The utility of cardiac sonography and capnography in predicting outcome in cardiac arrest

Emergency physicians and intensivists are increasingly utilizing capnography and bedside echocardiography during medical resuscitations. These techniques have shown promise in predicting outcomes in cardiac arrest, and no cases of return of spontaneous circulation in the setting of sonographic cardiac standstill and low end-tidal carbon dioxide have been reported. This case report illustrates an example of such an occurrence. Our aims are to report a case of return of spontaneous circulation in a patient with sonographic cardiac standstill, electrocardiographic pulseless electrical activity, and low end-tidal carbon dioxide tensions and to place the case in the context of previous literature on this topic. Case report and brief review of the literature. In 254 cases reported, no patient has survived in the setting of sonographic cardiac standstill and low end-tidal carbon dioxide tension, making the reported case unique. This case should serve to illustrate the utility and limitations of combined cardiac sonography and end-tidal carbon dioxide measurement in determining prognosis during cardiac arrest

A monument to the player: Preserving a landscape of socio-cultural capital in the transitional MMORPG

This is the pre-print version of the Article. The official published version can be accessed from the links below - Copyright @ 2012 Taylor & Francis LtdMassively multiplayer online role-playing games (MMORPGs) produce dynamic socio-ludic worlds that nurture both culture and gameplay to shape experiences. Despite the persistent nature of these games, however, the virtual spaces that anchor these worlds may not always be able to exist in perpetuity. Encouraging a community to migrate from one space to another is a challenge now facing some game developers. This paper examines the case of Guild Wars® and its “Hall of Monuments”, a feature that bridges the accomplishments of players from the current game to the forthcoming sequel. Two factor analyses describe the perspectives of 105 and 187 self-selected participants. The results reveal four factors affecting attitudes towards the feature, but they do not strongly correlate with existing motivational frameworks, and significant differences were found between different cultures within the game. This informs a discussion about the implications and facilitation of such transitions, investigating themes of capital, value perception and assumptive worlds. It is concluded that the way subcultures produce meaning needs to be considered when attempting to preserve the socio-cultural landscape

The comprehensive cohort model in a pilot trial in orthopaedic trauma

Background: The primary aim of this study was to provide an estimate of effect size for the functional outcome of operative versus non-operative treatment for patients with an acute rupture of the Achilles tendon using accelerated rehabilitation for both groups of patients. The secondary aim was to assess the use of a comprehensive cohort research design (i.e. a parallel patient-preference group alongside a randomised group) in improving the accuracy of this estimate within an orthopaedic trauma setting. Methods: Pragmatic randomised controlled trial and comprehensive cohort study within a level 1 trauma centre. Twenty randomised participants (10 operative and 10 non-operative) and 29 preference participants (3 operative and 26 non-operative). The ge range was 22-72 years and 37 of the 52 patients were men. All participants had an acute rupture of their Achilles tendon and no other injuries. All of the patients in the operative group had a simple end-to-end repair of the tendon with no augmentation. Both groups then followed the same eight-week immediate weight-bearing rehabilitation programme using an off-the-shelf orthotic. The disability rating index (DRI; primary outcome), EQ-5D, Achilles Total Rupture Score and complications were assessed ed at two weeks, six weeks, three months, six months and nine months after initial injury. Results: At nine months, there was no significant difference in DRI between patients randomised to operative or non-operative management. There was no difference in DRI between the randomised group and the parallel patient preference group. The use of a comprehensive cohort of patients did not provide useful additional information as to the treatment effect size because the majority of patients chose non-operative management. Conclusions: Recruitment to clinical trials that compare operative and non-operative interventions is notoriously difficult; especially within the trauma setting. Including a parallel patient preference group to create a comprehensive cohort of patients has been suggested as a way of increasing the power of such trials. In our study, the comprehensive cohort model doubled the number of patients involved in the study. However, a strong preference for non-operative treatment meant that the increased number of patients did not significantly increase the ability of the trial to detect a difference between the two interventions

Endogenous fantasy and learning in digital games.

Many people believe that educational games are effective because they motivate children to actively engage in a learning activity as part of playing the game. However, seminal work by Malone (1981), exploring the motivational aspects of digital games, concluded that the educational effectiveness of a digital game depends on the way in which learning content is integrated into the fantasy context of the game. In particular, he claimed that content which is intrinsically related to the fantasy will produce better learning than that which is merely extrinsically related. However, this distinction between intrinsic and extrinsic (or endogenous and exogenous) fantasy is a concept that has developed a confused standing over the following years. This paper will address this confusion by providing a review and critique of the empirical and theoretical foundations of endogenous fantasy, and its relevance to creating educational digital games. Substantial concerns are raised about the empirical basis of this work and a theoretical critique of endogenous fantasy is offered, concluding that endogenous fantasy is a misnomer, in so far as the "integral and continuing relationship" of fantasy cannot be justified as a critical means of improving the effectiveness of educational digital games. An alternative perspective on the intrinsic integration of learning content is described, incorporating game mechanics, flow and representations

Ethanol drinking, brain mitochondrial DNA, polyunsaturated fatty acids and effects of dietary anthocyanins

