An observational study of children interacting with an augmented story book

We present findings of an observational study investigating how young children interact with augmented reality story books. Children aged between 6 and 7 read and interacted with one of two story books aimed at early literacy education. The books pages were augmented using animated virtual 3D characters, sound, and interactive tasks. Introducing novel media to young children requires system and story designers to consider not only technological issues but also questions arising from story design and the design of interactive sequences. We discuss findings of our study and implications regarding the implementation of augmented story books

Vasopressin in vasodilatory shock: ensure organ blood flow, but take care of the heart!

Supplementary arginine vasopressin infusion in advanced vasodilatory shock may be accompanied by a decrease in cardiac index and systemic oxygen transport capacity in approximately 40% of patients. While a reduction of cardiac output most frequently occurs in patients with hyperdynamic circulation, it is less often observed in patients with low cardiac index. Infusion of inotropes, such as dobutamine, may be an effective strategy to restore systemic blood flow. However, when administering inotropic drugs, systemic blood flow should be increased to adequately meet systemic demands (assessed by central or mixed venous oxygen saturation) without putting an excessive beta-adrenergic stress on the heart. Overcorrection of cardiac index to hyperdynamic values with inotropes places myocardial oxygen supply at significant risk

Left ventricular rotation: a neglected aspect of the cardiac cycle

Purpose: To describe the mechanics and possible clinical importance of left ventricular (LV) rotation, exemplify techniques to quantify LV rotation and illustrate the temporal relationship of cardiac pressures, electrocardiogram and LV rotation. Materials and methods: Review of the literature combined with selected examples of echocardiographic measurements. Results: Rotation of the left ventricle around its longitudinal axis is an important but thus far neglected aspect of the cardiac cycle. LV rotation during systole maximizes intracavitary pressures, increases stroke volume, and minimizes myocardial oxygen demand. Shearing and restoring forces accumulated during systolic twisting are released during early diastole and result in diastolic LV untwisting or recoil promoting early LV filling. LV twist and untwist are disturbed in a number of cardiac diseases and can be influenced by several therapeutic interventions by altering preload, afterload, contractility, heart rate, and/or sympathetic tone. Conclusions: The concept of LV twisting and untwisting closely linking LV systolic and diastolic function may carry potential diagnostic and therapeutic importance for the management of critically ill patients. Future clinical studies need to address the feasibility of assessing LV twist and untwist as well as the relevance of its therapeutic modulation in critically ill patient

The relationship between extravascular lung water and oxygenation in three patients with influenza A (H1N1)-induced respiratory failure

Zusammenfassung: Diese Fallsammlung berichtet über die Korrelation zwischen extravaskulärem Lungenwasser (EVLW) und dem arteriellen Sauerstoffpartialdruck/fraktionierten inspiratorischen Sauerstoffkonzentration (PaO2/FiO2) Quotienten bei drei Patienten mit schwerem Influenza A (H1N1)-induziertem Lungenversagen. Alle Patienten erlitten eine ausgeprägte Hypoxie (PaO2, 26-42 mmHg), mussten mit dem Biphasic Airway Pressure Mode (PEEP, 12-15 mmHg; FiO2, 0,8-1) mechanisch beatmet werden und wurden in 12 stündlichen Intervallen in die Bauchlage gedreht. Alle Patienten waren während 8-11 Tagen mit dem PICCO® System monitorisiert. Während der mechanischen Beatmung wurden ingesamt 62 simultane Bestimmungen des PaO2/FiO2 Quotienten und des EVLW durchgeführt. Es zeigte sich ein signifikanter Zusammenhang zwischen dem EVLW und dem PaO2/FiO2 Quotienten (Spearman-rho Korrelationskoeffizient, -0,852; p < 0,001). Bei allen Patienten war eine Abnahme des EVLW von einer Verbesserung der Oxygenation begleitet. Die Serumkonzentrationen der Laktatdehydrogenase waren bei allen Patienten erhöht und korrelierten signifikant mit dem EVLW während des Intensivaufenthaltes (Spearman-rho Korrelationskoeffizient, 0,786; p < 0,001). Zusammenfassend erscheint es, dass das EVLW bei Patienten mit schwerem H1N1-induziertem Lungenversagen erhöht ist und dabei eng mit Einschränkungen der Oxygenationsfunktion korrelier

