There has been a significant increase in electronic cigarette (e-cigarette) use since its introduction in 2007. Ironically, there remains very few published literature on the respiratory complications of e-cigarettes. The use of personalized vaporizers or commonly known as “vaping” has started to overtake standard e-cigarette. Its dynamic vaporizer customization makes it challenging to assess long-term health effects. Case reports on the pulmonary complications of e-cigarettes are limited to bronchiectasis, eosinophilic pneumonia, pleural effusion, and suspected hypersensitivity pneumonitis. Diffuse alveolar hemorrhage (DAH) is bleeding into the alveolar spaces of the lung secondary to disruption of the alveolar-capillary basement membrane. We report a case of young male presenting with subacute respiratory failure. He was later found to have diffuse alveolar hemorrhage syndrome that is likely induced by aggressive vaping. This adds up to the rising concern on the possible serious complications of this innovative technology designed as a safer alternative to traditional cigarettes.
Rationale. The impact of emergency department length of stay (EDLOS) upon sepsis outcomes needs clarification. We sought to better understand the relationship between EDLOS and both outcomes and protocol compliance in sepsis. Methods. We performed a retrospective observational study of septic patients admitted to the ICU from the ED between January 2012 and December 2015 in a single tertiary care teaching hospital. 287 patients with severe sepsis and septic shock were included. Study population was divided into patients with EDLOS < 6 hrs (early admission) versus ≥6 hours (delayed admission). We assessed the impact of EDLOS on hospital mortality, compliance with sepsis protocol, and resuscitation. Statistical significance was determined by chi-square test. Results. Of the 287 septic ED patients, 137 (47%) were admitted to the ICU in <6 hours. There was no significant in-hospital mortality difference between early and delayed admissions (p = 0.68). Both groups have similar compliance with the 3-hour protocol (p = 0.77). There was no significant difference in achieving optimal resuscitation within 12 hours (p = 0.35). Conclusion. We found that clinical outcomes were not significantly different between early and delayed ICU admissions. Additionally, EDLOS did not impact compliance with the sepsis protocol with the exception of repeat lactate draw.
Every project in any aspect of the creative industry must start with an ideation process. The essence of this process is to allow rapid exploration of ideas with very little resource expenditure. For ideation to be successful an idea must be explorable in hours if not minutes. The tools that are used should be readily accessible to designers in the field. The video game industry is a production oriented industry and thus the majority of the technology in this industry has focused on production tools. Very little attention has been paid to the ideation stage in the game industry. In this paper we explore the cultural and technical reasons for this lack of focus on ideation within the video game industry.We introduce the concept of game sketching. Game sketching is not a technology, rather it is a set of technologies and methodologies intended to encourage exploration at a very early stage. We present an overview of one tool we have developed and then discuss our users' experiences. We finish the paper with a set of examples of game sketching. In particular we include two examples of a game sketch where our technology was not used at all. The intention of this paper is to introduce the concept of game sketching, and in so doing to get people to ask questions early in the ideation stage.
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