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This study tested the hypothesis that continuous bilateral erector spinae plane blocks placed preoperatively would reduce opioid consumption and improve outcomes compared with standard practice in open cardiac surgery patients. Patients who received bilateral continuous erector spinae plane blocks for primary open coronary bypass, aortic valve, or ascending aortic surgery were compared to a historical control group. Patients in the block group received a 0.5% ropivacaine bolus preoperatively followed by a 0.2% ropivacaine infusion begun postoperatively. No other changes were made to the perioperative care protocol. The primary outcome was opioid consumption. Secondary outcomes were time to extubation and length of stay. Twenty-eight patients received continuous erector spinae plane blocks and fifty patients served as historic controls. Patients who received blocks consumed less opioids, expressed as oral morphine equivalents, both intraoperatively (34 ± 17 vs. 224 ± 125 mg) and during their hospitalization (224 ± 108 vs. 461 ± 185 mg). Patients who received blocks had shorter times to extubation (126 ± 87 vs. 257 ± 188 min) and lengths of stay in the intensive care unit (35 ± 17 vs. 58 ± 42 h) and hospital (5.6 ± 1.6 vs. 7.7 ± 4.6 days). Continuous erector spinae plane blocks placed prior to open cardiac surgical procedures reduced opioid consumption, time to extubation, and length of stay compared to a standard perioperative pathway.

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This study investigates how a design-based research methodology is best suited to measuring the impact of a designed virtual reality experience to improve situated identity in Irish learners focusing on their attitudes, motivation, and confidence as Irish language learners. This paper describes the design of GaeltechVR: an immersive Irish language VR experience designed for the VIVE Pro. It also gives the results of a mixed-methods study to measure the impact in a local adult Irish language learner context. A questionnaire on situated attitudes and motivation to language learning (Ushioda & Dörnyei, 2009) was adapted for the Irish context to investigate a small scale sample of the local context's attitudes to Irish language learning. The participant's gameplay was recorded for analysis along with questionnaires on presence (Witmer & Singer, 1998), simulator sickness and an adapted questionnaire on their attitudes after the intervention.Using best practice in design-based research experiments (Nelson, Ketelhut, Clarke, Bowman, & Dede, 2013) the study had two main goals: To investigate the usability of the design of GaeltechVR and to measure the impact of the intervention on attitudes, identity and motivation in the local Irish language learning context.

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