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Background: Cirrhosis detection in primary care relies on low-performing biomarkers. Consequently, up to 75% of subjects with cirrhosis receive their first diagnosis with decompensation when causal treatments are less effective at preserving liver function. We investigated an unprecedented approach to cirrhosis detection based on dynamic breath testing. Methods: We enrolled 29 subjects with cirrhosis (Child–Pugh A and B), and 29 controls. All subjects fasted overnight. Breath samples were taken using Breath Biopsy® before and at different time points after the administration of 100 mg limonene. Absolute limonene breath levels were measured using gas chromatography–mass spectrometry. Results: All subjects showed a >100-fold limonene spike in breath after administration compared to baseline. Limonene breath kinetics showed first-order decay in >90% of the participants, with higher bioavailability in the cirrhosis group. At the Youden index, baseline limonene levels showed classification performance with an area under the roc curve (AUROC) of 0.83 ± 0.012, sensitivity of 0.66 ± 0.09, and specificity of 0.83 ± 0.07. The best performing timepoint post-administration was 60 min, with an AUROC of 0.91, sensitivity of 0.83 ± 0.07, and specificity of 0.9 ± 0.06. In the cirrhosis group, limonene bioavailability showed a correlation with MELD and fibrosis indicators, and was associated with signs of portal hypertension. Conclusions: Dynamic limonene breath testing enhances diagnostic performance for cirrhosis compared to static testing. The correlation with disease severity suggests potential for monitoring therapeutic interventions. Given the non-invasive nature of breath collection, a dynamic limonene breath test could be implemented in primary care.

Escape rooms are "live-action team-based games where players discover clues, solve puzzles, and accomplish tasks in one or more rooms in order to accomplish a specific goal (usually escaping from the room) in a limited amount of time." Escape Rooms are one type of Escape Game, which are narrative-based challenges that use puzzles, tasks, and a time limit, but may be table-based paper puzzles (such as a Puzzle Hunt) or a group activity to get a locked box open (such as Breakout Boxes). Escape Games are a type of Live-Action Game, which are Scott Nicholson Professor of Game Design and Development, Wilfrid Laurier University games where the player and the in-game avatar the player controls are the same thing. Rather than controlling something on a board or screen, players in Live-Action Games engage directly with the game world. This article discusses the benefits of using escape games in a classroom, provides three examples of different types of escape games, and explains how to avoid superficial educational game design.

The gold standard method for chronic liver diseases diagnosis and staging remains liver biopsy, despite the spread of less invasive surrogate modalities based on imaging and blood biomarkers. Still, more than 50% of chronic liver disease cases are detected at later stages when patients exhibit episodes of liver decompensation. Breath analysis represents an attractive means for the development of non-invasive tests for several pathologies, including chronic liver diseases. In this perspective review, we summarize the main findings of studies that compared the breath of patients with chronic liver diseases against that of control subjects and found candidate biomarkers for a potential breath test. Interestingly, identified compounds with best classification performance are of exogenous origin and used as flavoring agents in food. Therefore, random dietary exposure of the general population to these compounds prevents the establishment of threshold levels for the identification of disease subjects. To overcome this limitation, we propose the exogenous volatile organic compounds (EVOCs) probe approach, where one or multiple of these flavoring agent(s) are administered at a standard dose and liver dysfunction associated with chronic liver diseases is evaluated as a washout of ingested compound(s). We report preliminary results in healthy subjects in support of the potential of the EVOC Probe approach.

Background: Cirrhosis detection in primary care relies on low-performing biomarkers. Consequently, up to 75% of subjects with cirrhosis receive their first diagnosis with decompensation when causal treatments are less effective at preserving liver function. We investigated an unprecedented approach to cirrhosis detection based on dynamic breath testing. Methods: We enrolled 29 subjects with cirrhosis (Child–Pugh A and B), and 29 controls. All subjects fasted overnight. Breath samples were taken using Breath Biopsy® before and at different time points after the administration of 100 mg limonene. Absolute limonene breath levels were measured using gas chromatography–mass spectrometry. Results: All subjects showed a >100-fold limonene spike in breath after administration compared to baseline. Limonene breath kinetics showed first-order decay in >90% of the participants, with higher bioavailability in the cirrhosis group. At the Youden index, baseline limonene levels showed classification performance with an area under the roc curve (AUROC) of 0.83 ± 0.012, sensitivity of 0.66 ± 0.09, and specificity of 0.83 ± 0.07. The best performing timepoint post-administration was 60 min, with an AUROC of 0.91, sensitivity of 0.83 ± 0.07, and specificity of 0.9 ± 0.06. In the cirrhosis group, limonene bioavailability showed a correlation with MELD and fibrosis indicators, and was associated with signs of portal hypertension. Conclusions: Dynamic limonene breath testing enhances diagnostic performance for cirrhosis compared to static testing. The correlation with disease severity suggests potential for monitoring therapeutic interventions. Given the non-invasive nature of breath collection, a dynamic limonene breath test could be implemented in primary care. [ABSTRACT FROM AUTHOR]

