150-427: David Revell "Darkie" Bedell-Sivright (8 December 1880 – 5 September 1915) was a Scottish international rugby union forward who captained both Scotland and the British Isles . Born in Edinburgh, and educated at Fettes College where he learned to play rugby, he studied at Cambridge University and earned four Blues playing for them in the Varsity Match . He was first selected for Scotland in 1900 in
300-563: A British Isles team visited Australia and New Zealand—although a private venture, it laid the foundations for future British and Irish Lions tours; and the 1888–89 New Zealand Native football team brought the first overseas team to British spectators. During the early history of rugby union, a time before commercial air travel, teams from different continents rarely met. The first two notable tours both took place in 1888—the British Isles team touring New Zealand and Australia, followed by
450-412: A fever . Severe sepsis causes poor organ function or blood flow. The presence of low blood pressure , high blood lactate , or low urine output may suggest poor blood flow. Septic shock is low blood pressure due to sepsis that does not improve after fluid replacement . Sepsis is caused by many organisms including bacteria, viruses, and fungi. Common locations for the primary infection include
600-448: A focus of infection and reduce conditions favorable to microorganism growth or host defense impairment, such as drainage of pus from an abscess . It is one of the oldest procedures for control of infections, giving rise to the Latin phrase Ubi pus, ibi evacua , and remains important despite the emergence of more modern treatments. Early goal directed therapy (EGDT) is an approach to
750-488: A haka before each match, leading Welsh Rugby Union administrator Tom Williams to suggest that Wales player Teddy Morgan lead the crowd in singing the Welsh National Anthem, Hen Wlad Fy Nhadau , as a response. After Morgan began singing, the crowd joined in: the first time a national anthem was sung at the start of a sporting event. In 1905 France played England in its first international match. Rugby union
900-598: A New Zealand newspaper, Bedell-Sivright only ever claimed his side was "stale" after a loss, and never before. A New Zealand representative side was scheduled to tour the British Isles in 1905, and Bedell-Sivright did not report favourably on their chances of success. This may have contributed to the Home Nations underestimating the All Blacks ;– as the 1905 team become known – who ended up winning all but one of their 35 matches. Bedell-Sivright
1050-520: A PAMP and a PRR will cause a series of intracellular signalling cascades. Consequentially, transcription factors such as nuclear factor-kappa B and activator protein-1 , will up-regulate the expression of pro-inflammatory and anti-inflammatory cytokines. Upon detection of microbial antigens , the host systemic immune system is activated. Immune cells not only recognise pathogen-associated molecular patterns but also damage-associated molecular patterns from damaged tissues. An uncontrolled immune response
1200-538: A cart horse in Princes Street in Edinburgh after apparently laying down on a city tram track – this held up the traffic for an hour as no policeman would approach him. It is not clear exactly where Bedell-Sivright picked up the nickname "Darkie". One explanation is that it was due to "cynical" tactics he employed as captain, the other is that it was due to the dark rings around his eyes. On 25 January 1915 Bedell-Sivright
1350-628: A change in the risk of death with etomidate. Paralytic agents are not suggested for use in sepsis cases in the absence of ARDS , as a growing body of evidence points to reduced durations of mechanical ventilation , ICU and hospital stays. However, paralytic use in ARDS cases remains controversial. When appropriately used, paralytics may aid successful mechanical ventilation, however, evidence has also suggested that mechanical ventilation in severe sepsis does not improve oxygen consumption and delivery. Source control refers to physical interventions to control
1500-554: A deficiency of chemicals that constrict blood vessels such as vasopressin , and activation of ATP-sensitive potassium channels . In those with severe sepsis and septic shock, this sequence of events leads to a type of circulatory shock known as distributive shock . Early diagnosis is necessary to properly manage sepsis, as the initiation of rapid therapy is key to reducing deaths from severe sepsis. Some hospitals use alerts generated from electronic health records to bring attention to potential cases as early as possible. Within
1650-462: A fast heart rate , confusion , and edema . Early signs include a rapid heart rate, decreased urination , and high blood sugar . Signs of established sepsis include confusion, metabolic acidosis (which may be accompanied by a faster breathing rate that leads to respiratory alkalosis ), low blood pressure due to decreased systemic vascular resistance , higher cardiac output , and disorders in blood-clotting that may lead to organ failure. Fever
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#17328728410921800-580: A limited number of games, and Cambridge and Oxford continued their annual University Match . The first officially sanctioned international rugby sevens tournament took place in 1973 at Murrayfield, one of Scotland's biggest stadiums, as part of the Scottish Rugby Union centenary celebrations. In 1987, the first Rugby World Cup was held in Australia and New Zealand, and the inaugural winners were New Zealand. The first World Cup Sevens tournament
1950-415: A lineout throw is generally awarded to the opposition at the spot on the sideline where they left the field. Exceptions include a kick out "on the full" (i.e. the ball did not land in the field-of-play before going into touch) in which case the lineout would still take place on the sideline but back in line with where the ball was kicked, or when a team takes a free kick from a penalty where they would retain
2100-517: A match against Wales . After playing in all of Scotland's Home Nations Championship matches in 1901, 1902 and 1903, Bedell-Sivright toured with the British Isles side – now known as the British & Irish Lions – that toured South Africa in 1903. After playing the first 12 matches of the tour, he was injured and so did not play in any of the Test matches against South Africa . The next year Bedell-Sivright
2250-435: A mean arterial pressure of between 65 and 90 mmHg, a central venous oxygen saturation (ScvO 2 ) greater than 70% and a urine output of greater than 0.5 mL/kg/hour. The goal is to optimize oxygen delivery to tissues and achieve a balance between systemic oxygen delivery and demand. An appropriate decrease in serum lactate may be equivalent to ScvO 2 and easier to obtain. In the original trial, early goal-directed therapy
2400-493: A million cases per year in the United States. Rates of disease have been increasing. Some data indicate that sepsis is more common among males than females, however, other data show a greater prevalence of the disease among women. Descriptions of sepsis date back to the time of Hippocrates . In addition to symptoms related to the actual cause, people with sepsis may have a fever , low body temperature , rapid breathing ,
2550-413: A new consensus was reached to replace screening by systemic inflammatory response syndrome (SIRS) with the sequential organ failure assessment ( SOFA score ) and the abbreviated version ( qSOFA ). The three criteria for the qSOFA score include a respiratory rate greater than or equal to 22 breaths per minute, systolic blood pressure 100 mmHg or less and altered mental status. Sepsis is suspected when 2 of
2700-530: A preferred or standard 68 metre width, this is often used unless a ground has been specifically designed to accommodate a 70-metre rugby field. 100 metres is the typical length, with a line (see below) often marked at halfway with "50" on it, representing 50 metres from each goal line. The variations have been allowed in the Laws, possibly to accommodate older grounds (perhaps even pre-metrification when yards and feet were specified) and developing nations. The field of play
2850-558: A scholarship in Bedell-Sivright's honour; the scholarships of between £500 and £2000 per year are intended "to attract the best young talent in the UK [United Kingdom] to play and study at The University of Edinburgh". Writing in 1919, rugby journalist and author E. H. D. Sewell said of Bedell-Sivright "If a plebiscite was taken on the question: "Who was the hardest forward who ever played International football?" Sivright would get most votes if
