Motives for mixing alcohol with energy drinks and other non-alcoholic beverages and its effects on overall alcohol consumption among UK students

© 2015 Published by Elsevier Ltd. Introduction: A UK student survey examined the motivations for consuming energy drinks alone and mixed with alcohol, and aimed to determine whether the type of motive had a differential effect on overall alcohol consumption. Methods: The online survey (N = 1873) assessed alcohol consumption and motivations for consumption when mixed with energy drinks (AMED) and mixed with other non-alcoholic beverages (AMOB) using a within-subject design. Results: The most frequent neutral motives reported for AMED consumption included "I like the taste" (66.5%), and "to celebrate a special occasion" (35.2%). 52.6% of AMED consumers reported consuming AMED for at least one of five negative motives, primarily "to get drunk" (45.6%). Despite these negative motives those students reported consuming significantly less alcohol and fewer negative alcohol-related consequences on AMED occasions compared to alcohol-only (AO) occasions. Although the motives for consuming AMED and AMOB were comparable, more participants reported consuming AMED "to celebrate a special occasion", "to get drunk", because they "received the drink from someone else" or "because others drink it as well". However, significantly more students reported consuming AMOB than AMED because "It feels like I can drink more alcohol". Alcohol consumption was significantly less on AMED occasions compared to AMOB occasions, and both occasions significantly less than AO occasions. Conclusion: The majority of reasons for consuming AMED relate to neutral motives. Although 52.6% of students reported one or more negative motives for AMED consumption (predominantly "to get drunk") this had no differential effect on total alcohol consumption. The differences in motives suggest AMED is consumed more to enjoy special occasions and as a group-bonding experience, however alcohol consumption is significantly lower on such occasions in comparison to when AMOB or AO are consumed

Exploring the Impacts of Educational Simulations on The Development of 21st Century Skills and Sense of Self-Efficacy

The study of educational simulations at the secondary level has typically centered on programs that are competitive, shorter in duration, and characterized by their low fidelity, or a lack of realism. The resources required to hold longer, more immersive, and nuanced programs are often prohibitive for teachers of political science programs. As such, their effects on student learning outcomes have remained relatively unknown. In this paper, we explore the impact of a Model G20 (MG20) curriculum for high school and early college-aged students on students’ sense of self-efficacy and 21st century skills. MG20 is a weeklong, immersive international conference modeled after the real G20 summit. In it, students learn about global governance and roleplay as heads of state and government ministers to negotiate for their collective interests. Using a mixed methods approach, we examine student learning outcomes from two MG20 summits, held in the United States and in the UK. Results show that internationally diverse, immersive, collaborative role-playing simulations significantly improve students’ self-ascribed cross-cultural communication and public speaking skills, as well as students’ sense self-efficacy. This research suggests future study into new and emerging formats of educational simulations may reveal greater potential for such programs to enhance student learning

Clinical characteristics of emergency department heart failure patients initially diagnosed as non-heart failure

BACKGROUND: Since previous studies suggest the emergency department (ED) misdiagnosis rate of heart failure is 10–20% we sought to describe the characteristics of ED patients misdiagnosed as non-decompensated heart failure in the ED. METHODS: We analyzed a prospective convenience sample of 439 patients at 4 emergency departments who presented with signs or symptoms of decompensated heart failure. Patients with a cardiology criterion standard diagnosis of decompensated heart failure and an ED diagnosis of decompensated heart failure were compared to patients with a criterion standard of decompensated heart failure but no ED diagnosis of decompensated heart failure. Two senior cardiology fellows retrospectively determined the patient's heart failure status during their acute ED presentation. The Mann-Whitney u-test for two groups, the Kruskall-Wallis test for multiple groups, or Chi-square tests, were used as appropriate. RESULTS: There were 173 (39.4%) patients with a criterion standard diagnosis of decompensated heart failure. Among those with this criterion standard diagnosis of decompensated heart failure, discordant patients without an ED diagnosis of decompensated heart failure (n = 58) were more likely to have a history of COPD (p = 0.017), less likely to have a previous history of heart failure (p = 0.014), and less likely to have an elevated b-type natriuretic peptide (BNP) level (median 518 vs 764 pg/ml; p = 0.038) than those who were given a concordant ED diagnosis of decompensated heart failure. BNP levels were higher in those with a criterion standard diagnosis of decompensated heart failure than in those without a criterion standard diagnosis (median 657 vs 62.7 pg/ml). However, 34.6% of patients with decompensated heart failure had BNP levels in the normal (<100 pg/ml; 6.1%) or indeterminate range (100–500 pg/ml; 28.5%). CONCLUSION: We found the ED diagnoses of decompensated heart failure to be discordant with the criterion standard in 14.3% of patients, the vast majority of which were due to a failure to diagnose heart failure when it was present. Patients with a previous history of COPD, without a previous history of heart failure and with lower BNP levels were more likely to have an ED misdiagnosis of non-decompensated heart failure. Readily available, accurate, objective ED tests are needed to improve the early diagnosis of decompensated heart failure in ED patients

SenseMyStreet: Sensor Commissioning Toolkit for Communities

The rise of big data and smart sensing, with the promise of more educated and informed decisions, has fuelled a shift towards more data-driven decision-making in local and national government. However, we are observing a disconnect between the people who are affected by these decisions and their access to tools and resources to collect data in order to provide the needed evidence for change. To truly democratise this process and for citizens to become active prosumers of data, new mechanisms of citizen data production are needed. In this paper we report on a two-year ethnographic and iterative co-design process with the local community. This work encompassed the design, development and deployment of SenseMyStreet (SeMS), a bespoke sensor commissioning toolkit that enables citizens and community groups to use and commission a city's scientific-grade environmental monitors, determining where they will be located on their streets and collecting data to evidence hyper-local issues. Unlike prior research, which creates alternative data sources to contest city data, our toolkit helps integrate citizen commissioned data into the city datasets used by citizens and decision-makers. Reflecting on the design process and evaluating the ways people engaged with the digital tools of the toolkit, we highlight how commissioning can be configured to promote equity in the smart city, empower citizens to take ownership of issues and facilitate the creation of community networks that utilise the data for local benefit

