The Mutual Interaction of Online and Offline Identities in Massively Multiplayer Online Communities: A Study of EVE Online Players

This phenomenological study was conducted to examine the ways that individuals experience massively multiplayer online games, and the interaction between online and offline identities. Ten members of the EVE Online community were interviewed about their experiences of the boundaries and crossovers between offline self and online character. Interviews were transcribed, coded, and analyzed for consistent themes. Themes drawn from the data fell into three over- arching categories: the Appeal of EVE, or the player motivations and qualities of the game environment that influence player investment; Self/Character Interaction, describing the ways in which online and offline identities interact; and Moral Dilemmas, in which players describe their thoughts and reactions to the moral ambiguity of EVE Online. Appeal of EVE contained the themes of Importance of Social Interaction, My Choices Matter, Algerism, and EVE Relationships are Meaningful. Self/Character Interaction contained the themes of My Character and I Are the Same, My Character and I Are Different, Parallels, Friction Between Selves, One Identity Learning From the Other, and Intersections. Moral Dilemmas contained the themes of My Prosocial Choices, Someone Else’s Antisocial Choices, and Morality is Ambiguous. A final theme, not associated with any of the three categories, but present throughout all of them, was Emotional Content. These results were compared and contrasted with existing literature, and conclusions were drawn about the parallel processes between online and offline selves

Prophylaxis pharmacotherapy to prevent the onset of post traumatic brain injury depression: a systematic review

YesBackground: Depression is a common psychiatric problem following traumatic brain injury (TBI) with reported prevalence rates of 30-77% in the first year post-TBI. Given the negative influence of post-TBI depression on cognition, interpersonal, social, physical and occupational functioning; early initiation of pharmacotherapy to prevent post-TBI depression has been considered. This systematic review will synthesize the available evidence from published studies on the effectiveness and harms of pharmacotherapy for the secondary prevention of post-TBI depression. Method: Studies published before November 2017 were reviewed. Six databases were searched, with additional searching of key additional documents. Studies meeting inclusion criteria were evaluated for methodological quality. Results: Six articles addressing five studies met inclusion criteria. Study designs included three randomised controlled trials (RCT), two retrospective cohorts and one case-control. Prophylactic pharmacotherapy included antidepressants, beta-blockers and statins. In one RCT, the number-needed-to-treat with sertraline to prevent one case of depression post-TBI at 24 weeks was 5.9 (95%CI: 3.1-71.1). Prescribing beta-blockers prior to TBI reduced the depression risk regardless of the specific brain trauma. TBI patients with pre-existing hyperlipidemia not treated with statins had an increased depression risk compared to those without hyperlipidemia. Conclusion: Early initiation of sertraline prophylaxis in nondepressed TBI patients shows promise to reduce the odds of post-TBI depression developing. However, in the absence of rigorous study of tolerability, existing data are insufficient to recommend sertraline prophylaxis. Optimal timing and treatment duration with identification of patients most likely to benefit from prophylaxis require further consideration. Dedicated prospective studies assessing the effects of beta-blockers and statins on post-TBI depression are required.The Transport Accident Commission (TAC), through the Institute for Safety, Compensation and Recovery Research (ISCRR) at Monash University, provided funding for this review

Clozapine-associated secondary antibody deficiency

Purpose of review Clozapine has recently been described as a novel cause of secondary antibody deficiency (SAD), associated with long-term therapy. Here we critically review the evidence linking clozapine use to an increased infection risk, describe immunological alterations, and discuss potential mechanisms. Recent findings Individuals with schizophrenia are at two to five times more likely to develop pneumonia than the general population, in particular, when receiving clozapine. Delayed-onset distinguishes clozapine-associated hypogammaglobulinaemia from agranulocytosis or neutropenia that occur at lesser frequency. Biomarker searches in treatment-resistant schizophrenia highlight an immune signature associated with long-term clozapine use. This includes reduction in class-switched memory B cells, echoing common variable immunodeficiency. Recent identification of a role for dopamine in T follicular helper–B cell interactions may inform future clinical studies. Summary The detrimental impact of the increased infection risk associated with clozapine necessitates a re-evaluation of the current monitoring strategies as well as further studies to better understand the underlying mechanisms of SAD in this setting. On the basis of available evidence, we suggest simple modifications to clozapine monitoring including integration of routine vaccination, smoking cessation, and assessment of humoral immunity. Further studies are required to understand the role of clozapine in neuroinflammation as well as other potentially autoantibody-mediated diseases

