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In recent years, university teaching methods have evolved and almost all higher education institutions use e-learning platforms to deliver courses and learning activities. However, these digital learning environments present significant dropout and low completion rates. This is primarily due to the lack of student motivation and engagement. Gamification which can be defined as the application of game design elements in non-game activities has been used to address the issue of learner distraction and stimulate students’ involvement in the course. However, choosing the right combination of game elements remains a challenge for gamification designers and practitioners due to the lack of proven design approaches, and there is no one-size-fits-all approach that works regardless of the gamification context. Therefore, our study focused on providing a comprehensive overview of the current state of gamification in online learning in higher education that can serve as a resource for gamification practitioners when designing gamified systems. In this paper, we aimed to systematically explore the different game elements and gamification theory that have been used in empirical studies; establish different ways in which these game elements have been combined and provide a review of the state-of-the-art of approaches proposed in the literature for gamifying e-learning systems in higher education. A systematic search of databases was conducted to select articles related to gamification in digital higher education for this review, namely, Scopus and Google Scholar databases. We included studies that consider the definition of gamification as the application of game design elements in non-game activities, designed for online higher education. We excluded papers that use the term of gamification to refer to game-based learning, serious games, games, video games, and those that consider face-to-face learning environments. We found that PBL elements (points, badges, and leaderboards), levels, and feedback and are the most commonly used elements for gamifying e-learning systems in higher education. We also observed the increasing use of deeper elements like challenges and storytelling. Furthermore, we noticed that of 39 primary studies, only nine studies were underpinned by motivational theories, and only two other studies used theoretical gamification frameworks proposed in the literature to build their e-learning systems. Finally, our classification of gamification approaches reveals the trend towards customization and personalization in gamification and highlights the lack of studies on content gamification compared to structural gamification.

Background Alterations in the renin–angiotensin system have been implicated in the pathophysiology of septic shock. In particular, angiotensin 1–7 (Ang-(1–7)), an anti-inflammatory heptapeptide, has been hypothesized to have beneficial effects. The aim of the present study was to test the effects of Ang-(1–7) infusion on the development and severity of septic shock. Methods This randomized, open-label, controlled study was performed in 14 anesthetized and mechanically ventilated sheep. Immediately after sepsis induction by bacterial peritonitis, animals received either Ang-(1–7) ( n  = 7) or placebo ( n  = 7) intravenously. Fluid resuscitation, antimicrobial therapy, and peritoneal lavage were initiated 4 h after sepsis induction. Norepinephrine administration was titrated to maintain mean arterial pressure (MAP) between 65 and 75 mmHg. Results There were no differences in baseline characteristics between groups. Septic shock was prevented in 6 of the 7 animals in the Ang-(1–7) group at the end of the 24-h period. Fluid balance and MAP were similar in the two groups; however, MAP was achieved with a mean norepinephrine dose of 0.4 μg/kg/min in the Ang-(1–7) group compared to 4.3 μg/kg/min in the control group. Heart rate and cardiac output index were lower in the Ang (1–7) than in the control group, as were plasma interleukin-6 levels, and creatinine levels. Platelet count and PaO 2 /FiO 2 ratio were higher in the Ang-(1–7) group. Mean arterial lactate at the end of the experiment was 1.6 mmol/L in the Ang-(1–7) group compared to 7.4 mmol/L in the control group. Conclusions In this experimental septic shock model, early Ang-(1–7) infusion prevented the development of septic shock, reduced norepinephrine requirements, limited interleukine-6 increase and prevented renal dysfunction.

Background Angiotensin II is one of the vasopressors available for use in septic shock. However, its effects on the septic myocardium remain unclear. The aim of the study was to compare the effects of angiotensin II and norepinephrine on cardiac function and myocardial oxygen consumption, inflammation and injury in experimental septic shock. Methods This randomized, open-label, controlled study was performed in 20 anesthetized and mechanically ventilated pigs. Septic shock was induced by fecal peritonitis in 16 animals, and four pigs served as shams. Resuscitation with fluids, antimicrobial therapy and abdominal drainage was initiated one hour after the onset of septic shock. Septic pigs were randomly allocated to receive one of the two drugs to maintain mean arterial pressure between 65 and 75 mmHg for 8 h. Results There were no differences in MAP, cardiac output, heart rate, fluid balance or tissue perfusion indices in the two treatment groups but myocardial oxygen consumption was greater in the norepinephrine-treated animals. Myocardial mRNA expression of interleukin-6, interleukin-6 receptor, interleukin-1 alpha, and interleukin-1 beta was higher in the norepinephrine than in the angiotensin II group. Conclusions In septic shock, angiotensin II administration is associated with a similar level of cardiovascular resuscitation and less myocardial oxygen consumption, and inflammation compared to norepinephrine.

