The Australasian Resuscitation In Sepsis Evaluation : fluids or vasopressors in emergency department sepsis (ARISE FLUIDS), a multi-centre observational study describing current practice in Australia and New Zealand

Objectives: To describe haemodynamic resuscitation practices in ED patients with suspected sepsis and hypotension. Methods: This was a prospective, multicentre, observational study conducted in 70 hospitals in Australia and New Zealand between September 2018 and January 2019. Consecutive adults presenting to the ED during a 30-day period at each site, with suspected sepsis and hypotension (systolic blood pressure <100 mmHg) despite at least 1000 mL fluid resuscitation, were eligible. Data included baseline demographics, clinical and laboratory variables and intravenous fluid volume administered, vasopressor administration at baseline and 6- and 24-h post-enrolment, time to antimicrobial administration, intensive care admission, organ support and in-hospital mortality. Results: A total of 4477 patients were screened and 591 were included with a mean (standard deviation) age of 62 (19) years, Acute Physiology and Chronic Health Evaluation II score 15.2 (6.6) and a median (interquartile range) systolic blood pressure of 94 mmHg (87–100). Median time to first intravenous antimicrobials was 77 min (42–148). A vasopressor infusion was commenced within 24 h in 177 (30.2%) patients, with noradrenaline the most frequently used (n = 138, 78%). A median of 2000 mL (1500–3000) of intravenous fluids was administered prior to commencing vasopressors. The total volume of fluid administered from pre-enrolment to 24 h was 4200 mL (3000–5661), with a range from 1000 to 12 200 mL. Two hundred and eighteen patients (37.1%) were admitted to an intensive care unit. Overall in-hospital mortality was 6.2% (95% confidence interval 4.4–8.5%). Conclusion: Current resuscitation practice in patients with sepsis and hypotension varies widely and occupies the spectrum between a restricted volume/earlier vasopressor and liberal fluid/later vasopressor strategy

Travel blogs on China as a destination image formation agent: A qualitative analysis using Leximancer

The Internet spreads tourism information around the world and specifically travel blogs function as an online version of word-of-mouth (eWOM). This research explored the role of blogs as a destination image formation agent for China's inbound tourism. Data were collected from 630 bloggers who wrote on two blog websites about their travels within China in 2011 and 2012. The bloggers on TravelBlog.org and TravelPod.com were mainly from English-speaking countries. Qualitative analysis using Leximancer software was applied and identified nine major textual themes and the relationships among these themes. In order of relative importance, the themes were place, Chinese, people, food, train, city, hotel, China, and students. The research indicated that international tourists tended to have positive images of China

Looking at handaxes from another angle: Assessing the ergonomic and functional importance of edge form in Acheulean bifaces

Edge angle is widely considered to be a morphological attribute that influences the functional performance of lithic technologies. However, the comparative performance capabilities of handaxes that vary in terms of edge angles has never been investigated under experimental conditions. Similarly, detailed accounts of Acheulean handaxe angle variation from archaeological examples have not been reported in the literature. Consequently, it has not previously been possible to assess the extent to which Palaeolithic individuals adhered to specific edge angle ranges during handaxe production or whether resultant artifactual properties may have been in response to varying rates of utility. Here, using a substantial experimental program (n = 500 handaxes), we investigate the impact that edge angle variation has on the cutting efficiency of handaxes at a “whole tool” and “edge-point localized” level. We then examine edge angles in a temporally and geographically wide range of handaxes (n = 643) and assess the extent to which hominins were likely altering tool production choices in response to functional pressures. Our experimental results demonstrate that, up to a certain value, higher edge angles in handaxes can actually increase functional performance. Furthermore, results indicate that edges in the proximal portion of handaxes have the greatest influence over efficiency rates. Combined with examination of archaeological specimens, these results suggest that hominins actively pursued the production of more obtuse edges in the proximal (butt) portion of handaxes in order to increase ergonomic features that facilitated greater efficiency during use. Edge angle values in the proximal portion of the archaeological handaxes were, however, consistently found to be below an efficiency threshold identified at ?70 degrees, above which, an edge’s ability to effectively be applied to cutting tasks decreases markedly. This further suggests that the proximal edges of handaxes, at least occasionally, were required as a functional working edge