3000-648: A state of adrenal insufficiency and tissue resistance to corticosteroids may occur. This has been termed critical illness–related corticosteroid insufficiency . Treatment with corticosteroids might be most beneficial in those with septic shock and early severe ARDS, whereas its role in others such as those with pancreatitis or severe pneumonia is unclear. However, the exact way of determining corticosteroid insufficiency remains problematic. It should be suspected in those poorly responding to resuscitation with fluids and vasopressors. Neither ACTH stimulation testing nor random cortisol levels are recommended to confirm
3150-466: A successful penalty kick or a drop goal each score 3 points. The values of each of these scoring methods have been changed over the years. According to World Rugby's Laws of the Game, a typical rugby ground, formally known as the "playing enclosure", is formed by two major zones: The referee (and their assistants) generally have full authority and responsibility for all players and other officials inside
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#17328728410923300-423: A team, like a general of an army, has an important part to play, and with every point he must be acquainted, or else disaster will almost invariably befall his side. The British team now on its way to Australasia will, judging from what one can learn, be well served in the way of leadership. D. R. Bedell-Sivright, who has been chosen as the skipper, has had vast experience as a leader. G. W. McArthur, selector of
3450-534: Is Chatswood Oval in Sydney, Australia, an elliptically shaped cricket ground which is the home of Gordon rugby club, that has curved dead-ball lines to maximise the available in-goal space. Where multiple sports share a field (e.g. a rugby league and a rugby union club sharing one field), lines may be overlaid on top of each other, sometimes in different colours. However, particularly for television, rugby union line markings are generally painted white. Some exceptions include
3600-399: Is also correlated with an increased chance that someone with sepsis will benefit from and respond to IV fluids . Infections leading to sepsis are usually bacterial but may be fungal , parasitic , or viral . Gram-positive bacteria were the primary cause of sepsis before the introduction of antibiotics in the 1950s. After the introduction of antibiotics, gram-negative bacteria became
3750-477: Is associated with lower mortality in sepsis. The differential diagnosis for sepsis is broad and has to examine (to exclude) the non-infectious conditions that may cause the systemic signs of SIRS: alcohol withdrawal , acute pancreatitis , burns , pulmonary embolism , thyrotoxicosis , anaphylaxis , adrenal insufficiency , and neurogenic shock . Hyperinflammatory syndromes such as hemophagocytic lymphohistiocytosis (HLH) may have similar symptoms and are on
3900-408: Is considered "out-of-bounds" for the ball and the players, normally resulting in the non-infringing team receiving possession of the ball at a restart. The perimeter area can be divided into two areas: For the purposes of determining if a ball is "out-of-bounds" (i.e. has left the playing area), the perimeter area extends indefinitely away from the playing area. When a ball or player goes into touch,
4050-457: Is controversial, with some reviews finding benefit, and others not. Disease severity partly determines the outcome. The risk of death from sepsis is as high as 30%, while for severe sepsis it is as high as 50%, and septic shock 80%. Sepsis affected about 49 million people in 2017, with 11 million deaths (1 in 5 deaths worldwide). In the developed world , approximately 0.2 to 3 people per 1000 are affected by sepsis yearly, resulting in about
4200-445: Is divided by a solid "halfway" line, drawn perpendicular to the sidelines at their midpoint. A 0.5m line is marked perpendicular to the halfway lines at its midpoint, designating the spot where the kickoffs shall be taken. The areas between each goal line and the halfway line are known as "halves" as in other football codes. A pair of solid lines are also drawn perpendicular to the sidelines, 22 metres (formerly 25 yards) from each end of
4350-804: Is followed primarily in the United Kingdom, Ireland, France, New Zealand, Australia, Pacific Islands - Fiji , Tonga , Samoa , Georgia , Oceania , Southern Africa , Argentina , and in recent times also, Italy , Japan , South America , the United States , Canada and Eastern Europe , its growth occurring during the expansion of the British Empire and through French proponents ( Rugby Europe ) in Europe. Countries that have adopted rugby union as their de facto national sport include Fiji , Georgia, Madagascar , New Zealand, Samoa , Tonga , and Wales . International matches have taken place since 1871 when
4500-433: Is helpful when looking for the possible location of the infection. Other potential causes of similar signs and symptoms include anaphylaxis , adrenal insufficiency , low blood volume , heart failure , and pulmonary embolism . Sepsis requires immediate treatment with intravenous fluids and antimicrobial medication. Ongoing care often continues in an intensive care unit . If an adequate trial of fluid replacement
4650-485: Is important in determining the survival of the person. Some recommend they be given within one hour of making the diagnosis, stating that for every hour of delay in the administration of antibiotics, there is an associated 6% rise in mortality. Others did not find a benefit with early administration. Several factors determine the most appropriate choice for the initial antibiotic regimen. These factors include local patterns of bacterial sensitivity to antibiotics, whether
David Bedell-Sivright - Misplaced Pages Continue
4800-475: Is no myocardial ischemia , hypoxemia , or acute bleeding. In a 2014 trial, blood transfusions to keep target hemoglobin above 70 or 90 g/L did not make any difference to survival rates; meanwhile, those with a lower threshold of transfusion received fewer transfusions in total. Erythropoietin is not recommended in the treatment of anemia with septic shock because it may precipitate blood clotting events. Fresh frozen plasma transfusion usually does not correct
4950-737: Is not enough to maintain blood pressure, then the use of medications that raise blood pressure becomes necessary. Mechanical ventilation and dialysis may be needed to support the function of the lungs and kidneys, respectively. A central venous catheter and an arterial catheter may be placed for access to the bloodstream and to guide treatment. Other helpful measurements include cardiac output and superior vena cava oxygen saturation . People with sepsis need preventive measures for deep vein thrombosis , stress ulcers , and pressure ulcers unless other conditions prevent such interventions. Some people might benefit from tight control of blood sugar levels with insulin . The use of corticosteroids
5100-450: Is not intended to replace the SIRS definition. qSOFA has also been found to be poorly sensitive though decently specific for the risk of death with SIRS possibly better for screening. NOTE - Surviving Sepsis Campaign 2021 Guidelines recommends "against using qSOFA compared with SIRS, NEWS, or MEWS as a single screening tool for sepsis or septic shock". Examples of end-organ dysfunction include
5250-563: Is not recommended in people who has SIRS without any infectious origin such as acute pancreatitis and burns unless sepsis is suspected. Once-daily dosing of aminoglycoside is sufficient to achieve peak plasma concentration for a clinical response without kidney toxicity. Meanwhile, for antibiotics with low volume distribution (vancomycin, teicoplanin, colistin), a loading dose is required to achieve an adequate therapeutic level to fight infections. Frequent infusions of beta-lactam antibiotics without exceeding total daily dose would help to keep
5400-477: Is often used as a first-line treatment for hypotensive septic shock because evidence shows that there is a relative deficiency of vasopressin when shock continues for 24 to 48 hours. Norepinephrine raises blood pressure through a vasoconstriction effect, with little effect on stroke volume and heart rate. In some people, the required dose of vasopressor needed to increase the mean arterial pressure can become exceedingly high that it becomes toxic. In order to reduce
5550-532: Is poor. Within twelve hours, it is essential to diagnose or exclude any source of infection that would require emergent source control, such as a necrotizing soft tissue infection, an infection causing inflammation of the abdominal cavity lining , an infection of the bile duct , or an intestinal infarction. A pierced internal organ (free air on an abdominal X-ray or CT scan), an abnormal chest X-ray consistent with pneumonia (with focal opacification), or petechiae , purpura , or purpura fulminans may indicate
