefits of hosting the event, they struggle to conceptualize benefits in relation to their own business settings. This suggests a disconnect between the legacy rhetoric of large-scale sporting events and the conversion of these opportunities into outcomes by private enterprises in the host city. Against this background, the article outlines a range of practical implications for private enterprise and key areas for future research

Designing sustainability changes in a tourist accommodation context from a systems perspective

Pro-sustainability changes are slow and incremental at best in the tourism sector. Research on the topic can take the form of secondary data (e.g., content analysis of strategic documents, social media posts), survey-based intent studies (e.g., willingness to pay), survey-based studies of self-reported behaviors, observation of actual behaviors (e.g., benchmarking studies), lab-based experimental manipulations of measurable behaviors, and, finally, in situ, or field-based, experimental manipulations of measurable behaviors. The latter are some of the rarest studies and are held up as the gold standard for changing behaviors by providing evidence-based, measurable, and actionable sustainability interventions for tourism businesses. This study draws inspiration from a 4-year program of action research into pro-sustainability changes in tourist accommodations. It questions whether any of these approaches are sufficient for changing sustainability-oriented behaviors. This questioning extends to whether the theoretical approaches that underpin even “gold standard experiments” capture the operational contexts of accommodation businesses. It proposes instead that a scaffolded approach, built from a systems map of the theories, tools, experimental findings, interviews with stakeholders and operational context is necessary to create sustainability transformations in tourism businesses. This is a radical departure from the dependent/independent variable approach adopted in traditional scientific methods and that requires a different ontological approach to the science of sustainability. The study has implications for contextualizing intervention-based experimental studies within a wider system of influential factors within tourist accommodations

Heart failure following blood cancer therapy in pediatric and adult populations

Aim: The link between chemotherapy treatment and cardiotoxicity is well established, particularly for adults with blood cancers. However, it is less clear for children. This analysis aimed to compare the trajectory and mortality of children and adults who received chemotherapy for blood cancers and were subsequently hospitalised for heart failure. Methods: Linked data from the Queensland Cancer Registry, Death Registry and Hospital Administration records for initial chemotherapy and later heart failure were reviewed (1996-2009). Of all identified blood cancer patients (N=23,434); 8,339 received chemotherapy, including 817 children (aged ≤18 years at time of cancer diagnosis) and 7,522 adults. Time-varying Cox proportional hazards regression models were used to compare the characteristics and survival between the two groups. Results: Of those who were subsequently hospitalised for heart failure, 70% of children and 46% of adults had the index admission within 12 months of their cancer diagnosis. Of these, 53% of the pediatric heart failure population and 71% of the adult heart failure population died within the study period. Following adjustment for age, sex and chemotherapy admissions, children with heart failure had an increased mortality risk compared to their non-heart failure counterparts, a difference which was much greater than that between the adult groups. Conclusion: The impact of heart failure on children previously treated for blood cancer is more severe than for adults, with earlier morbidity and greater mortality. Improved strategies are needed for the prevention and management of cardiotoxicity in this population

Heart Failure Following Cancer Therapy in Patients with Hematological Malignancies Aged 18 Years and Under: A Linked Health Data Analysis (1996-2009)

Made available in accordance with Publisher's Open Access policyntroduction: The causal link between chemotherapy treatments and subsequent cardiotoxicity is well established, particularly for children with hematological malignancies. Little information exists on the characteristics and outcomes for patients with heart failure (HF) after chemotherapy. This study aimed to describe the characteristics, survival and mortality of patients who received chemotherapy for hematological cancer (leukemias, lymphomas and related disorders) before 18 years old and subsequently developed HF compared to those who did not. Methods: Linked health data (1996-2009) from the Queensland Cancer Registry, Death Registry and Hospital Administration records for HF and chemotherapy admissions were reviewed. From all breast and hematological cancers patients (n=73,158), 15,987 received chemotherapy, including 819 patients aged ≤18 years at time of cancer diagnosis. Patients were categorized as those with an index HF admission (occurred after cancer diagnosis) and those without an index HF admission (non HF). Results: Of the 819 patients, 3.7% (n=30) had an index HF admission. Median age of HF patients at time of cancer diagnosis was 5 years (IQR 3-12) compared to 7 years (IQR 3-14) in the non HF group (p=0.503). Median follow up from cancer diagnosis was 2.5 years in the HF group compared to 5.42 years in the non HF group (p<0.01). Of those who developed HF, 70% (n=21) had the index admission within 12 months of their cancer diagnosis. Of those with HF, 53.3% (n=16) died (all cause) compared to 14.6% (n=115) with no HF. On adjustment for age, sex and chemotherapy admissions, HF patients had an almost 5 fold increased mortality risk compared to non HF patients (HR 4.91 [95% CI, 2.88-8.36]) Conclusions: This study demonstrated that in children with hematological cancers the onset of HF occurred soon after chemotherapy and mortality risk is almost 5 times that of children who do not develop HF. Innovative strategies are still needed for the prevention and management of cardiotoxicity in this populatio