Influence of handaxe size and shape on cutting efficiency: a large-scale experiment and morphometric analysis

Handaxes represent one of the most temporally enduring and geographically widespread of Palaeolithic artifacts and thus comprised a key technological strategy of many hominin populations. Archaeologically observable variation in the size (i.e., mass) and shape properties of handaxes has been frequently noted. It is logical to ask whether some of this variability may have had functional implications. Here, we report the results of a large-scale (n = 500 handaxes) experiment designed to examine the influence of variation in handaxe size and shape on cutting efficiency rates during a laboratory task. We used a comprehensive dataset of morphometric (size-adjusted) shape variables and statistical methods (including multivariate methods) to address this issue. Our first set of analyses focused on handaxe mass/size variability. This analysis demonstrated that, at a broad-scale level of variation, handaxe mass may have been free to vary independently of functional (cutting) efficiency. Our analysis also, however, identified that there will be a task-specific threshold in terms of functional effectiveness at the lower end of handaxe mass variation. This implies that hominins may have targeted design forms to meet minimal (task-specific) thresholds, and may also have managed handaxe reduction and discard in respect to such factors. Our second set of analyses focused on handaxe shape variability. This analysis also indicated that considerable variation in handaxe shape may occur independently of any strong effect on cutting efficiency. We discuss how these results have several implications for considerations of handaxe variation in the archaeological record. At a general level, our results demonstrate that variability within and between handaxe assemblages in terms of their size and shape properties will not necessarily have had immediate or strong impact on their effectiveness when used for cutting, and that such variability may have been related to factors other than functional issues

Stop and Search or Stop and Engage? Factors Influencing Community Police Engagement Around Drug Supply Issues

The police service in London report a commitment to inspiring confidence from, and responding to the needs of black and minority ethnic communities. They are also committed to tackling the supply of crack cocaine and heroin, with which members of the Jamaican and Turkish communities respectively are strongly identified. Members of these communities report concerns about drug supply issues, but are extremely reluctant to co-operate with the police to address them because they perceive that they are unfairly targeted, particularly by the stop and search strategy. The challenge is to implement a long-term, community engagement programme with strategic level commitment

'It's like an itch and I want to get it away but it's still there' : understandings and experiences of anxiety and depression among young people with intellectual disabilities

This paper reports findings from a study funded by the Foundation for People with Learning Disabilities which aimed to explore experiences of anxiety and depression among 17 young people with learning disabilities in Scotland. A series of unstructured interviews were conducted with the young people while one semi-structured interview took place with their families and/ or with relevant professionals. The young people talked about their distress in various ways, including medical terms, bodily sensations, feelings and emotions, behaviours, and specific fears. Those who could identify the cause(s) of their distress referred to stressful life events, troublesome medical conditions, difficulties negotiating the transition to adulthood and social isolation. The young people said relatively little about what helped reduce their distress: a few had good formal or informal support while others had tried to develop their own coping strategies. The findings are discussed in relation to social crisis theory. Policy and practice implications are highlighted

Evaluation of the New Opportunities for PE and Sport Initiative : annual report year two

The New Opportunities for PE and Sport initiative (NOPES) is a £751 million sports investment across the UK with intended key outcomes of: improving physical education and sport in schools ; higher standards across the whole school ; increased physical activity in the school age population and their communities ; improved collaboration co-operation and partnership between schools and their communities ; promotion of social inclusion and ; innovation and best practice in the design and management of facilities. Across the UK the programme is predominantly capital in nature, proving funding for new sport facilities. However, in Scotland there is a revenue funded Activities Programme which is split into two strands, Out of School Hours Activities and Active Steps, which have their own particular key outcomes. This report details the progress and findings of the evaluation of the NOPES programme for the 12 month period from February 2004 to January 2005. The evaluation is being conducted for the Big Lottery Fund by the Loughborough Partnership, led by the Institute of Youth Sport