5700-624: Is recommended as the fluid of choice for resuscitation. Albumin can be used if a large amount of crystalloid is required for resuscitation. Crystalloid solutions shows little difference with hydroxyethyl starch in terms of risk of death. Starches also carry an increased risk of acute kidney injury , and need for blood transfusion. Various colloid solutions (such as modified gelatin) carry no advantage over crystalloid. Albumin also appears to be of no benefit over crystalloids. The Surviving Sepsis Campaign recommended packed red blood cells transfusion for hemoglobin levels below 70 g/L if there
5850-702: Is recommended for moderate to severe ARDS in sepsis as it opens more lung units for oxygen exchange. Predicted body weight is calculated based on sex and height, and tools for this are available. Recruitment maneuvers may be necessary for severe ARDS by briefly raising the transpulmonary pressure. It is recommended that the head of the bed be raised if possible to improve ventilation. However, β2 adrenergic receptor agonists are not recommended to treat ARDS because it may reduce survival rates and precipitate abnormal heart rhythms . A spontaneous breathing trial using continuous positive airway pressure (CPAP), T piece, or inspiratory pressure augmentation can be helpful in reducing
6000-453: Is recommended. For methicillin-resistant Staphylococcus aureus (MRSA), vancomycin or teicoplanin is recommended. For Legionella infection, addition of macrolide or fluoroquinolone is chosen. If fungal infection is suspected, an echinocandin , such as caspofungin or micafungin , is chosen for people with severe sepsis, followed by triazole ( fluconazole and itraconazole ) for less ill people. Prolonged antibiotic prophylaxis
6150-423: Is the most common presenting symptom in sepsis, but fever may be absent in some people such as the elderly or those who are immunocompromised. The drop in blood pressure seen in sepsis can cause lightheadedness and is part of the criteria for septic shock . Oxidative stress is observed in septic shock, with circulating levels of copper and vitamin C being decreased. Diastolic blood pressure falls during
David Bedell-Sivright - Misplaced Pages Continue
6300-440: Is the third and final row of the forward positions, who are often referred to as the loose forwards. The three positions in the back row are the two flankers and the number 8 . The two flanker positions, known as the blindside flanker and openside flanker, are the final row in the scrum. They are usually the most mobile forwards in the game. Their main role is to win possession through 'turn overs'. The number 8 packs down between
6450-413: Is then activated because leukocytes are not recruited to the specific site of infection, but instead they are recruited all over the body. Then, an immunosuppression state ensues when the proinflammatory T helper cell 1 (TH1) is shifted to TH2, mediated by interleukin 10 , which is known as "compensatory anti-inflammatory response syndrome". The apoptosis (cell death) of lymphocytes further worsens
6600-976: The Top 14 in France, the Bunnings NPC in New Zealand, the League One in Japan and the Currie Cup in South Africa. Other transnational club competitions include the United Rugby Championship of club teams from Ireland, Italy, Scotland, South Africa and Wales, European Rugby Champions Cup in Europe, and Super Rugby in Australia, New Zealand and the Pacific Islands. Primitive forms of football included harpastum , played by
6750-448: The Varsity matches – contested against Oxford University – between 1899 and 1902; this won him four sporting Blues . He was first capped for Scotland in 1900 in a match against Wales at St Helen's , Swansea. The match was a turning point for Welsh rugby, who won 12–3, but the selectors stuck with Bedell-Sivright who won another 21 caps for his country. He is
6900-482: The cells lining blood vessels , leading to endothelial damage. The damaged endothelial surface inhibits anticoagulant properties as well as increases antifibrinolysis , which may lead to intravascular clotting, the formation of blood clots in small blood vessels, and multiple organ failure . The low blood pressure seen in those with sepsis is the result of various processes, including excessive production of chemicals that dilate blood vessels such as nitric oxide ,
7050-593: The central venous pressure reaches 8–12 mmHg. Once these goals are met, the central venous oxygen saturation (ScvO2), i.e., the oxygen saturation of venous blood as it returns to the heart as measured at the vena cava, is optimized. If the ScvO2 is less than 70%, blood may be given to reach a hemoglobin of 10 g/dL and then inotropes are added until the ScvO2 is optimized. In those with acute respiratory distress syndrome (ARDS) and sufficient tissue blood fluid, more fluids should be given carefully. Crystalloid solution
7200-463: The immune system . Common signs and symptoms include fever , increased heart rate , increased breathing rate , and confusion . There may also be symptoms related to a specific infection, such as a cough with pneumonia , or painful urination with a kidney infection . The very young, old, and people with a weakened immune system may have no symptoms of a specific infection, and their body temperature may be low or normal instead of constituting
7350-561: The peptidoglycan of the gram-positive bacterial cell wall, and CpG bacterial DNA . These PAMPs are recognized by the pattern recognition receptors (PRRs) of the innate immune system, which may be membrane-bound or cytosolic. There are four families of PRRs: the toll-like receptors , the C-type lectin receptors, the NOD-like receptors , and the RIG-I-like receptors . Invariably, the association of
7500-401: The quick SOFA score (qSOFA), replaced the SIRS system of diagnosis. qSOFA criteria for sepsis include at least two of the following three: increased breathing rate, change in the level of consciousness, and low blood pressure. Sepsis guidelines recommend obtaining blood cultures before starting antibiotics; however, the diagnosis does not require the blood to be infected . Medical imaging
7650-502: The split between rugby union and rugby league . Historically rugby union was an amateur sport, but in 1995 formal restrictions on payments to players were removed, making the game openly professional at the highest level for the first time. Rugby union spread from the Home Nations of the United Kingdom and Ireland , with other early exponents of the sport including Australia , New Zealand , South Africa and France . The sport
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#17328728410927800-456: The 1830s, "running in" with the ball in hand was allowed but subject to hacking and "collaring". Former Rugby School student Albert Pell is credited with having formed the first "football" team while a student at Cambridge University . Major private schools each used different rules during this early period, with former pupils from Rugby and Eton attempting to carry their preferred rules through to their universities. A significant event in
7950-588: The 1904 British Isles team, on Bedell-Sivright In 1904, at the request of the England Rugby Board (known as the Rugby Football Union ), Bedell-Sivright was selected to lead a British Lions team on a tour of Australia and New Zealand. He only played in one Test, against Australia, because of a broken leg, but the team did go undefeated in Australia ;– winning all their matches there, and
8100-522: The English Rugby Union team. However, it was considered the Combined British team by Argentina because it also included three Scots. Note 5 : Jack Jones was captain for the first test, but Tommy Smyth remained the tour captain. Note 6 : Bleddyn Williams captained in the third and fourth tests v New Zealand and the first test v Australia. Note 7 : Cliff Morgan captained in
8250-720: The First World War, and died on active service during the Gallipoli Campaign . Bedell-Sivright had a reputation as an aggressive and hard rugby player, as well as a ferocious competitor. He was an inaugural inductee into the Scottish Rugby Hall of Fame, and in 2013 was inducted into the International Rugby Board (IRB) Hall of Fame . David Bedell-Sivright was born in Edinburgh in 1880 to William Henry Revell Bedell-Sivright of North Queensferry . Bedell-Sivright