BHPR research: qualitative1. Complex reasoning determines patients' perception of outcome following foot surgery in rheumatoid arhtritis

Background: Foot surgery is common in patients with RA but research into surgical outcomes is limited and conceptually flawed as current outcome measures lack face validity: to date no one has asked patients what is important to them. This study aimed to determine which factors are important to patients when evaluating the success of foot surgery in RA Methods: Semi structured interviews of RA patients who had undergone foot surgery were conducted and transcribed verbatim. Thematic analysis of interviews was conducted to explore issues that were important to patients. Results: 11 RA patients (9 ♂, mean age 59, dis dur = 22yrs, mean of 3 yrs post op) with mixed experiences of foot surgery were interviewed. Patients interpreted outcome in respect to a multitude of factors, frequently positive change in one aspect contrasted with negative opinions about another. Overall, four major themes emerged. Function: Functional ability & participation in valued activities were very important to patients. Walking ability was a key concern but patients interpreted levels of activity in light of other aspects of their disease, reflecting on change in functional ability more than overall level. Positive feelings of improved mobility were often moderated by negative self perception ("I mean, I still walk like a waddling duck”). Appearance: Appearance was important to almost all patients but perhaps the most complex theme of all. Physical appearance, foot shape, and footwear were closely interlinked, yet patients saw these as distinct separate concepts. Patients need to legitimize these feelings was clear and they frequently entered into a defensive repertoire ("it's not cosmetic surgery; it's something that's more important than that, you know?”). Clinician opinion: Surgeons' post operative evaluation of the procedure was very influential. The impact of this appraisal continued to affect patients' lasting impression irrespective of how the outcome compared to their initial goals ("when he'd done it ... he said that hasn't worked as good as he'd wanted to ... but the pain has gone”). Pain: Whilst pain was important to almost all patients, it appeared to be less important than the other themes. Pain was predominately raised when it influenced other themes, such as function; many still felt the need to legitimize their foot pain in order for health professionals to take it seriously ("in the end I went to my GP because it had happened a few times and I went to an orthopaedic surgeon who was quite dismissive of it, it was like what are you complaining about”). Conclusions: Patients interpret the outcome of foot surgery using a multitude of interrelated factors, particularly functional ability, appearance and surgeons' appraisal of the procedure. While pain was often noted, this appeared less important than other factors in the overall outcome of the surgery. Future research into foot surgery should incorporate the complexity of how patients determine their outcome Disclosure statement: All authors have declared no conflicts of interes

Effect of Hydrocortisone on Mortality and Organ Support in Patients With Severe COVID-19: The REMAP-CAP COVID-19 Corticosteroid Domain Randomized Clinical Trial.

