The management of diabetic ketoacidosis in children

The object of this review is to provide the definitions, frequency, risk factors, pathophysiology, diagnostic considerations, and management recommendations for diabetic ketoacidosis (DKA) in children and adolescents, and to convey current knowledge of the causes of permanent disability or mortality from complications of DKA or its management, particularly the most common complication, cerebral edema (CE). DKA frequency at the time of diagnosis of pediatric diabetes is 10%–70%, varying with the availability of healthcare and the incidence of type 1 diabetes (T1D) in the community. Recurrent DKA rates are also dependent on medical services and socioeconomic circumstances. Management should be in centers with experience and where vital signs, neurologic status, and biochemistry can be monitored with sufficient frequency to prevent complications or, in the case of CE, to intervene rapidly with mannitol or hypertonic saline infusion. Fluid infusion should precede insulin administration (0.1 U/kg/h) by 1–2 hours; an initial bolus of 10–20 mL/kg 0.9% saline is followed by 0.45% saline calculated to supply maintenance and replace 5%–10% dehydration. Potassium (K) must be replaced early and sufficiently. Bicarbonate administration is contraindicated. The prevention of DKA at onset of diabetes requires an informed community and high index of suspicion; prevention of recurrent DKA, which is almost always due to insulin omission, necessitates a committed team effort

On the mechanisms governing gas penetration into a tokamak plasma during a massive gas injection

A new 1D radial fluid code, IMAGINE, is used to simulate the penetration of gas into a tokamak plasma during a massive gas injection (MGI). The main result is that the gas is in general strongly braked as it reaches the plasma, due to mechanisms related to charge exchange and (to a smaller extent) recombination. As a result, only a fraction of the gas penetrates into the plasma. Also, a shock wave is created in the gas which propagates away from the plasma, braking and compressing the incoming gas. Simulation results are quantitatively consistent, at least in terms of orders of magnitude, with experimental data for a D 2 MGI into a JET Ohmic plasma. Simulations of MGI into the background plasma surrounding a runaway electron beam show that if the background electron density is too high, the gas may not penetrate, suggesting a possible explanation for the recent results of Reux et al in JET (2015 Nucl. Fusion 55 093013)

Enhancing One Life Rather than Living Two: Playing MMOs with Offline Friends

We use ethnographic, interview, and survey data to examine problematic play within the popular online game, World of Warcraft, or ‘WoW’ for short. Research shows that players drawn to the interpersonal dimensions of online games are more prone to experience negative outcomes associated with their computer use. Our study suggests that it is not only whether online gamers seek meaningful social interactions that determine if WoW play becomes problematic, but exactly how players interact with others in online game-worlds. Specifically, levels of problematic WoW play depend on the extent gamers play with offline or ‘real-life’ friends and relations. Our survey data reveals both a direct relationship between playing WoW with offline friends and problematic online gaming and also an indirect one mediated by ‘immersion’ (defined as the extent that players feel like they are in a virtual world and in some cases actually their character). Interpreting these results through ethnographic and interview data, we suggest that playing WoW with real-life friends allows gamers to transfer in-game accomplishments and experiences into offline social networks. Rather than competing and conflicting with the world outside of the game, WoW played in this way tends to enhance gamers’ offline lives. Further, by keeping gamers in touch with perspectives outside of WoW, playing with real-life friends instills critical distance and greater awareness of how excessive play can damage offline commitments and relationships, allowing gamers to better monitor, evaluate, and ultimately regulate excessive game-play

Cultural Consonance and Mental Wellness in the World of Warcraft: Online Games as Cognitive Technologies of ‘Absorption-Immersion’

We use survey data—interpreted through ethnographic interviews and our own game-playing experiences—to model the way culture impacts the therapeutic dynamics of play in the popular online game World of Warcraft (WoW). To do so, we utilize cognitive anthropological understandings of ‘cultural consonance’ (Dressler and Bindon 2000)—that is, the extent to which individuals embody or fail to embody socially shared and sanctioned models of success. We find that players who report more individual ‘consonance’ with culturally shared models of ‘real-life’ or offline success are more likely to play in healthier ways as assessed through players’ self-reports of the impact of WoW on their life happiness, stress relief, and patterns of problematic play. We uncover both direct relationships between an individual’s relative degree of cultural consonance and these wellness outcomes and also indirect ones mediated by ‘absorption-immersion’ (defined as the extent that players feel like they are in a virtual world and in some cases actually their character). Overall, we suggest that WoW—and more generally multiplayer online role-playing games (‘MMORPGs’ or ‘MMOs’ for short) of which WoW is one example—can be thought of as cultural-cognitive technologies promoting a partitioned or ‘dissociated’ consciousness (Lynn 2005) in which players can attribute dimensions of self to in-game characters for potential psychological benefit or harm