8400-586: The International Rugby Football Board (IRFB) and the International Rugby Board (IRB), has been the governing body for rugby union since 1886, and currently has 116 countries as full members and 18 associate members. In 1845, the first laws were written by pupils at Rugby School; other significant events in the early development of rugby include the decision by Blackheath F.C. to leave The Football Association in 1863 and, in 1895,
8550-506: The Laws: Generally, points where the dashed lines intersect other lines will be marked with a "T" or cross shape, although the extensions of dashed lines are generally not drawn within 5 metres of the goal lines or sidelines, to allow a clear demarcation of the field of play's boundaries. The Laws require the playing area to be rectangular in shape, however variations may be permitted with the approval of relevant unions. A notable example
8700-801: The New Zealand team touring Europe. Traditionally the most prestigious tours were the Southern Hemisphere countries of Australia, New Zealand and South Africa making a tour of a Northern Hemisphere, and the return tours made by a joint British and Irish team. Tours would last for months, due to long traveling times and the number of games undertaken; the 1888 New Zealand team began their tour in Hawkes Bay in June and did not complete their schedule until August 1889, having played 107 rugby matches. Touring international sides would play Test matches against international opponents, including national, club and county sides in
8850-591: The PCT to direct antibiotic therapy for improved antibiotic stewardship and better patient outcomes. A 2012 systematic review found that soluble urokinase-type plasminogen activator receptor (SuPAR) is a nonspecific marker of inflammation and does not accurately diagnose sepsis. This same review concluded, however, that SuPAR has prognostic value, as higher SuPAR levels are associated with an increased rate of death in those with sepsis. Serial measurement of lactate levels (approximately every 4 to 6 hours) may guide treatment and
9000-472: The Romans, where two opposing teams competed to throw a large ball into an opposition net, fighting for possession of the ball. Medieval Irishmen played caid , carrying an inflated bladder and using arched trees as goals. The Welsh played an inter-parish game using a wooden ball called cnapan . Frenchmen played soule and Georgians played lelo. "Football" as a game was well established by 1803 at Rugby School and by
9150-659: The Scottish forwards as "fast, vigorous and good dribblers", and they led 7–6 at half-time. However the New Zealanders were the better team, and scored six unanswered points in the second half to win 12–6. In 1906 the South Africans were touring the British Isles, and Bedell-Sivright was selected for the Scotland side that defeated them 6–0. This was the last Home Nations team to defeat South Africa in nearly 60 years. Hence he became
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#17328728410929300-475: The Wallabies (Australia's national team) who often have yellow markings. Local clubs may use black, yellow, or other colours on grass, with other surfaces possibly requiring different marking techniques. Unlike association football, where on-field advertising is strictly forbidden in the laws, World Rugby allows sponsors logos to be painted on the playing surface. This is another way in which clubs can make money in
9450-462: The absence of antigen presentation . This forced receptor interaction induces the production of pro-inflammatory chemical signals ( cytokines ) by T-cells. There are a number of microbial factors that may cause the typical septic inflammatory cascade . An invading pathogen is recognized by its pathogen-associated molecular patterns (PAMPs). Examples of PAMPs include lipopolysaccharides and flagellin in gram-negative bacteria, muramyl dipeptide in
9600-464: The antibiotics level above minimum inhibitory concentration (MIC), thus providing a better clinical response. Giving beta-lactam antibiotics continuously may be better than giving them intermittently. Access to therapeutic drug monitoring is important to ensure adequate drug therapeutic level while at the same time preventing the drug from reaching toxic level. The Surviving Sepsis Campaign has recommended 30 mL/kg of fluid to be given in adults in
9750-431: The backs and the forwards is that the backs are expected to have superior kicking and ball-handling skills, especially the fly-half, scrum-half, and full-back. The half-backs consist of two positions, the scrum-half and the fly-half , also known in the Southern Hemisphere as half-back and first five-eighth respectively. The fly-half is crucial to a team's game plan, orchestrating the team's performance. They are usually
9900-472: The ball in hand. In its most common form, a game is played between two teams of 15 players each, using an oval-shaped ball on a rectangular field called a pitch. The field has H-shaped goalposts at both ends. Rugby union is a popular sport around the world, played by people regardless of gender, age or size. In 2023, there were more than 10 million people playing worldwide, of whom 8.4 million were registered players. World Rugby , previously called
10050-422: The ball is kicked into touch by a player who had at least one foot on or behind their own 22-metre line, the line-out formed at the spot where the ball crossed the touch-line instead of being taken in line with the spot from where it was kicked. Additional broken or dashed lines (of 5 metre dash lengths, according to the Laws ) are drawn in each half or on each side of, the field, each with specific purposes under
10200-417: The ball. Forwards play a vital role in tackling and rucking opposing players. Players in these positions are generally bigger and stronger and take part in the scrum and line-out. The forwards are often collectively referred to as the 'pack', especially when in the scrum formation. The front row consists of three players: two props (the loosehead prop and the tighthead prop) and the hooker . The role of
10350-425: The blood also does not demonstrate any survival benefit for septic shock. If the person has been sufficiently fluid resuscitated but the mean arterial pressure is not greater than 65 mmHg, vasopressors are recommended. Norepinephrine (noradrenaline) is recommended as the initial choice. Delaying initiation of vasopressor therapy during septic shock is associated with increased mortality. Norepinephrine
10500-490: The blood pressure should be adequate, close monitoring of blood pressure and blood supply to organs should be in place, and the lactate should be measured again if initially it was raised. A related bundle, the " Sepsis Six ", is in widespread use in the United Kingdom ; this requires the administration of antibiotics within an hour of recognition, blood cultures, lactate, and hemoglobin determination, urine output monitoring, high-flow oxygen, and intravenous fluids. Apart from
10650-578: The case of Northern Hemisphere rugby, or provincial/state sides in the case of Southern Hemisphere rugby. Between 1905 and 1908, all three major Southern Hemisphere rugby countries sent their first touring teams to the Northern Hemisphere: New Zealand in 1905, followed by South Africa in 1906 and Australia in 1908. All three teams brought new styles of play, fitness levels and tactics, and were far more successful than critics had expected. The New Zealand 1905 touring team performed
10800-558: The clubs that had favoured the Rugby Rules formed the Rugby Football Union in 1871, and their code became known as " rugby football ". In 1895, there was a major schism within rugby football in England in which numerous clubs from Northern England resigned from the RFU over the issue of reimbursing players for time lost from their workplaces. The split highlighted the social and class divisions in
10950-528: The diagnosis. The method of stopping glucocorticoid drugs is variable, and it is unclear whether they should be slowly decreased or simply abruptly stopped. However, the 2016 Surviving Sepsis Campaign recommended to taper steroids when vasopressors are no longer needed. A target tidal volume of 6 mL/kg of predicted body weight (PBW) and a plateau pressure less than 30 cm H 2 O is recommended for those who require ventilation due to sepsis-induced severe ARDS. High positive end expiratory pressure (PEEP)
11100-499: The differential diagnosis. In common clinical usage, neonatal sepsis refers to a bacterial blood stream infection in the first month of life, such as meningitis , pneumonia , pyelonephritis , or gastroenteritis , but neonatal sepsis also may be due to infection with fungi, viruses, or parasites. Criteria with regard to hemodynamic compromise or respiratory failure are not useful because they present too late for intervention. Early recognition and focused management may improve