Comparing virtual patients with synthesized and natural speech

Virtual Patient (VP) simulations are often designed to use pre-recorded speech in order to provide more realism and immersion. However, using actors for recording these utterances has certain downsides. It can add to the cost during implementation, can take considerable time especially when a large number of VPs have to be created, and is not very flexible for example when sentences or words have to be added frequently. This study aims to explore the use of synthesized speech as an alternative to pre-recorded speech for VPs. Two medical scenarios have been prepared for this study, and both have been implemented using a VP with natural language or with synthesized speech. In a pilot study we explored students' retention rates of the symptoms reported by the VP under both conditions to investigate whether synthesized speech can serve as a good enough alternative

Arbeitslosigkeitsrisiko und Region

Die Diplomarbeit setzt sich mit dem Zusammenhang zwischen Arbeitslosigkeitsrisiko, Region und regionaler Wirtschaftsstruktur auseinander. Am Beispiel von Österreich wird mittels logistischer Mehrebenenregression untersucht, ob und in welchem Umfang die wirtschaftliche Zusammensetzung einer Region einen Einfluss auf das individuelle Arbeitslosigkeitsrisiko von Erwerbspersonen ausübt. Zentral ist die Frage nach selektiver Bevorzugung und Benachteiligung (z.B.: Werden bestimmte ArbeitnehmerInnengruppen am Arbeitsmarkt regional systematisch benachteiligt?) und regional unterschiedlicher Wirkung von individuellen Merkmalen wie Bildung und berufliche Stellung. Die Ergebnisse zeigen nicht nur, dass die wirtschaftliche Struktur der Wohnregion einen Einfluss auf das Arbeitslosigkeitsrisiko hat, sondern auch, dass Geringqualifizierte in Industrieregionen einen besseren Stand am Arbeitsmarkt haben als in Regionen mit starkem Dienstleistungssektor. Auch kann gezeigt werden, dass Frauen in Regionen mit starker Bauwirtschaft Männern gegenüber benachteiligt sind. Diese Erkenntnisse bieten auch für die Politik die Möglichkeit regional neue arbeitsmarktpolitische Maßnahmen zu setzen um bestimmten ArbeitnehmerInnengruppen beim Ausstieg aus der Arbeitslosigkeit zu helfen.The focus of this diploma thesis is an assessment of the correlation between the factors risk of unemployment, region and regional economic structure. The conducted multilevel logistic regression analysis shows if and to what extend the economic structure of a region influences the risk of unemployment of individual labour force. The key question concerns selective preference and discrimination (e.g. Can we register deliberate/systematic and regional discrimination of specific groups of employees on the labour market?) as well as the different levels of impact of individual characteristics such as education and professional status in the various regions. The results not only show that the risk of unemployment depends on the economic structure of the residential area but also that lower-qualified people in industrial regions have a better status on the labour market than people in regions with a strong services sector. It also reveals the discrimination of women towards men in regions with a focus on the building sector. The underlying results should be an incentive for decision makers to implement new regional labour market policy measures in order to help specific groups of employees to get back into the working world

Re-thinking resuscitation: Leaving blood pressure cosmetics behind and moving forward to permissive hypotension and a tissue perfusion-based approach

Definitions of shock and resuscitation endpoints traditionally focus on blood pressures and cardiac output. This carries a high risk of overemphasizing systemic hemodynamics at the cost of tissue perfusion. In line with novel shock definitions and evidence of the lack of a correlation between macro- and microcirculation in shock, we recommend that macrocirculatory resuscitation endpoints, particularly arterial and central venous pressure as well as cardiac output, be reconsidered. In this viewpoint article, we propose a three-step approach of resuscitation endpoints in shock of all origins. This approach targets only a minimum individual and context-sensitive mean arterial blood pressure (for example, 45 to 50 mm Hg) to preserve heart and brain perfusion. Further resuscitation is exclusively guided by endpoints of tissue perfusion irrespectively of the presence of arterial hypotension ('permissive hypotension'). Finally, optimization of individual tissue (for example, renal) perfusion is targeted. Prospective clinical studies are necessary to confirm the postulated benefits of targeting these resuscitation endpoints