Games and other forms of play are used in today's libraries to attract underserved patrons, to introduce patrons to other library resources and services, and to facilitate engagement between library patrons. While many perceive gaming as a new library service, gaming services have been part of librarianship since the nineteenth century through chess clubs. During the Great Depression, libraries supported patrons with puzzle contests and developed circulating toy and game collections. Academic libraries built game collections for research and classroom needs, while school libraries collected and facilitated educational games to aid teachers. Video games have been used in libraries to help patrons learn to use technology and to bring groups of patrons together to enjoy shared experiences. The goal of this article is to demonstrate the different ways in which libraries have used games, toys, and puzzles over the last 150 years through both collections and services.

One of the great failings in educational game design is a focus on the question-and-answer model of gameplay. This type of educational game has players engage in some sort of time-wasting activity like rolling a die and moving, and then the focus of the game, the activity of answering a question, is triggered. Thousands of educational games use this roll-and-move model for gameplay inspired by the popularity of Trivial Pursuit. Many librarians and educators creating games for their patrons and students revert to this question-asking model because it is so familiar. However, a different approach, in which the gameplay emerges from the content, can create board game experiences that are vibrant, motivating, and provide opportunities for deep engagement with the material. In this article, the author focuses on creating original games for the classroom. While this is the most time-consuming approach, instructors can control how the content in the game maps to curricular goals. If the goal of having games in the classroom is to help students acquire content, then games that provide an intrinsic integration of content with gameplay are the appropriate choice.

As demands on libraries continue to grow, outpacing budget increases, more librarians are forced to make difficult decisions about what materials and services stay and go. Charles R. McClure has written that many librarians use an "adhocracy" method to make these decisions, relying on no data or simple aggregates in determining a course of action. Others, however, have turned to a more data-driven approach that moves beyond generalized aggregations, such as running totals and overall means, to reveal underlying patterns in the data that clarify which services or materials are worth retaining. In this article, the author discusses "data warehousing" techniques that explore a large dataset for nontrivial, novel, and useful patterns, using different statistical, analytical, and visualization tools. (Contains 1 figure.)

Archaeologists have used material artifacts found in a physical space to gain an understanding about the people who occupied that space. Likewise, as users wander through a digital library, they leave behind data-based artifacts of their activity in the virtual space. Digital library archaeologists can gather these artifacts and employ inductive techniques, such as bibliomining, to create generalizations. These generalizations are the basis for hypotheses, which are tested to gain understanding about library services and users. In this article, the development of traditional archaeological methods is presented and used to create a conceptual framework for the artifact-based evaluation in digital libraries.

While a growing number of the digital reference services in libraries have become part of collaborative reference networks, other entities that serve similar information-seeking needs such as special collections and museums have not joined these networks, even though they are answering an increasing number of questions from off-site patrons via the Internet. This article examines the differences between questions asked electronically of traditional reference services and those asked of special collections services; it further explores how a better understanding of digital reference in special collections will facilitate the development of the tools and models needed to create a bridge between digital human intermediation at general academic libraries, special collections, and museums.

Describes a Delphi study conducted to determine factors that affect the process of routing and assigning reference questions received electronically by digital reference services, both to experts within the service and between services. Fifteen factors were determined, by expert consensus, to be important at the conclusion of this study. (Author/AEF)

Discusses quality issues regarding Web sites and describes research that created an intelligent agent for automated collection development in a digital academic library setting, which uses a predictive model based on facets of each Web page to select scholarly works. Describes the use of bibliomining, or data mining for libraries. (Author/LRW)