Background This study aimed at exploring whether moderate ethanol drinking may have adverse effects on the fatty acids composition and on mitochondrial DNA (mtDNA) of rat brain. A secondary aim was to examine whether dietary antioxidant anthocyanins (ACN) can be protective. Methods One group of rats received ethanol 12% and another water as an exclusive liquid to drink for 8 weeks. In order to test the impact of ACN consumption, two other groups of rats were fed an ACN-rich diet in combination with either ethanol or water. Brain fatty acids were measured by gas chromatography and mtDNA alterations, markers of mitochondrial suffering, were studied through an original real-time qPCR-based protocol. Results Linoleic acid (LA, 18:2n-6) and eicosadienoic acid (20:2n-6) were significantly decreased, by 12% and 31% respectively, in the brains of both ethanol groups. The other brain lipids, including arachidonic acid (20:4n-6) and n-3 polyunsaturated fatty acids, were not modified. These changes were associated with a significant increase in deleted mtDNA (by 28%) in the ethanol group, without total mtDNA depletion. The ACN-rich diet prevented the increase in mtDNA common deletion (mtDNA CD). Conclusion These data demonstrate that moderate ethanol drinking reduces certain brain n-6 and results in mtDNA injury. The antioxidant anthocyanins protect brain mtDNA but do not restore normal n-6 levels. Further studies are required to investigate the consequences of a decrease in n-6 levels in brain

Coextensive space: virtual reality and the developing relationship between the body, the digital and physical space

Virtual Reality (VR) has traditionally required external sensors placed around a designated play space. In contrast, more recent wired and wireless systems, such as the Oculus Rift S (released in March 2019) and the Oculus Quest (released in May 2019) use cameras located on the outside of these devices to monitor their physical position. Users can now mark out a physical space that is then digitally tracked within their display. Once a play space has been established, users are alerted if they come close to breaching this boundary by the visual inclusion of a grid. Should this threshold be breached, the headset display shifts to an image of the surrounding concrete environment. We contend that physical space is increasingly being incorporated into the digital space of VR in a manner that meaningfully differs from older systems. We build our argument in the following way. First, the article explores how theories surrounding VR have implicated only a limited relationship with physical space. Second, the article introduces the concept of coextensive space as a way of understanding the developing relationship between the physical, digital and concrete reality enacted by current VR systems

“It’s like my life but more, and better!” - Playing with the Cathaby Shark Girls: MMORPGs, young people and fantasy-based social play

This article is available open access through the publisher’s website at the link below. Copyright @ 2011 A B Academic Publishers.Digital technology has opened up a range of new on-line leisure spaces for young people. Despite their popularity, on-line games and Massive Multiplayer Online Role Playing Games in particular are still a comparatively under-researched area in the fields of both Education and more broadly Youth Studies. Drawing on a Five year ethnographic study, this paper considers the ways that young people use the virtual spaces offered by MMORPGs. This paper suggests that MMORPGs represent significant arenas within which young people act out a range of social narratives through gaming. It argues that MMORPG have become important fantasy spaces which offer young people possibilities to engage in what were formally material practices. Although this form of play is grounded in the everyday it also extends material practices and offers new and unique forms of symbolic experimentation, thus I argue that game-play narratives cannot be divorced from the everyday lives of their participants

Radical-mediated dehydrogenation of bile acids by means of hydrogen atom transfer to triplet carbonyls

The aim of the present paper is to explore the potential of radical-mediated dehydrogenation of bile salts (BSs), which is reminiscent of the enzymatic action of hydroxysteroid dehydrogenase enzymes (HSDH). The concept has been demonstrated using triplet carbonyls that can be efficiently generated upon selective UVA-excitation. Hydrogen atom transfer (HAT) from BSs to triplet benzophenone (BP) derivatives gave rise to radicals, ultimately leading to reduction of the BP chromophore with concomitant formation of the oxo-analogs of the corresponding BSs. The direct reactivity of triplet BP with BSs in the initial step was evaluated by determining the kinetic rate constants using laser flash photolysis (LFP). The BP triplet decay was monitored (lambda(max) = 520 nm) upon addition of increasing BS concentrations, and the obtained rate constant values indicated a reactivity of the methine hydrogen atoms in the order of C-3 < C-12 < C-7. The steady-state kinetics of the overall process, monitored through the disappearance of the typical BP absorption band at 260 nm, was much faster under N-2 than under O-2, also supporting the role of the oxygen-quenchable triplet in the dehydrogenation process. Furthermore, irradiation of deaerated aqueous solutions of sodium cholate in the presence of KPMe provided the oxo-analogs, 3[O], 7[O]-CA, 3[O]-CA and 7[O]-CA, arising from the HAT process.Financial support from the Spanish Government (Grants SEV-2012-0267 and CTQ2012-38754-C03-03), Generalitat Valenciana (Prometeo Program) and the Technical University of Valencia (Predoctoral FPI fellowship for P. Miro) is gratefully acknowledged.Miró Richart, P.; Marín García, ML.; Miranda Alonso, MÁ. (2016). Radical-mediated dehydrogenation of bile acids by means of hydrogen atom transfer to triplet carbonyls. Organic and Biomolecular Chemistry. 14(9):2679-2683. https://doi.org/10.1039/c5ob02561cS2679268314