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Rationale:The technique used to provide continuous positive airway pressure (CPAP) to the newborn may influence lung function and breathing efficiency. Objectives: To compare differences in gas exchange physiology and lung injury resulting from treatment of respiratory distress with either bubble or constant pressure CPAP and to determine if the applied flow influences short-term outcomes. What This Study Adds to the FieldIn an ovine model of preterm lung disease, treatment with bubble CPAP immediately after birth enhances gas exchange, lung mechanics, gas mixing efficiency, and lung volume compared with constant pressure CPAP.in New York, where B-CPAP has been a cornerstone of clinical treatment practice since the 1970s. Despite the lengthy period over which B-CPAP has been used, surprisingly little is known about the importance or relevance of the bubble component of the CPAP treatment.During B-CPAP, the expiratory limb of the CPAP circuit vents through an underwater seal. The resulting bubbles create pressure oscillations that are transmitted back to the airway opening. The noisy nature of the pressure waveform delivered to the airway opening generates broadband frequency composition and oscillatory pressure amplitudes that are in the order of 4 cm H 2 O around the mean pressure. Although this noisy component may contribute to gas mixing in a similar fashion to mechanisms present during high-frequency oscillatory ventilation (4), only two previous studies have examined the effect of B-CPAP on gas exchange. Lee and colleagues (4) randomized a group of infants ready for extubation to receive either B-CPAP or ventilator-derived (constant pressure) CPAP (CP-CPAP) for a period of 15 minutes before crossover to the alternative treatment. Although there were no differences in Pa CO 2 between B-CPAP and CP-CPAP groups, the babies treated with B-CPAP had lower respiratory rates and lower minute volumes, suggesting more efficient ventilation. More recently, Morley and colleagues reported a crossover study of clinically stable infants treated with CPAP in the neonatal intensive care unit (5). They found no differences in transcutaneous measurements of arterial CO 2 or in oxygen saturation between CPAP with and without bubbles over the brief 30-minute study epochs. Both studies tested the effect of B-CPAP on clinically stable infants in the recovery stage of neonatal respiratory illness, and focused predominantly on the concept that the bubble component was likely to influence CO 2 clearance.

A wiki is able to provide a learning environment which is closely aligned with the social‐constructivist approach and is more natural than many tools where open collaboration and the exchange of ideas are important. This case study analyses and evaluates essential aspects for the successful deployment of a wiki in a higher education setting using Salmon's five‐stage e‐learning framework. Indicators of the learning benefits were determined by qualitative analysis of students' wiki contributions. Students' perceptions were captured through interviews and questionnaires at the start and end of the project, thereby providing indicators of their motivation towards this method of learning. Our results suggest that a wiki can promote effective collaborative learning and confidence in formative self and peer assessment by facilitating rapid feedback, vicarious learning through observing others' contributions and easy navigation and tracking facilities. Student authorship was also encouraged. Issues identified included providing easy access to the wiki, lack of personalisation, possible vandalism and plagiarism. Also, students with learning difficulties might require extra help and take longer to familiarise themselves with this new e‐learning environment

Collaborative learning through case-based or problem-based learning (PBL) scenarios is an excellent way for students to acquire knowledge and develop decision-making skills. However, the process is threatened by the movement towards more self-directed learning and the migration of students from campus-based to workplace-based learning. Paper-based PBL cases can only proceed in a single direction which can prevent learners from exploring the impact of their decisions. The PREVIEW project, outlined in this article, trialled a replacement to traditional paper PBL with virtual patients (VPs) delivered through a virtual world platform. The idea was that an immersive 3D environment could provide (a) greater realism (b) active decision-making and (c) a suitable environment for collaboration amongst work-based learners meeting remotely. Five VP scenarios were designed for learners on a Paramedic Foundation Degree within the virtual world second life (SL). A player using the MedBiquitous VP international standard allowed cases to be played both within SL and on the web. Three testing days were run to evaluate the scenarios with paramedic students and tutors. Students unfamiliar with the SL environment worked through five PBL scenarios in small groups, shadowed by 'in-world' facilitators. Feedback indicated that the SL environment engages students effectively in learning, despite some technology barriers. Students believed SL could provide a more authentic learner environment than classroom-based PBL.

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