Traumatic injury survivors’ perceptions of their future: a longitudinal qualitative study

AIM: Persistent disability following traumatic injuries can disrupt future plans and create uncertainty about how to mitigate future impacts. It is unknown how or whether perceptions of the future change in the years after injury. Therefore, the aim of this study was to explore trauma survivors’ perceptions of their future over time. METHODS: A longitudinal qualitative study, nested within a population-based longitudinal cohort study, was undertaken in Victoria, Australia with survivors of serious injury. Sixty-six seriously injured adults (≥16 years) without severe neurotrauma were interviewed at 3 years post-injury (n = 66), and re-interviewed at 4 (n = 63) and 5 years (n = 57) post-injury. A longitudinal thematic analysis was performed. RESULTS: Many traumatically injured people had persistent physical and mental impacts. Participants reported being anxious about pain, mobility, work, housing and accommodation, social activities, and finances in their future. Others were hopeful and optimistic regarding their future and developed coping strategies and adopted new viewpoints. CONCLUSION: ver time, most seriously injured people’s perceptions of the future remained consistent. Some had enduring anxiety and others sustained hopeful approaches. Personalised and targeted interventions that address specific concerns could reduce anxiety and support positive adjustment following traumatic injury

Developing a targeted, theory-informed implementation intervention using two theoretical frameworks to address health professional and organisational factors: a case study to improve the management of mild traumatic brain injury in the emergency department

Background Despite the availability of evidence-based guidelines for the management of mild traumatic brain injury in the emergency department (ED), variations in practice exist. Interventions designed to implement recommended behaviours can reduce this variation. Using theory to inform intervention development is advocated; however, there is no consensus on how to select or apply theory. Integrative theoretical frameworks, based on syntheses of theories and theoretical constructs relevant to implementation, have the potential to assist in the intervention development process. This paper describes the process of applying two theoretical frameworks to investigate the factors influencing recommended behaviours and the choice of behaviour change techniques and modes of delivery for an implementation intervention. Methods A stepped approach was followed: (i) identification of locally applicable and actionable evidence-based recommendations as targets for change, (ii) selection and use of two theoretical frameworks for identifying barriers to and enablers of change (Theoretical Domains Framework and Model of Diffusion of Innovations in Service Organisations) and (iii) identification and operationalisation of intervention components (behaviour change techniques and modes of delivery) to address the barriers and enhance the enablers, informed by theory, evidence and feasibility/acceptability considerations. We illustrate this process in relation to one recommendation, prospective assessment of post-traumatic amnesia (PTA) by ED staff using a validated tool. Results Four recommendations for managing mild traumatic brain injury were targeted with the intervention. The intervention targeting the PTA recommendation consisted of 14 behaviour change techniques and addressed 6 theoretical domains and 5 organisational domains. The mode of delivery was informed by six Cochrane reviews. It was delivered via five intervention components : (i) local stakeholder meetings, (ii) identification of local opinion leader teams, (iii) a train-the-trainer workshop for appointed local opinion leaders, (iv) local training workshops for delivery by trained local opinion leaders and (v) provision of tools and materials to prompt recommended behaviours. Conclusions Two theoretical frameworks were used in a complementary manner to inform intervention development in managing mild traumatic brain injury in the ED. The effectiveness and cost-effectiveness of the developed intervention is being evaluated in a cluster randomised trial, part of the Neurotrauma Evidence Translation (NET) program