When common things aren't so common: A case report of hepatopulmonary syndrome.

A 60-year-old smoker with a history of liver cirrhosis and chronic obstructive pulmonary syndrome (COPD) presented with hypoxic respiratory failure. This was felt secondary to an exacerbation of COPD. Despite treatment, the patient required 10 L of oxygen to achieve saturations of 88% on ambulation. Interstitial lung disease, pulmonary emboli and pulmonary hypertension were excluded as potential aetiologies of hypoxia. Given the history of cirrhosis, hepatopulmonary syndrome was postulated. Contrast echocardiography suggested an extracardiac shunt; a technetium-99m macroaggregated albumin scan confirmed the diagnosis.

Lost in Learning: Hypertext Navigational Efficiency Measures Are Valid for Predicting Learning in Virtual Reality Educational Games.

The lostness measure, an implicit and unobtrusive measure originally designed for assessing the usability of hypertext systems, could be useful in Virtual Reality (VR) games where players need to find information to complete a task. VR locomotion systems with node-based movement mimic actions for exploration and browsing found in hypertext systems. For that reason, hypertext usability measures, such as "lostness" can be used to identify how disoriented a player is when completing tasks in an educational game by examining steps made by the player. An evaluation of two different lostness measures, global and local lostness, based on two different types of tasks, is described in a VR educational game using 13 college students between 14 and 18 years old in a first study and extended using 12 extra participants in a second study. Multiple Linear Regression analyses showed, in both studies, that local lostness, and not global lostness, had a significant effect on a post-game knowledge test. Therefore, we argued that local lostness was able to predict how well-participants would perform on a post-game knowledge test indicating how well they learned from the game. In-game experience aspects (engagement, cognitive interest, and presence) were also evaluated and, interestingly, it was also found that participants learned less when they felt more present in the game. We believe these two measures relate to cognitive overload, which is known to have an adverse effect on learning. Further research should investigate the lostness measure for use in an online adaptive game system and design the game system in such a way that the risk of cognitive overload is minimized when learning, resulting in higher retention of information.

Virtual Reality Aids Game Navigation: Evidence from the Hypertext Lostness Measure.

Instead of traditional free movement, node-based movement can be used in virtual reality (VR) games. In node-based movement systems, players navigate by jumping to set locations. Node-based movement is similar to hypertext navigation. We show that the hypertext lostness measure can be used as a game analytic to evaluate navigational efficiency. In a randomized controlled trial with 25 adolescent participants, an immersive desktop game environment and a VR game environment were compared on the transmission of in-game educational content and navigational efficiency. Results show that the hypertext lostness measure is also valuable outside its original hypertext domain: in VR. VR did not improve players' retention of factual knowledge, but did significantly improve players' spatial knowledge and navigational efficiency. We conclude (a) the hypertext lostness measure is also valuable for node-based VR games and (b) VR games add to spatial learning, even when compared with already immersive desktop games.

Physical attractiveness and criminal justice processing: results from a longitudinal sample of youth and young adults.

A substantial body of research examining the role that attractiveness plays in a wide range of outcomes has revealed that attractiveness is a beneficial characteristic across multiple domains of life, including some related to crime and the criminal justice system. The current study uses these findings as a springboard to examine the potential association between attractiveness and multiple measures of criminal justice processing, including being arrested, being convicted, being sentenced to probation and being incarcerated. Analysis of data drawn from the National Longitudinal Study of Adolescent to Adult Health revealed that more attractive persons were less likely to be arrested and convicted than less attractive persons, but there was no association with odds of being sentenced to probation or incarcerated. Follow-up analyses revealed that the beneficial effect of being attractive was confined solely to females. We discuss possible reasons for these results and provide suggestions for future research.

A longitudinal analysis of shooter games and their relationship with conduct disorder and cself-reported delinquency.

PURPOSE: Despite several decades of research, little scholarly consensus has emerged regarding the role of violent video games in the development of youth psychopathology or crime. METHOD: The current study employed the Avon Longitudinal Study of Parents and Children longitudinal dataset to examine the impact of the shooter game genre ownership in childhood on later adolescent conduct disorder and criminal behavior. ANALYSIS: Multivariate Poisson regressions with the robust estimator correlation matrix were performed comparing effects of independent and confounding variables. RESULTS: Results revealed that early childhood mental health symptoms at age seven related to ADHD, depression and early conduct disorder predicted criminal behavior at age fifteen. Male gender also predicted criminal behavior at age fifteen. However, exposure to shooter games did not predict adolescent conduct disorder or criminal behavior. CONCLUSION: We have found support that suggests that the role of violent video games in the development of youth psychopathology or crime is very little if any. Lack of a relationship between exposure to shooter games and later conduct and criminal behavior problems may be understood within the context of the Catalyst Model.

Carbimazole-induced eosinophilic pleural effusion.

We report the case of a 41-year-old woman who presented with a unilateral exudative effusion with prominent eosinophils on pleural cytology. Carbimazole had been started 4 weeks prior to presentation. No immediate cause was identified on imaging or laboratory testing. The effusion persisted at 2-month follow-up. Further investigation at this time, including autoimmune serology was negative. At 2-month follow-up, the effusion was loculated on ultrasound imaging and had a low fluid pH on diagnostic aspiration, in keeping with an empyema. The patient received treatment for pleural empyema, including antibiotics, intercostal drain insertion and video-assisted thoracoscopic pleural biopsy. Carbimazole was stopped, and following treatment for the empyema, the effusion did not reaccumulate.This case illustrates the diagnostic difficulties that pleural effusions may present. It demonstrates that drug reactions should be considered in the differential diagnosis following thorough investigation for other potential causes and also describes the complications that may occur.

Quality of life in patients with chronic obstructive pulmonary disease and comorbid anxiety or depression.

The authors examined 179 veterans with chronic obstructive pulmonary disease (COPD) to determine the relative contribution of clinical depression and/or anxiety (Beck Depression and Beck Anxiety Inventories) to their quality of life (Chronic Respiratory Questionnaire and Medical Outcomes Survey Short Form). Multiple-regression procedures found that both depression and anxiety were significantly related to negative quality-of-life outcomes (anxiety with both mental and physical health quality-of-life outcomes, and depression primarily with mental health). When comorbid with COPD, mental health symptoms of depression and anxiety are some of the most salient factors associated with quality-of-life outcomes.