11250-415: The duration of ventilation. Minimizing intermittent or continuous sedation is helpful in reducing the duration of mechanical ventilation. General anesthesia is recommended for people with sepsis who require surgical procedures to remove the infective source. Usually, inhalational and intravenous anesthetics are used. Requirements for anesthetics may be reduced in sepsis. Inhalational anesthetics can reduce
11400-489: The early development of rugby football was the production of a written set of rules at Rugby School in 1845, followed by the Cambridge Rules that were drawn up in 1848. Formed in 1863, the national governing body The Football Association (FA) began codifying a set of universal football rules. These new rules specifically banned players from running with the ball in hand and also disallowed hacking (kicking players in
11550-444: The early stages of sepsis, causing a widening/increasing of pulse pressure , which is the difference between the systolic and diastolic blood pressures. If sepsis becomes severe and hemodynamic compromise advances, the systolic pressure also decreases, causing a narrowing/decreasing of pulse pressure. A pulse pressure of over 70 mmHg in patients with sepsis is correlated with an increased chance of survival. A widened pulse pressure
11700-480: The field are divided into eight forwards (two more than in rugby league ) and seven backs . There are typically significantly more forwards on the bench than backs with, for example, South Africa having a 7-1 split in favour of forwards in their August 2023 match against New Zealand in Twickenham. A 6-2 or 5-3 split is more common. The main responsibilities of the forward players are to gain and retain possession of
11850-405: The field for 20 minutes while disputing the decision with Dolan and the other officials. Eventually the British side returned to play, but without Dobson. Following the match Bedell-Sivright accused the referee of incompetence, and an inquiry eventually cleared Dobson of using indecent language, but he became the first British Isles player ever ordered off. The five-match New Zealand leg of the tour
12000-401: The field of play and called the 22-metre lines, or "22"s. An area at each end, also known as the "22", is bounded by, but does not include, the sidelines, goal line and 22-metre line. In this area, a defensive player who cleanly catches a ball kicked by the other team, without the ball having already touched the ground after the kick, is entitled to claim a free kick, or " mark ". Additionally, if
12150-418: The field to accommodate fitter and faster (or heavier) players. Fixed cameras on tripods and advertising hoardings are often the main culprits for injuring players in the perimeter area. Sepsis Sepsis is a potentially life-threatening condition that arises when the body's response to infection causes injury to its own tissues and organs. This initial stage of sepsis is followed by suppression of
12300-516: The first Home Nations' player to contest a Test match against each of Australia, New Zealand, and South Africa. Bedell-Sivright was one of the inaugural inductees into the Scottish Rugby Hall of Fame in 2010, and in 2013 was inducted into the IRB Hall of Fame in a ceremony that honoured players from the British & Irish Lions (as the British Isles team is now known) and Australia during that year's Lions tour of Australia . Edinburgh University RFC have
12450-459: The first game was played between Scotland and England at Raeburn Place in Edinburgh. The Rugby World Cup , first held in 1987, is held every four years. The Six Nations Championship in Europe and The Rugby Championship in the Southern Hemisphere are other important international competitions that are held annually. National club and provincial competitions include the Premiership in England,
12600-474: The first test that he should withdraw from further test matches, handing on field captaincy to Frank Stout , but remained tour captain. Note 3 : David Bedell-Sivright was injured during the first test. Teddy Morgan took over captaincy on the field but Bedell-Sivright remained tour captain. Note 4 : The team that John Raphael captained was not selected by the four Home Nations governing body, but had been organised by Oxford University and billed as
12750-418: The first three hours followed by fluid titration according to blood pressure, urine output, respiratory rate, and oxygen saturation with a target mean arterial pressure (MAP) of 65 mmHg. In children an initial amount of 20 mL/kg is reasonable in shock. In cases of severe sepsis and septic shock where a central venous catheter is used to measure blood pressures dynamically, fluids should be administered until
12900-456: The first three hours of suspected sepsis, diagnostic studies should include white blood cell counts , measuring serum lactate, and obtaining appropriate cultures before starting antibiotics, so long as this does not delay their use by more than 45 minutes. To identify the causative organism(s), at least two sets of blood cultures using bottles with media for aerobic and anaerobic organisms are necessary. At least one should be drawn through
13050-425: The first to receive the ball from the scrum-half following a breakdown, lineout, or scrum, and need to be decisive with what actions to take and be effective at communicating with the outside backs. Many fly-halves are also their team's goal kickers. The scrum-half is the link between the forwards and the backs. They receive the ball from the lineout and remove the ball from the back of the scrum, usually passing it to
13200-537: The fly-half. They also feed the scrum and sometimes have to act as a fourth loose forward. There are four three quarter positions: two centres (inside and outside) and two wings (left and right). In the Southern Hemisphere, the inside centre is commonly referred to as the second five-eighth, while the outside centre is simply known as the centre. The centres will attempt to tackle attacking players; whilst in attack, they should employ speed and strength to breach opposition defences. The wings are generally positioned on
13350-499: The following: More specific definitions of end-organ dysfunction exist for SIRS in pediatrics. Consensus definitions, however, continue to evolve, with the latest expanding the list of signs and symptoms of sepsis to reflect clinical bedside experience. Biomarkers can help diagnosis because they can point to the presence or severity of sepsis, although their exact role in the management of sepsis remains undefined. A 2013 review concluded moderate-quality evidence exists to support
13500-414: The goal lines, equivalent to American football's "end zones". The in-goal areas must be between 6 and 22 metres (6.6 and 24.1 yards) deep and cover the full width of the field. A ball grounded in this area by an attacking player will generally result in a try being awarded, unless there has been a previous infringement, or the player has gone out-of-bounds whilst in possession of the ball. The perimeter area
13650-497: The heart, finger/toes, and abdominal organs, resulting in a lack of oxygen supply to these tissues. Dopamine is typically not recommended. Although dopamine is useful to increase the stroke volume of the heart, it causes more abnormal heart rhythms than norepinephrine and also has an immunosuppressive effect. Dopamine is not proven to have protective properties on the kidneys. Dobutamine can also be used in hypotensive septic shock to increase cardiac output and correct blood flow to
13800-583: The heart, impaired calcium transport, and low production of adenosine triphosphate (ATP), can cause myocardial depression, reducing cardiac contractility and causing heart failure . In the gastrointestinal tract , increased permeability of the mucosa alters the microflora, causing mucosal bleeding and paralytic ileus . In the central nervous system , direct damage of the brain cells and disturbances of neurotransmissions causes altered mental status. Cytokines such as tumor necrosis factor , interleukin 1 , and interleukin 6 may activate procoagulation factors in
13950-474: The host. Sepsis caused by gram-negative bacteria is thought to be largely due to a response by the host to the lipid A component of lipopolysaccharide , also called endotoxin . Sepsis caused by gram-positive bacteria may result from an immunological response to cell wall lipoteichoic acid . Bacterial exotoxins that act as superantigens also may cause sepsis. Superantigens simultaneously bind major histocompatibility complex and T-cell receptors in
