Real life lessons for the developing world

2010 ◽  
Vol 6 (1) ◽  
pp. 17-37 ◽  
Author(s):  
Patricia G. Lange

Games have received increased scholarly attention due to the economic value they generate. Yet, some studies still conceptualize games as ‘‘virtual’’ realms that are theoretically distinct from ‘‘real world’’ experiences. Based on an ethnographic investigation of two online, text-based gaming environments, this study analyzes dynamics such as technical acculturation, access to technical knowledge, and opportunities for self-expression by studying social interaction that occurred in non-revenue-generating games. Frameworks that focus on dynamics such as in-game conversation in broader game-centric domains or ecologies should be considered to accommodate a wider variety of gaming forms and related interdisciplinary research questions. Different games have different consequences, and it is important to understand the varying consequential contexts that games afford. Whether or not the consequences may be measured economically, it is nevertheless important to consider how social interactions may complicate forms of self-expression in ways that impact the human spirit.


2021 ◽  
Author(s):  
Ernst Fredericks ◽  
Abigail Titus ◽  
Shiraaz Gabriel ◽  
Willem De Villiers

Abstract Background: Inflammatory bowel disease (IBD) is a chronic relapsing and remitting inflammation of the bowel. Biologic therapy is safe and effective in IBD. Anti-TNF agents were the first biologics introduced for treatment of IBD. As more and more anti-TNF agents joined the market, treating physicians started using ant-TNF agents consecutively when the first agent failed. Data for this treatment choice is scanty and therefore we set out to evaluate tandem use of anti-TNF agents in IBD patients.Method: The South African Gastroenterology Society (SAGES) established a national database for all IBD patients commenced on biologic therapy. We used this registry to evaluate the data for all patients who received consecutive anti-TNF agents. Demographic and clinical details as well as treatment outcomes for all patients were documented. Results: Eight-seven (7.6%) of 1150 patients received consecutive anti-TNF agents. The Crohn’s disease (CD) group had 42 (48%) patients and ulcerative colitis (UC) group 45 (52%). Gender distribution was equal with 45 (52%) male and 42 (48%) female patients. All patients failed the first anti-TNF agent over time, but better remission rates were obtained with consecutive anti-TNF agents. Patients treated with adalimumab during any stage of the study, had a higher rate of dose escalation compared to infliximab prior to switching to next anti-TNF agent. Similarly, side effects were also more significant with adalimumab, although few. Few patients required a switch to a third and further biologic agent. All patients remained in clinical remission over 4 years of the study.Conclusion: It is reasonable to try a second anti-TNF agent when the first agent failed in IBD. Switching between different anti-TNF agents maintained clinical remission and avoided surgery and hospitalisation. This is a cost-effective strategy especially in resource constraint settings. Adalimumab is associated with higher rates of dose escalation and worse side-effect profile


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