Controle químico da helmintosporiose (Bipolaris incurvata) em coqueiro cultivar 'Anão-verde' em condições de campo Chemical control of Bipolaris incurvata in coconut cv. 'Anão-Verde' under field conditions

Avaliou-se a eficácia de fungicidas para o controle da helmintosporiose (Bipolaris incurvata) do coqueiro, em condições de campo. O experimento foi conduzido em Ocauçu - SP, em plantas com 8 meses de idade. Foram realizadas três pulverizações com intervalo quinzenal, utilizando-se de 600 litros de calda/ha, com os ingredientes ativos: prothioconazole (0,100 e 0,150 L/ha), tebuconazole (0,150 e 0,200 L/ha) e propiconazole (0,125 e 0,250 L/ha). A primeira pulverização foi realizada em plantas com sintomas foliares da doença, de modo que todas as plantas avaliadas tinham as folhas velhas como fonte de inóculo. O controle proporcionado pelos ingredientes ativos, foi avaliado em folhas jovens que, sob condições climáticas favoráveis, foram suscetíveis ao ataque do patógeno. Constatou-se que todos os fungicidas e doses utilizados foram eficientes no controle da helmintosporiose (Bipolaris incurvata).<br>Helmintosporiose fungicide control efficacy was evaluated in coconut plants, at field conditions. The experiment was conducted in Ocauçu-SP (Brasil), using 8-months old plants. Three sprayings were applied, within 15 days intervals, with 600 liters of spray volume/ha. The treatments were defined by three doses of the following fungicides: prothioconazole (0.100 and 0.150 L/ha), tebuconazole (0.150 and 0.200 L/ha) and propiconazole (0.125 and 0.250 L/ha). The first spray was in symptomatic plants, therefore every evaluated plant had its old leaves as the inoculum source. The disease index evaluation was done in young leaves, which are susceptible to this pathogen under favorable environment conditions. All the fungicides and their doses used were efficient in controlling helmintosporiose leaf spot, except for their respective check-treatments (control treatments)

Functional genomics reveals that Clostridium difficile Spo0A coordinates sporulation, virulence and metabolism

Background Clostridium difficile is an anaerobic, Gram-positive bacterium that can reside as a commensal within the intestinal microbiota of healthy individuals or cause life-threatening antibiotic-associated diarrhea in immunocompromised hosts. C. difficile can also form highly resistant spores that are excreted facilitating host-to-host transmission. The C. difficile spo0A gene encodes a highly conserved transcriptional regulator of sporulation that is required for relapsing disease and transmission in mice. Results Here we describe a genome-wide approach using a combined transcriptomic and proteomic analysis to identify Spo0A regulated genes. Our results validate Spo0A as a positive regulator of putative and novel sporulation genes as well as components of the mature spore proteome. We also show that Spo0A regulates a number of virulence-associated factors such as flagella and metabolic pathways including glucose fermentation leading to butyrate production. Conclusions The C. difficile spo0A gene is a global transcriptional regulator that controls diverse sporulation, virulence and metabolic phenotypes coordinating pathogen adaptation to a wide range of host interactions. Additionally, the rich breadth of functional data allowed us to significantly update the annotation of the C. difficile 630 reference genome which will facilitate basic and applied research on this emerging pathogen. Supplemental Material Identification of differentially expressed genes in C. difficile 630∆erm spo0A mutant by transcriptional profiling. Scatter plot of the log2 fold changes against the normalised mean read abundance per gene (calculated at the base level). Red dots represent genes considered to be significantly differentially expressed (P = ≤ 0.01). Black dots signify genes not deemed to be significantly differentially expressed according to these criteria. Table summarizing genes differentially expressed in a C. difficile spo0A mutant relative to the parental strain based on transcriptomics and proteomics. Datasets are presented in the context of the entire updated reference genome annotation for C. difficile 630. Table summarizing gene regulation genes that are controlled by C. difficile Spo0A

Restorative Magical Adventure or Warcrack?: Motivated MMO Play and the Pleasures and Perils of Online Experience

Combining perspectives from the new science of happiness with discussions regarding “problematic” and “addictive” play in multiplayer online games, we examine how player motivations pattern both positive and negative gaming experiences. Specifically, using ethnographic interviews and a survey, we explore the utility of Yee’s (2007) 3-factor motivational framework for explaining the positive or negative quality of experiences in the popular online game World of Warcraft. We find that playing to Achieve is strongly associated with distressful play, results that support findings from other studies. By contrast, Social and Immersion play lead more typically to positive gaming experiences, conclusions diverging from those frequently reported in the literature. Overall, we suggest that paying attention to the positive as well as negative dimensions of inhabiting these online worlds will both provide both for more balanced portraits of gamers’ experiences and also potentially clarify pathways toward problematic and addictive play