14100-497: The immune system . Either of these phases may prove fatal. On the other hand, systemic inflammatory response syndrome (SIRS) occurs in people without the presence of infection, for example, in those with burns , polytrauma , or the initial state in pancreatitis and chemical pneumonitis . However, sepsis also causes similar response to SIRS. Bacterial virulence factors , such as glycocalyx and various adhesins , allow colonization, immune evasion, and establishment of disease in
14250-484: The immunosuppression. Neutrophils , monocytes , macrophages , dendritic cells , CD4+ T cells , and B cells all undergo apoptosis, whereas regulatory T cells are more apoptosis resistant. Subsequently, multiple organ failure ensues because tissues are unable to use oxygen efficiently due to inhibition of cytochrome c oxidase . Inflammatory responses cause multiple organ dysfunction syndrome through various mechanisms as described below. Increased permeability of
14400-406: The infection is thought to be a hospital or community-acquired infection, and which organ systems are thought to be infected. Antibiotic regimens should be reassessed daily and narrowed if appropriate. Treatment duration is typically 7–10 days with the type of antibiotic used directed by the results of cultures. If the culture result is negative, antibiotics should be de-escalated according to
14550-512: The initiation of antibiotics. Cultures from other sites such as respiratory secretions, urine, wounds, cerebrospinal fluid, and catheter insertion sites (in-situ more than 48 hours) are recommended if infections from these sites are suspected. In severe sepsis and septic shock, broad-spectrum antibiotics (usually two, a β-lactam antibiotic with broad coverage, or broad-spectrum carbapenem combined with fluoroquinolones , macrolides , or aminoglycosides ) are recommended. The choice of antibiotics
14700-510: The level of proinflammatory cytokines, altering leukocyte adhesion and proliferation, inducing apoptosis (cell death) of the lymphocytes, possibly with a toxic effect on mitochondrial function. Although etomidate has a minimal effect on the cardiovascular system, it is often not recommended as a medication to help with intubation in this situation due to concerns it may lead to poor adrenal function and an increased risk of death. The small amount of evidence there is, however, has not found
14850-451: The lung vessels causes leaking of fluids into alveoli, which results in pulmonary edema and acute respiratory distress syndrome (ARDS). Impaired utilization of oxygen in the liver impairs bile salt transport, causing jaundice (yellowish discoloration of the skin). In kidneys, inadequate oxygenation results in tubular epithelial cell injury (of the cells lining the kidney tubules), and thus causes acute kidney injury (AKI). Meanwhile, in
15000-468: The lungs, brain, urinary tract , skin, and abdominal organs . Risk factors include being very young or old, a weakened immune system from conditions such as cancer or diabetes , major trauma , and burns . Previously, a sepsis diagnosis required the presence of at least two systemic inflammatory response syndrome (SIRS) criteria in the setting of presumed infection. In 2016, a shortened sequential organ failure assessment score (SOFA score), known as
15150-406: The lungs. In one-third to one-half of cases, the source of infection is unclear. Sepsis is caused by a combination of factors related to the particular invading pathogen(s) and to the status of the immune system of the host. The early phase of sepsis characterized by excessive inflammation (sometimes resulting in a cytokine storm ) may be followed by a prolonged period of decreased functioning of
15300-427: The management of severe sepsis during the initial 6 hours after diagnosis. It is a step-wise approach, with the physiologic goal of optimizing cardiac preload, afterload, and contractility. It includes giving early antibiotics. EGDT also involves monitoring of hemodynamic parameters and specific interventions to achieve key resuscitation targets which include maintaining a central venous pressure between 8–12 mmHg,
15450-437: The most common cause of fungal sepsis is an infection by Candida species of yeast , a frequent hospital-acquired infection . The most common causes for parasitic sepsis are Plasmodium (which leads to malaria ), Schistosoma and Echinococcus . The most common sites of infection resulting in severe sepsis are the lungs, the abdomen, and the urinary tract. Typically, 50% of all sepsis cases start as an infection in
15600-414: The most important attributes of a good full-back are dependable catching skills and a good kicking game. Rugby union is played between two teams – the one that scores more points wins the game. Points can be scored in several ways: a try , scored by grounding the ball in the in-goal area (between the goal line and the dead-ball line), is worth 5 points and a subsequent conversion kick scores 2 points;
15750-575: The only Scottish player to have won three Triple Crowns – wins over Ireland, Wales and England within the same Home Nations Championship (now the Six Nations) ;– in 1901, 1903 and 1907. In 1903 Bedell-Sivright was selected for his first match with invitational touring side the Barbarians . He played a total of five games for the side between 1903 and 1907, and captained them against Cardiff RFC in 1907. Bedell-Sivright
15900-490: The outcomes in sepsis. Current professional recommendations include a number of actions ("bundles") to be followed as soon as possible after diagnosis. Within the first three hours, someone with sepsis should have received antibiotics, and intravenous fluids if there is evidence of either low blood pressure or other evidence for inadequate blood supply to organs (as evidenced by a raised level of lactate); blood cultures also should be obtained within this time period. After six hours
16050-414: The outside of the backline. Their primary function is to finish off moves and score tries. Wings are usually the fastest players in the team and are elusive runners who use their speed to avoid tackles. The full-back is normally positioned several metres behind the back line. They often field opposition kicks and are usually the last line of defence should an opponent break through the back line. Two of
16200-408: The person's clinical response or stopped altogether if an infection is not present to decrease the chances that the person is infected with multiple drug resistance organisms. In case of people having a high risk of being infected with multiple drug resistant organisms such as Pseudomonas aeruginosa , Acinetobacter baumannii , the addition of an antibiotic specific to the gram-negative organism
16350-440: The playing area and perimeter area, although depending on how large the perimeter is, other surfaces such as dirt, artificial turf, etc. may be used outside of a "sliding" perimeter from the bounds of the playing area. For the most part, the "playing area" is where the majority of play occurs. The ball is generally considered live whilst in this area, so long as players do not infringe, with special rules applied to specific zones of
16500-442: The playing area. The playing area consists of: A typical "field of play" is generally 100 metres long by 68–70 metres wide for senior rugby, depending on the specific requirements of each ground. The Laws require the field of play to be between 94 and 100 metres (103 and 109 yards) long, with a width of between 68 and 70 metres (74 and 77 yards). As other football codes, such as association football and rugby league, have specified
16650-432: The playing enclosure. Fences or ropes (particularly at amateur clubs) are generally used to mark the extent of this area, although in modern stadia this may include the entire arena floor or other designated space. The Laws, above all, require that the playing enclosure's surface be safe, whilst also permitting grass, sand, clay, snow or conforming artificial turf to be used; the surface would generally be uniform across both
16800-699: The pre-1995 period of rugby union was marked by frequent accusations of " shamateurism ", including an investigation in Britain by a House of Commons Select committee in early 1995. Following the introduction of professionalism trans-national club competitions were started, with the Heineken Cup in the Northern Hemisphere and Super Rugby in the Southern Hemisphere. The Tri Nations , an annual international tournament involving Australia, New Zealand and South Africa, kicked off in 1996. In 2012 , this competition
16950-427: The predominant cause of sepsis from the 1960s to the 1980s. After the 1980s, gram-positive bacteria, most commonly staphylococci , are thought to cause more than 50% of cases of sepsis. Other commonly implicated bacteria include Streptococcus pyogenes , Escherichia coli , Pseudomonas aeruginosa , and Klebsiella species. Fungal sepsis accounts for approximately 5% of severe sepsis and septic shock cases;
