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

A historical perspective on the discovery of statins

Cholesterol is essential for the functioning of all human organs, but it is nevertheless the cause of coronary heart disease. Over the course of nearly a century of investigation, scientists have developed several lines of evidence that establish the causal connection between blood cholesterol, atherosclerosis, and coronary heart disease. Building on that knowledge, scientists and the pharmaceutical industry have successfully developed a remarkably effective class of drugs—the statins—that lower cholesterol levels in blood and reduce the frequency of heart attacks

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