Importance: Evidence regarding corticosteroid use for severe coronavirus disease 2019 (COVID-19) is limited. Objective: To determine whether hydrocortisone improves outcome for patients with severe COVID-19. Design, Setting, and Participants: An ongoing adaptive platform trial testing multiple interventions within multiple therapeutic domains, for example, antiviral agents, corticosteroids, or immunoglobulin. Between March 9 and June 17, 2020, 614 adult patients with suspected or confirmed COVID-19 were enrolled and randomized within at least 1 domain following admission to an intensive care unit (ICU) for respiratory or cardiovascular organ support at 121 sites in 8 countries. Of these, 403 were randomized to open-label interventions within the corticosteroid domain. The domain was halted after results from another trial were released. Follow-up ended August 12, 2020. Interventions: The corticosteroid domain randomized participants to a fixed 7-day course of intravenous hydrocortisone (50 mg or 100 mg every 6 hours) (n = 143), a shock-dependent course (50 mg every 6 hours when shock was clinically evident) (n = 152), or no hydrocortisone (n = 108). Main Outcomes and Measures: The primary end point was organ support-free days (days alive and free of ICU-based respiratory or cardiovascular support) within 21 days, where patients who died were assigned -1 day. The primary analysis was a bayesian cumulative logistic model that included all patients enrolled with severe COVID-19, adjusting for age, sex, site, region, time, assignment to interventions within other domains, and domain and intervention eligibility. Superiority was defined as the posterior probability of an odds ratio greater than 1 (threshold for trial conclusion of superiority >99%). Results: After excluding 19 participants who withdrew consent, there were 384 patients (mean age, 60 years; 29% female) randomized to the fixed-dose (n = 137), shock-dependent (n = 146), and no (n = 101) hydrocortisone groups; 379 (99%) completed the study and were included in the analysis. The mean age for the 3 groups ranged between 59.5 and 60.4 years; most patients were male (range, 70.6%-71.5%); mean body mass index ranged between 29.7 and 30.9; and patients receiving mechanical ventilation ranged between 50.0% and 63.5%. For the fixed-dose, shock-dependent, and no hydrocortisone groups, respectively, the median organ support-free days were 0 (IQR, -1 to 15), 0 (IQR, -1 to 13), and 0 (-1 to 11) days (composed of 30%, 26%, and 33% mortality rates and 11.5, 9.5, and 6 median organ support-free days among survivors). The median adjusted odds ratio and bayesian probability of superiority were 1.43 (95% credible interval, 0.91-2.27) and 93% for fixed-dose hydrocortisone, respectively, and were 1.22 (95% credible interval, 0.76-1.94) and 80% for shock-dependent hydrocortisone compared with no hydrocortisone. Serious adverse events were reported in 4 (3%), 5 (3%), and 1 (1%) patients in the fixed-dose, shock-dependent, and no hydrocortisone groups, respectively. Conclusions and Relevance: Among patients with severe COVID-19, treatment with a 7-day fixed-dose course of hydrocortisone or shock-dependent dosing of hydrocortisone, compared with no hydrocortisone, resulted in 93% and 80% probabilities of superiority with regard to the odds of improvement in organ support-free days within 21 days. However, the trial was stopped early and no treatment strategy met prespecified criteria for statistical superiority, precluding definitive conclusions. Trial Registration: ClinicalTrials.gov Identifier: NCT02735707

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570

Volunteer tourism as an emerging trend or an expansion of ecotourism? A look at potential clients' perceptions of volunteer tourism organisations

Volunteer tourism (VT) has recently been proposed as an alternative to ecotourism to link tourism and nature conservation. It is believed that VT represents an emerging tourism sector for vacationers who want to make a difference during their holidays. This investigation questions this belief using potential tourists' perceptions of volunteer tourism organisations. \ud \ud Through a multiple sorting procedure, respondents interpreted the promotional material of volunteer tourism organisations to describe this form of tourism and differentiate between organisations. The results suggested that respondents distinguish between organisations offering a volunteering experience and a holiday experience.\ud \ud \ud Furthermore, the respondent's level of familiarity with expedition activities was important, as respondents with a high level of familiarity seek different benefits from their experience. The study suggests that volunteer tourism is a diverse sector, with different emphases on holiday and volunteering elements