Pulmonary hypertension in chronic lung disease and hypoxia

Pulmonary hypertension (PH) frequently complicates the course of patients with various forms of chronic lung disease (CLD). CLD-associated PH (CLD-PH) is invariably associated with reduced functional ability, impaired quality of life, greater oxygen requirements and an increased risk of mortality. The aetiology of CLD-PH is complex and multifactorial, with differences in the pathogenic sequelae between the diverse forms of CLD. Haemodynamic evaluation of PH severity should be contextualised within the extent of the underlying lung disease, which is best gauged through a combination of physiological and imaging assessment. Who, when, if and how to screen for PH will be addressed in this article, as will the current state of knowledge with regard to the role of treatment with pulmonary vasoactive agents. Although such therapy cannot be endorsed given the current state of findings, future studies in this area are strongly encouraged

Out of equilibrium: understanding cosmological evolution to lower-entropy states

Despite the importance of the Second Law of Thermodynamics, it is not absolute. Statistical mechanics implies that, given sufficient time, systems near equilibrium will spontaneously fluctuate into lower-entropy states, locally reversing the thermodynamic arrow of time. We study the time development of such fluctuations, especially the very large fluctuations relevant to cosmology. Under fairly general assumptions, the most likely history of a fluctuation out of equilibrium is simply the CPT conjugate of the most likely way a system relaxes back to equilibrium. We use this idea to elucidate the spacetime structure of various fluctuations in (stable and metastable) de Sitter space and thermal anti-de Sitter space.Comment: 27 pages, 11 figure

Testing The Friedmann Equation: The Expansion of the Universe During Big-Bang Nucleosynthesis

In conventional general relativity, the expansion rate H of a Robertson-Walker universe is related to the energy density by the Friedmann equation. Aside from the present day, the only epoch at which we can constrain the expansion history in a model-independent way is during Big-Bang Nucleosynthesis (BBN). We consider a simple two-parameter characterization of the behavior of H during BBN and derive constraints on this parameter space, finding that the allowed region of parameter space is essentially one-dimensional. We also study the effects of a large neutrino asymmetry within this framework. Our results provide a simple way to compare an alternative cosmology to the observational requirement of matching the primordial abundances of the light elements.Comment: 18 pages, Final version to be published in Phys. Rev.

In it together! Cultivating space for intergenerational dialogue, empathy and hope in a climate of uncertainty

The urgent and interlocking social, economic and ecological crises faced by societies around the world require dialogue, empathy and above all, hope that transcends social divides. At a time of uncertainty and crisis, many societies are divided, with distrust and divides exacerbated by media representations pitting different groups against one another. Acknowledging intersectional interrelationships, this collaborative paper considers one type of social distinction – generation – and focuses on how trust can be rebuilt across generations. To do this, we collate key insights from eight projects that shared space within a conference session foregrounding creative, intergenerational responses to the climate and related crises. Prompted by a set of reflective questions, presenters commented on the methodological resources that were co-developed in intergenerational research and action spaces. Most of the work outlined was carried out in the UK, situated in challenges that are at once particular to local contexts, and systematic of a wider malaise that requires intergenerational collaboration. Reflecting across the projects, we suggest fostering ongoing, empathetic dialogues across generations is key to addressing these challenges of the future, securing communities that are grounded as collaborative and culturally responsive, and resilient societies able to adapt to and mitigate the impacts of change

What’s Next for Acute Heart Failure Research?

Each year over one million patients with acute heart failure (AHF) present to a United States emergency department (ED). The vast majority are hospitalized for further management. The length of stay and high postdischarge event rate in this cohort have changed little over the past decade. Therapeutic trials have failed to yield substantive improvement in postdischarge outcomes; subsequently, AHF care has changed little in the past 40 years. Prior research studies have been fragmented as either “inpatient” or “ED-based.” Recognizing the challenges in identification and enrollment of ED patients with AHF, and the lack of robust evidence to guide management, an AHF clinical trials network was developed. This network has demonstrated, through organized collaboration between cardiology and emergency medicine, that many of the hurdles in AHF research can be overcome. The development of a network that supports the collaboration of acute care and HF researchers, combined with the availability of federally funded infrastructure, will facilitate more efficient conduct of both explanatory and pragmatic trials in AHF. Yet many important questions remain, and in this document our group of emergency medicine and cardiology investigators have identified four high-priority research areas

Clinical and Research Considerations for Patients with Hypertensive Acute Heart Failure

Management approaches for patients in the emergency department (ED) who present with acute heart failure (AHF) have largely focused on intravenous diuretics. Yet, the primary pathophysiologic derangement underlying AHF in many patients is not solely volume overload. Patients with hypertensive AHF (H-AHF) represent a clinical phenotype with distinct pathophysiologic mechanisms that result in elevated ventricular filling pressures. To optimize treatment response and minimize adverse events in this subgroup, we propose that clinical management be tailored to a conceptual model of disease based on these mechanisms. This consensus statement reviews the relevant pathophysiology, clinical characteristics, approach to therapy, and considerations for clinical trials in ED patients with H-AHF