Dead Space 3 brings Isaac Clarke and merciless soldier, John Carver, on a journey across space to discover the source of the Necromorph outbreak. Crash-landed on the frozen planet of Tau Volantis, the pair must comb the harsh environment for raw materials and scavenged parts. Isaac will then put his engineering skills to the ultimate test to create and customize weapons and survival tools. The ice planet holds the key to ending the Necromorph plague forever, but first the team must overcome avalanches, treacherous ice-climbs, and the violent wilderness. Facing deadlier evolved enemies and the brutal elements, the unlikely pair must work together to save mankind from the impending apocalypse.
Once again Necromorphs are back and it is your responsibility to stop them. Your suit projects a helicopter display and weapons. The vacuum areas show timers, which indicate oxygen levels. Explore the space and collect all the necessary items to create tools and weapons. Also, take the advantage of your hi-tech suits to attack the enemies and defend yourself. You can roll through the ground and take cover to be safe. Dead Space 3 is not easy to survive; you will have to overcome critical challenges like avalanches, violence, wildness, deadly enemies and a harsh environment. Each mission will lead you closer to saving mankind.
The pay-for-convenience model has been creeping into some big-name online titles for a while now. Subscription-free MMOs like Guild Wars 2 and The Old Republic let players pay for convenience as well as vanity items. The option is also showing up in competitive multiplayer modes for primarily single-player games like EA's Mass Effect 3 and Ubisoft's Assassin's Creed 3, which let players buy consumable improvements rather than earning them through matches.
A number of clinically relevant benefits have been associated with NHF therapy: reduction in respiratory rate, a decrease of minute ventilation during sleep, improved alveolar ventilation, and a reduction in wasted ventilation and the work of breathing (4, 11, 23, 28), although how NHF produces these effects is not yet understood. A mechanistic study on healthy volunteers suggested two different ventilatory responses to NHF, one when awake and another during sleep (19). In this study it was speculated that the reduction of dead space ventilation due to clearance of anatomical dead space in the upper airways could be the principal driver for the reduction of minute ventilation during sleep, which may potentially lead to a reduction in the work of breathing. In a previous study using upper airway models the authors demonstrated the fast-occurring flow-dependent clearance of nasal cavities by NHF (18). Dead space clearance is difficult to study in vivo because of the complexity in quantifying the respiratory gases in the airways. However, many have proposed it to be the major physiological mechanism that improves respiratory support (20, 22, 26) and reduces arterial and tissue CO2 (1, 7, 14).
The aim of this study was to measure upper airway dead space reduction during NHF therapy to test a hypothesis that NHF in a dose-dependent manner can clear dead space in the upper airways and decrease rebreathing.
Values are means ± SD. NS, nonsmokers; S, smokers; XS, exsmokers; BMI, body mass index; VDA, anatomical dead space volume based on height (7a), VN, nasal volume corresponding to Nasal1 and Nasal2 ROIs derived from individual MRI scans.
The reduction of dead space by NHF may increase alveolar volume if tidal volume remains the same. It may also slow down the respiratory rate or reduce tidal volume and minute ventilation, as has been observed in this study and also as previously reported in healthy subjects during sleep (19). Reduction of the respiratory rate is the most frequently described respiratory parameter associated with NHF therapy in adults and children (1, 16, 26), and it is also reported to be a simple and informative predictor of potentially serious clinical events (3). It might be speculated that the reduction of respiratory rate by NHF can be more substantial in patients with an increased respiratory rate. In this study the authors observed very small reduction of the respiratory rate, which was within normal limits, but the small sample size and the study design did not allow for any definitive conclusion. Reduction of dead space may also affect gas exchange: a reduction of arterial CO2 (1, 20) and an increase of oxygenation (7, 20) by NHF were shown, although these effects were not evident in this study probably because the NHF application times (10 min) were too short.
The ratio of dead space to tidal volume increases during shallow breathing or when the total physiological dead space is raised because of an increase of alveolar dead space in conditions like emphysema, pulmonary embolism, or acute respiratory distress syndrome (9, 13); this requires an increase of breathing frequency to maintain the same level of alveolar ventilation. For the above-mentioned conditions a small reduction of dead space would lead to a significant improvement in gas exchange resulting in the reduction of minute ventilation or/and the normalizing of blood gas parameters.
Physiological effects and clinical outcomes related to the reduction of dead space during NHF may also be affected by the generated positive airway pressure that can modify breathing patterns and change the efficiency of the dead space clearance. On the basis of the data from the scintigraphy it is also likely that the efficiency of dead space clearance can potentially be increased with the reduction of respiratory rate. 2b1af7f3a8