Background Anoxic brain injuries represent the main determinant of poor outcome after cardiac arrest (CA). Large animal models have been described to investigate new treatments during CA and post‐resuscitation phase, but a detailed model that includes extensive neuromonitoring is lacking. Method Before an electrically‐induced 10‐minute CA and resuscitation, 46 adult pigs underwent neurosurgery for placement of a multifunctional probe (intracranial pressure or ICP, tissue oxygen tension or PbtO2 and cerebral temperature) and a bolt‐based technique for the placement and securing of a regional blood flow probe and two sEEG electrodes; two modified cerebral microdialysis (CMD) probes were also inserted in the frontal lobes and accidental misplacement was prevented using a perforated head support. Result 42 animals underwent the CA procedure and 41 achieved the return of spontaneous circulation (ROSC). In 4 cases (8.6%) an adverse event took place during preparation, but only in two cases (4.3%) this was related to the neurosurgery. In 6 animals (13.3%) the minor complications that occurred resolved after probe repositioning. Conclusion Herein we provide a detailed comprehensive neuromonitoring approach in a large animal model of CA that might help future research. The figures displays multiple neuromonitoring devices in place to allow simultaneous measurements of multiple brain‐derived parameters during cardiac arrest and post‐resuscitation period.

Objective To investigate the accuracy of information provided by ChatGPT-4o to patients about tracheotomy. Methods Twenty common questions of patients about tracheotomy were presented to ChatGPT-4o twice (7-day intervals). The accuracy, clarity, relevance, completeness, referencing, and usefulness of responses were assessed by a board-certified otolaryngologist and a board-certified intensive care unit practitioner with the Quality Analysis of Medical Artificial Intelligence (QAMAI) tool. The interrater reliability and the stability of the ChatGPT-4o responses were evaluated with intraclass correlation coefficient (ICC) and Pearson correlation analysis. Results The total scores of QAMAI were 22.85 ± 4.75 for the intensive care practitioner and 21.45 ± 3.95 for the otolaryngologist, which consists of moderate-to-high accuracy. The otolaryngologist and the ICU practitioner reported high ICC (0.807; 95%CI: 0.655–0.911). The highest QAMAI scores have been found for clarity and completeness of explanations. The QAMAI scores for the accuracy of the information and the referencing were the lowest. The information related to the post-laryngectomy tracheostomy remains incomplete or erroneous. ChatGPT-4o did not provide references for their responses. The stability analysis reported high stability in regenerated questions. Conclusion The accuracy of ChatGPT-4o is moderate-to-high in providing information related to the tracheotomy. However, patients using ChatGPT-4o need to be cautious about the information related to tracheotomy care, steps, and the differences between temporary and permanent tracheotomies.

Background Extracellular histones have been associated with severity and outcome in sepsis. The aim of the present study was to assess the effects of sodium-β-O-Methyl cellobioside sulfate (mCBS), a histone-neutralizing polyanion, on the severity and outcome of sepsis in an experimental model. Methods This randomized placebo-controlled experimental study was performed in 24 mechanically ventilated female sheep. Sepsis was induced by fecal peritonitis. Animals were randomized to three groups: control, early treatment, and late treatment ( n  = 8 each). mCBS was given as a bolus (1 mg/kg) followed by a continuous infusion (1 mg/kg/h) just after sepsis induction in the early treatment group, and 4 h later in the late treatment group. Fluid administration and antimicrobial therapy were initiated 4 h T4 after feces injection, peritoneal lavage performed, and a norepinephrine infusion titrated to maintain mean arterial pressure (MAP) between 65–75 mmHg. The experiment was blinded and lasted maximum 24 h. Results During the first 4 h, MAP remained > 65 mmHg in the early treatment group but decreased significantly in the others ( p  < 0.01 for interaction, median value at T4: (79 [70–90] mmHg for early treatment, 57 [70–90] mmHg for late treatment, and 55 [49–60] mmHg for the control group). mCBS-treated animals required significantly less norepinephrine to maintain MAP than controls ( p  < 0.01 for interaction) and had lower creatinine ( p  < 0.01), lactate ( p  < 0.01), and interleukin-6 ( p  < 0.01) levels, associated with reduced changes in H3.1 nucleosome levels ( p  = 0.02). Early treatment was associated with lower norepinephrine requirements than later treatment. Two control animals died; all the mCBS-treated animals survived. Conclusions Neutralization of extracellular histones with mCBS was associated with reduced norepinephrine requirements, improved tissue perfusion, less renal dysfunction, and lower circulating IL-6 in experimental septic shock and may represent a new therapeutic approach to be tested in clinical trials.