17100-401: The presence of an infection. Previously, SIRS criteria had been used to define sepsis. If the SIRS criteria are negative, it is very unlikely the person has sepsis; if it is positive, there is just a moderate probability that the person has sepsis. According to SIRS, there were different levels of sepsis: sepsis, severe sepsis, and septic shock. The definition of SIRS is shown below: In 2016
17250-415: The professional era and is also often used by host nations, professional leagues and tournaments as additional revenue streams, particularly when games are broadcast. In recent years, augmented reality technology has been used to replace painting to protect the surface or save costs on painting fields, producing a similar effect for broadcast albeit sometimes with poorer results. The in-goal areas sit behind
17400-755: The qSOFA criteria are met. The SOFA score was intended to be used in the intensive care unit (ICU) where it is administered upon admission to the ICU and then repeated every 48 hours, whereas the qSOFA could be used outside the ICU. Some advantages of the qSOFA score are that it can be administered quickly and does not require labs. However, the American College of Chest Physicians (CHEST) raised concerns that qSOFA and SOFA criteria may lead to delayed diagnosis of serious infection, leading to delayed treatment. Although SIRS criteria can be too sensitive and not specific enough in identifying sepsis, SOFA also has its limitations and
17550-448: The rate of death in newborns and adults with sepsis. Evidence for the use of IgM -enriched polyclonal preparations of IVIG is inconsistent. On the other hand, the use of antithrombin to treat disseminated intravascular coagulation is also not useful. Meanwhile, the blood purification technique (such as hemoperfusion , plasma filtration, and coupled plasma filtration adsorption) to remove inflammatory mediators and bacterial toxins from
17700-425: The required dose of vasopressor, epinephrine may be added. Epinephrine is not often used as a first-line treatment for hypotensive shock because it reduces blood flow to the abdominal organs and increases lactate levels. Vasopressin can be used in septic shock because studies have shown that there is a relative deficiency of vasopressin when shock continues for 24 to 48 hours. However, vasopressin reduces blood flow to
17850-425: The right to throw-in. The perimeter area should be clear and free of obstructions and heavy, solid objects which could pose a danger to players for at least 5 metres from the playing area, according to the Laws. Players often leave the playing area whether accidentally or due to being forced off of the field, sometimes sliding or needing to slow down from a sprint. Many venues at elite levels leave larger spaces around
18000-476: The seas. Among the forwards of the teams since 1899 he divided honours with A. F. Harding , the famous Welshman, and, at his best, was fit for a world's team. Sivright as captain was somewhat' dour, but as [a] player he was magnificent. A man of superb physique, it is hard to think that he has died an ordinary death at his age, and not to a bullet from the enemy. The Referee (Sydney), 15 September 1915 Note 2 : Matthew Mullineux decided that after losing
18150-574: The shins), both of which were legal and common tactics under the Rugby School's rules of the sport. In protest at the imposition of the new rules, the Blackheath Club left the FA followed by several other clubs that also favoured the "Rugby Rules". Although these clubs decided to ban hacking soon afterwards, the split was permanent, and the FA's codified rules became known as " association football " whilst
18300-458: The skin and one through each vascular access device (such as an IV catheter) that has been in place more than 48 hours. Bacteria are present in the blood in only about 30% of cases. Another possible method of detection is by polymerase chain reaction . If other sources of infection are suspected, cultures of these sources, such as urine, cerebrospinal fluid, wounds, or respiratory secretions, also should be obtained, as long as this does not delay
18450-427: The sport in England. Although the rules of the game were not a factor in the split, the breakaway teams subsequently adopted some rule changes and this became the separate code of " rugby league ". The RFU's code thereafter took on the name "rugby union" to differentiate it from rugby league, but both versions of the sport are known simply as "rugby" throughout most of the world. The first rugby football international
18600-432: The tallest players in the team and specialise as line-out jumpers. The main role of the lock in line-outs is to make a standing jump, often supported by the other forwards, to either collect the thrown ball or ensure the ball comes down on their side. Locks also have an important role in the scrum, binding directly behind the three front row players and providing forward drive. The back row, not to be confused with 'Backs',
18750-467: The third test. Note 11 : Tour captain Sam Warburton was named on the bench for the first test. Peter O'Mahony was the captain on the field. Rugby union Rugby union football , commonly known simply as rugby union or often just rugby , is a close-contact team sport that originated at Rugby School in England in the first half of the 19th century. Rugby is based on running with
18900-551: The third test. Note 8 : David Watkins captained in the second and foruth tests v New Zealand. Note 9 : Michael Owen captained the Lions in the first tour game, the test vs. Argentina in Cardiff. Brian O'Driscoll was injured at the beginning of the first test against New Zealand. Gareth Thomas replaced him as tour captain. Note 10 : Sam Warburton was injured in the second test. Alun Wyn Jones replaced him as captain for
19050-453: The three Test matches 17–0, 17–3 and 16–0. A notable incident on the Australian leg of the tour was a dispute between the British side and one of the Australian referees. The referee – Hugh Dolan – had ordered off British Isles player Denys Dobson after claiming Dobson had directed a personal insult at him. Bedell-Sivright was not playing, but pulled his team from
19200-690: The timely administration of fluids and antibiotics , the management of sepsis also involves surgical drainage of infected fluid collections and appropriate support for organ dysfunction. This may include hemodialysis in kidney failure , mechanical ventilation in lung dysfunction, transfusion of blood products , and drug and fluid therapy for circulatory failure. Ensuring adequate nutrition—preferably by enteral feeding , but if necessary, by parenteral nutrition —is important during prolonged illness. Medication to prevent deep vein thrombosis and gastric ulcers also may be used. Two sets of blood cultures (aerobic and anaerobic) are recommended without delaying
19350-823: The tissues. Dobutamine is not used as often as epinephrine due to its associated side effects, which include reducing blood flow to the gut. Additionally, dobutamine increases the cardiac output by abnormally increasing the heart rate. The use of steroids in sepsis is controversial. Studies do not give a clear picture as to whether and when glucocorticoids should be used. The 2016 Surviving Sepsis Campaign recommends low dose hydrocortisone only if both intravenous fluids and vasopressors are not able to adequately treat septic shock. The 2021 Surviving Sepsis Campaign recommends IV corticosteroids for adults with septic shock who have an ongoing requirement for vasopressor therapy. A 2019 Cochrane review found low-quality evidence of benefit, as did two 2019 reviews. During critical illness,
19500-455: The tour Bedell-Sivright briefly settled in Australia, before returning to Scotland to study medicine. He captained Scotland against the touring New Zealanders in 1905, and in 1906 helped his country defeat the visiting South Africans 6–0. After retiring from international rugby in 1908 he went on to become Scotland's amateur boxing champion. A surgeon by profession, he joined the Royal Navy during
19650-424: The two locks at the back of the scrum. The role of the number 8 in the scrum is to control the ball after it has been heeled back from the front of the pack, and the position provides a link between the forwards and backs during attacking phases. The role of the backs is to create and convert point-scoring opportunities. They are generally smaller, faster and more agile than the forwards. Another distinction between