Towards an understanding of the volunteer tourism experience

A new form of tourism, volunteer tourism, has been put forward as a solution to an apparent decreasing public understanding of environmental debates and financial commitment towards resolving conservation concerns. This tourism sector makes use of holiday-makers who volunteer to fund and work on conservation projects around the world and aims to provide to provide sustainable alternative travel that can assist in community development, scientific research or ecological restoration. Unlike ecotourism where profit drives the operator, many volunteer tourism companies are non-profit organisations, whose aim is to allow travellers to work alongside researchers on environmentally or socially beneficial projects. Such volunteer work provides a means for direct interaction between environmental scientists and the general public and is a potentially powerful tool for creating an increasingly global environmental ethic. Previous studies of volunteer tourism suggest that participants share similar characteristics to (extreme) ecotourists, i.e. tourists who desire a high level of interaction with the environment, to be environmentally responsible and to be challenged, but unlike ecotourists, volunteer tourists are believed to be motivated by a sense of altruism. Researchers describe the volunteer tourism experience as a form of serious leisure, with a focus on learning and contributing to a worthwhile cause. Other motivations that have been associated with volunteer tourism, volunteering and tourism include escape, relaxation, relationship enhancement, self-development, building a personal power base, advancing a personal agenda, developing a career that leads to status or other rewards, interest in the subject matter, and an interest in helping the researcher. How ubiquitous these motivations are and how they shape the volunteer tourism experience is not yet understood. This research investigated the volunteer tourists’ expectations and experiences in order to enhance volunteer tourism’s potential as a conservation tool. It sought to identify key variables and factors which shape this sector; and to prepare the way for subsequent large scale empirical studies. It applied new data collection tools (a daily diary) to a new field of tourism research (the volunteer tourism experience) The research aims were (i) to identify differences between organisational images that might lead to different volunteer tourist experiences (Study One), (ii) to determine the socio-demographic and motivational profiles of volunteer tourists (Study Two), (iii) to examine volunteer tourists’ experiences and to identify patterns of experience and the elements that lead to a satisfying experience (Study Three), and finally (iv) to understand the experience from the expedition staff’s point of view (Study Four). Study One looked at a sample of volunteer tourism organisations (n=29) to identify their projected and perceived organisational images. The former were investigated by assessing promotional photographs, mission statements and volunteer tourist testimonies, and the latter were analysed using a multiple sorting procedure performed by 30 postgraduate students. Based on the results, a general typology was developed resulting in four groups – “research conservation” expeditions, “holiday conservation” expeditions, “adventure holiday” expeditions and “community holiday” expeditions. The four groups could be distinguished based on their mission statements, photographs, testimonies, and sorting criteria. Study Two investigated the expectations, motivations and socio-demographic profiles of volunteer tourists. Volunteers from six organisations (n=77) were studied using a diary-based method. This relatively small sample size was due to the nature of volunteer tourism (infrequent trips with small groups in very remote locations). Distinct socio-demographic and motivational profiles were found: four organisations appeared to attract a younger market with a lower level of prior conservation involvement, less travel experience and who were motivated by personal development and experiential and recreational goals, while two organisations catered to an older market, who have a higher level of conservation involvement and travel experience and who were more motivated to learn and help the researcher. Study Three investigated volunteer tourist experiences based on the findings from the previous two studies. The positive and negative elements of their volunteer tourism experiences were investigated, along with on-site satisfaction and moods. The results indicated that whilst most of the volunteer tourists’ motivations and expectations were fulfilled, their moods, satisfaction levels and overall assessment of the expedition were dependent on the presence of four elements: the opportunity for skill/knowledge development, having fun, experiencing new things, and contributing to a worthwhile project. Furthermore, certain experience patterns could be identified from the volunteer tourists’ diaries; some volunteers were confident and highly involved in the expedition, some were slightly more anxious and did not become so involved in all aspects of the expedition, whilst others were primarily concerned with their own achievements, and lastly some show lower levels of involvement in the project. The final study investigated the staff’s expectations of the volunteers. Staff were asked to describe their qualifications for the job and the role they expected the volunteers to fulfil, to rate the items from Study Two that might have motivated their volunteers to join the expedition and to assess the volunteers’ performance. In most cases, staff placed a greater emphasis on the volunteering and research aspects of the expedition, often to the detriment of fun and social elements. They felt their science and research experience qualified them for the job, that volunteers should be hard working and perform to the best of their ability. Overall, the research revealed that whilst volunteer tourists have poorly defined expectations of their expedition, they are generally satisfied as long as the four elements mentioned above are present during the expedition. The need for fun and new and different experiences contradict previous notions of volunteer tourism as a form of serious leisure involving altruistic motivations. Moreover, staff could be made more aware of the different roles they are to fulfil during the expedition. Methodological and conceptual contributions of this research include the development of an experience data collection tool and an integrative approach to studying volunteer tourism. The role of altruism as a motivating force was challenged, whilst the importance of having fun, contributing to a worthwhile project, learning and experiencing new and different things was highlighted. Opportunities for future research into the role of personality, staff attitudes and volunteer rewards, as well as the organisation’s evaluation of volunteer tourism as a form of recreation experience were presented. Furthermore, some of the variables that define this sector and may be useful employed in an Equity model of volunteer tourism were identified and may be used to refine the current state of knowledge regarding volunteer tourism as an exchange of services and benefits between two parties. Finally, recommendations are made to help enhance volunteer tourism’s potential as a conservation tool

Migration

[Extract] Most baleen whales undertake annual migrations from their feeding grounds in the cooler, food-abundant waters of the high latitudes to their mating and birthing grounds in warmer, sheltered waters of the low latitudes