Extracellular histones have been associated with severity and outcome in sepsis. The aim of the present study was to assess the effects of sodium-[beta]-O-Methyl cellobioside sulfate (mCBS), a histone-neutralizing polyanion, on the severity and outcome of sepsis in an experimental model. This randomized placebo-controlled experimental study was performed in 24 mechanically ventilated female sheep. Sepsis was induced by fecal peritonitis. Animals were randomized to three groups: control, early treatment, and late treatment (n = 8 each). mCBS was given as a bolus (1 mg/kg) followed by a continuous infusion (1 mg/kg/h) just after sepsis induction in the early treatment group, and 4 h later in the late treatment group. Fluid administration and antimicrobial therapy were initiated 4 h T4 after feces injection, peritoneal lavage performed, and a norepinephrine infusion titrated to maintain mean arterial pressure (MAP) between 65-75 mmHg. The experiment was blinded and lasted maximum 24 h. During the first 4 h, MAP remained > 65 mmHg in the early treatment group but decreased significantly in the others (p < 0.01 for interaction, median value at T4: (79 [70-90] mmHg for early treatment, 57 [70-90] mmHg for late treatment, and 55 [49-60] mmHg for the control group). mCBS-treated animals required significantly less norepinephrine to maintain MAP than controls (p < 0.01 for interaction) and had lower creatinine (p < 0.01), lactate (p < 0.01), and interleukin-6 (p < 0.01) levels, associated with reduced changes in H3.1 nucleosome levels (p = 0.02). Early treatment was associated with lower norepinephrine requirements than later treatment. Two control animals died; all the mCBS-treated animals survived. Neutralization of extracellular histones with mCBS was associated with reduced norepinephrine requirements, improved tissue perfusion, less renal dysfunction, and lower circulating IL-6 in experimental septic shock and may represent a new therapeutic approach to be tested in clinical trials.

The present research uses mathematical analysis instruments for a comparative study between the Islamic financing system and the Ribaoui financing system usually called the classical financing scheme. The former system deals with contracts based on variable returns while the second i-e the ribaoui system is based on fixed return contracts. Using the principles of partial equilibrium theory for risk adverse investors, the study demonstrates that returns are higher with contracts based on profit and loss sharing.

The evolving digital economy presents significant challenges for traditional auditing practices. This research investigates the transformative potential of integrating Artificial Intelligence (AI) and blockchain technologies into digital audits, aiming to enhance trust and transparency. Through a systematic literature review and thematic analysis of 45 relevant studies, we identify key trends and assess the impact of AI and blockchain on data reliability, audit automation, continuous auditing capabilities, and information asymmetry. Our findings demonstrate that this integration can significantly improve audit efficiency and effectiveness, resulting in stronger audit evidence, greater accountability, and ultimately, heightened trust and transparency within the audit process. To further advance the field, the study proposes future research directions, including exploring industry-specific applications, analyzing long-term impacts on organizational performance and sustainability, and investigating integration with other emerging technologies. By embracing these advancements, the auditing profession can leverage the power of AI and blockchain to ensure its continued relevance and value in the digital age.

To analyze epidemiological characteristics, clinical symptoms, radiological aspects, treatment and outcome of central nervous system hydatidosis and compare our results with those reported in literature. In our retrospective study, we reviewed 39 cases of primary central nervous system hydatid cysts operated on in our hospital between 1998 and 2007. There were 20 male and 19 female patients (sex-ratio M/F = 1.05) between 2 and 68 years of age (mean = 26.5 years). Thirteen of the patients were children (33.3%) with a mean age of 6.8 years and 26 were adults (66.7%) with a mean age of 36.3 years. The location of hydatid cysts was intracranial in 27 cases (69.2%) and spinal in 12 cases (30.8%). Headache and motor deficits were the predominant symptoms in patients with intracranial hydatidosis whereas back pain and spinal cord compression syndrome were the most frequent clinical presentations in patients with spinal hydatidosis. All patients underwent surgical resection of the cyst. Pathologic findings were consistent with hydatid cyst in all cases. During the follow-up period which ranged between 12 months and 5 years, 12 patients had recurrence (30.7%). Only one patient with intracranial hydatid cyst died postoperatively due to anaphylactic shock. Despite all the advances in imaging techniques and therapeutic methods, central nervous system hydatidosis remains difficult to cure and patient outcomes are not satisfactory especially in case of spinal involvement due to the high incidence of recurrence.