19800-453: The two props is to support the hooker during scrums, to provide support for the jumpers during line-outs and to provide strength and power in rucks and mauls. The third position in the front row is the hooker. The hooker is a key position in attacking and defensive play and is responsible for winning the ball in the scrum. Hookers normally throw the ball in at line-outs. The second row consists of two locks or lock forwards. Locks are usually
19950-495: The underlying clotting abnormalities before a planned surgical procedure. However, platelet transfusion is suggested for platelet counts below (10 × 10 /L) without any risk of bleeding, or (20 × 10 /L) with high risk of bleeding, or (50 × 10 /L) with active bleeding, before a planned surgery or an invasive procedure. IV immunoglobulin is not recommended because its beneficial effects are uncertain. Monoclonal and polyclonal preparations of intravenous immunoglobulin (IVIG) do not lower
20100-484: The use of EGDT is still considered reasonable. Neonatal sepsis can be difficult to diagnose as newborns may be asymptomatic. If a newborn shows signs and symptoms suggestive of sepsis, antibiotics are immediately started and are either changed to target a specific organism identified by diagnostic testing or discontinued after an infectious cause for the symptoms has been ruled out. Despite early intervention, death occurs in 13% of children who develop septic shock, with
20250-436: The use of antibiotics. Within six hours, if blood pressure remains low despite initial fluid resuscitation of 30 mL/kg, or if initial lactate is ≥ four mmol/L (36 mg/dL), central venous pressure and central venous oxygen saturation should be measured. Lactate should be re-measured if the initial lactate was elevated. Evidence for point of care lactate measurement over usual methods of measurement, however,
20400-417: The use of the procalcitonin level as a method to distinguish sepsis from non-infectious causes of SIRS. The same review found the sensitivity of the test to be 77% and the specificity to be 79%. The authors suggested that procalcitonin may serve as a helpful diagnostic marker for sepsis, but cautioned that its level alone does not definitively make the diagnosis. More current literature recommends utilizing
20550-428: The voting was confined to players, and probably so in any event." Bedell-Sivright is described as one of the "hardest" men to ever play for Scotland, with author Nick Oswald – who wrote a book on the history of Scottish rugby – describing him as "a very aggressive forward. He didn't excel in any one aspect of the game, but he was an absolutely ferocious competitor." On hearing of his death, it
20700-554: Was appointed captain for the British Isles team that toured Australia and New Zealand . Due to a broken leg he played only one Test match during the tour – against Australia – but was involved in a notable incident during a non-Test match. Despite not playing, Bedell-Sivright pulled the British team from the field for 20 minutes after disputing the decision by a local referee to send-off one of their players. Bedell-Sivright eventually allowed his side to resume play, but without their ejected teammate. Following
20850-519: Was bitten by an unidentified insect. He complained of being fatigued and was taken offshore and transferred to the hospital ship HMHS Dunluce Castle. Two days later, on 5 September, he died of septicaemia and was buried at sea off Cape Helles . He is commemorated on the Portsmouth Naval Memorial. Bedell-Sivright learned his rugby while a student at Fettes College, but first came to note as a player when he represented Cambridge University in
21000-830: Was commissioned as a surgeon in the Royal Navy. He was posted to the Hawke Battalion of the Royal Naval Division stationed at Gallipoli during the Dardanelles Campaign in May 1915. He was loaned to the Royal Scots Fusiliers from 8 to 20 June, and was then posted to the Portsmouth Battalion of Royal Marine Light Infantry . After a period onshore in the trenches while serving at an advanced dressing station, he
21150-570: Was educated at Fettes College . before going to Trinity College, Cambridge in 1899 to read medicine. He later completed his medical training at the University of Edinburgh . His brother John played for Cambridge University RFC , and gained a single international cap in 1902. There are many tales surrounding Bedell-Sivright, and it is difficult to separate fact from fiction. He had a reputation for aggression, and in 1909 became Scottish amateur boxing champion. After one international he rugby tackled
21300-463: Was extended to include Argentina , a country whose impressive performances in international games (especially finishing in third place in the 2007 Rugby World Cup) was deemed to merit inclusion in the competition. As a result of the expansion to four teams, the tournament was renamed The Rugby Championship. Each team starts the match with 15 players on the field and typically seven or eight substitutes but this varies at amateur level. The 15 players on
21450-495: Was far less successful for the British team. The tourists won their first two matches, but their third – the sole Test against New Zealand – was lost 9–3. Bedell-Sivright did not play in the Test after injuring himself in the teams' first New Zealand tour match, but blamed that loss, and their subsequent draw and loss (the final loss was 13–0 to Auckland ) on fatigue after their tour of Australia. According to
21600-520: Was found to reduce mortality from 46.5% to 30.5% in those with sepsis, and the Surviving Sepsis Campaign has been recommending its use. However, three more recent large randomized control trials (ProCESS, ARISE, and ProMISe), did not demonstrate a 90-day mortality benefit of early goal-directed therapy when compared to standard therapy in severe sepsis. It is likely that some parts of EGDT are more important than others. Following these trials
21750-678: Was held at Murrayfield in 1993. Rugby Sevens was introduced into the Commonwealth Games in 1998 and was added to the Olympic Games of 2016. Both men and women's Sevens took place at the 2020 Olympic Games in Tokyo. Rugby union was an amateur sport until the IRB declared the game "open" in August 1995 (shortly after the completion of the 1995 World Cup), removing restrictions on payments to players. However,
21900-518: Was included as an event in the Olympic Games four times during the early 20th century. No international rugby games and union-sponsored club matches were played during the First World War, but competitions continued through service teams such as the New Zealand Army team . During the Second World War no international matches were played by most countries, though Italy, Germany and Romania played
22050-409: Was later chosen to tour with two different British Isles teams. The first was the 1903 tour of South Africa under the captaincy of fellow Scottish international Mark Morrison . Although at the centre of the British Isles pack, Beddel-Sivright did not play in any of the test matches . He played in the first 12 tour matches, where the team won six and lost six, but was injured thereafter. A captain of
22200-629: Was played on 27 March 1871 between Scotland and England in Edinburgh . Scotland won the game by one goal and one try to one goal. By 1881 both Ireland and Wales had representative teams and in 1883 the first international competition, the Home Nations Championship had begun. 1883 is also the year of the first rugby sevens tournament, the Melrose Sevens , which is still held annually. Two important overseas tours took place in 1888:
22350-551: Was reported that: It is cabled that Dr. D. R. Bedell-Sivright, who captained the British team in Australia and New Zealand in 1904, has died at the Dardanelles. He was a surgeon in the navy, and it is likely that he died on one of the warships engaged there against the Turks. Sivright was a Scottish forward of the most brilliant type, a hard player, but a clever one. He was one of the finest all-round forwards ever seen in Australia from over
22500-697: Was so impressed with Australia that he decided to settle there. After a year he became bored of jackarooing (stock-rearing), and decided to leave and head back to Scotland to study medicine. While studying in Edinburgh he joined the Edinburgh University RFC – captaining them for two seasons in 1906–07 and 1908–09. He had returned to Scotland in time to face the touring New Zealanders, and so he captained his country against them at Inverleith . The All Blacks had not been troubled in any of their previous matches on tour, scoring 612 points, and conceding only 15. Rugby writer Winston McCarthy described
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