bluuebunny/crossref_metadata_2025 huggingface dataset:
Case–control study of milk curd obstruction in newborn infants in a tertiary surgical neonatal intensive care unit
Authors: Walsh Orla , Anthony Ross , Wang Zeke , Cormack Barbara Elizabeth , Bloomfield Frank Harry
Published: October 2024

Background

Milk curd obstruction (MCO), in which milk becomes inspissated, is a rare, serious, complication of preterm birth. Case reports implicate male sex and bovine-derived human milk fortifier (HMF) use as predisposing factors. We investigated this through a case–control study.

Methods

MCO cases in the Starship Child Health neonatal database between 2008 and 2020 were matched with controls in a 1:2 ratio based on gestational age (±1 week), birth weight (±200 g) and date of birth (±1 month). Data were analysed using the Student’s t-test, Mann-Whitney U-test or χ² test as appropriate. Data are median (IQR) or n (%).

Results

Of 20 MCO cases, gestation was 26.1 (24.5–28.1) weeks, birth weight was 822 (713–961) g, 15 (75%) were male. 40 controls were well-matched for gestation (26.1 (24.8–27.9) weeks) and birth weight (849 (690–1066) g) but only 18 (45%) were male (p=0.05). MCO occurred at 21 (15–33) days; 6 (30%) cases died compared with 3 (7.5%) controls (p=0.06). HMF was commenced at 243 (150–309) hours in cases and 224 (172–321) hours in controls (p=0.95); full-fortification (manufacturer’s recommended dose) was achieved in 8 (40%) cases and 27 (68%) controls (p=0.08). In cases, MCO occurred 10 (7–17) days after commencing HMF. Medically/surgically-managed gut pathology occurred in 7 (35%) cases prior to MCO but in no controls (p<0.001).

Conclusions

Our data support male sex but not HMF use as a predisposition to MCO. Evidence of prior medical/surgical gut pathology may be a premonition for MCO; however, further research is required to confirm this.
Ultrasound-guided spinal anaesthesia for a patient with severe scoliosis
Authors: Yoshimura Manabu , Morimoto Yasuhiro
Published: October 2024

Ultrasound (US) guided spinal anaesthesia is gaining recognition for its ability to minimise technical difficulties encountered in patients with atypical spinal anatomy. Spinal anaesthesia is administered during a surgical procedure lithotripsy in patients with respiratory complications that can result from severe scoliosis or cerebral palsy. Here, we report a case in which US-guided spinal anaesthesia proved feasible and advantageous in a patient with cerebral paralysis and severe scoliosis. A man in his 60s with cerebral paralysis and severe scoliosis was scheduled for spinal anaesthesia because of his nocturnal SpO2 drops and need for nasal high flow. Using US guidance, we confirmed that the needle entry angle was consistent with the rotating spinous process. The spinal needle was then advanced successfully, and spinal anaesthesia was administered without issue. The US technique for detecting the rotation of the vertebrae and puncturing them is useful in patients with severe scoliosis.
Association of polymorphisms in theHTRA1gene with myopia
Authors: Chen Shu Ying , Xu You Mei , Tam Pancy O S , Pang Chi Pui , Tham Clement C , Yam Jason C , Chen Li Jia
Published: October 2024

Purpose

To evaluate the associations of single-nucleotide polymorphisms (SNPs) in thehigh-temperature requirement protease A 1(HTRA1)gene with myopia.

Methods

25 SNPs inHTRA1were selected, including 23 haplotype-tagging SNPs, SNP rs2142308 from a previous genome-wide association study (GWAS) of myopia and rs11200638, a SNP strongly associated with age-related macular degeneration (AMD). All SNPs were genotyped in a Hong Kong Chinese cohort of 533 myopia subjects (including 175 high myopia, 189 moderate myopia and 189 mild myopia) and 280 non-myopic controls. The association of individual SNPs were evaluated in overall myopia and different subgroups of myopia using logistic regression.

Results

A tagging SNP, rs11200647, was significantly associated with myopia (p=2.17×10-4, OR=0.67). Nominal associations were detected for the AMD-associated SNP rs11200638 (p=0.0042, OR=1.37) and tagging SNPs rs12266322 (p=0.0048, OR=0.59) and rs17103569 (p=0.047, OR=1.34). The association of rs11200647 with myopia remained significant after adjusting for rs11200638, rs12266322 and rs17103569. In sub-group analysis, two tagging SNPs, rs11200647 (p=2.24×10-4, OR=0.58) and rs12266322 (p=8.31×10-4, OR=0.39), showed significant association with moderate myopia. In haplotype association analysis, haplotypes AT (p=1.00×10-4, OR=1.77) and haplotype GT (p=0.0019, OR=0.64), defined by rs11200647 and rs66884382, were significantly associated with myopia.

Conclusions

This study provided new evidence to supportHTRA1as an associated gene for myopia, especially moderate myopia. The findings suggested that myopia and AMD may have shared genetic components.
Impact of the COVID-19 pandemic on time to treatment, treatment patterns and outcomes among patients with acute coronary syndrome in Yogyakarta, Indonesia: a retrospective cohort study
Authors: Dewi Pramitha Esha Nirmala , Youngkong Sitaporn , Sunantiwat Montaya , Nathisuwan Surakit , Thavorncharoensap Montarat
Published: October 2024

Objective

This study aimed to evaluate the impact of the COVID-19 pandemic on the management of acute coronary syndrome (ACS) in Yogyakarta, Indonesia with respect to time to treatment, treatment pattern and treatment outcome.

Design

This is a retrospective cohort study in which medical records of hospitalised patients with ACS were reviewed.

Setting

Three hospitals in Yogyakarta, Indonesia.

Participants

Patients hospitalised with ACS during two pandemic periods (first pandemic period: March–August 2020; second pandemic period: March–August 2021) and prepandemic period (March–August 2019).

Outcome measures

Time to treatment, treatment pattern and treatment outcome.

Results

A total of 598 patients with ST-elevation myocardial infarction (STEMI) and 615 with non-ST-elevation ACS were identified. Of these, 313, 484 and 416 were identified during the prepandemic period, first pandemic period and second pandemic period, respectively. For STEMI, the proportion of patients with a delay from symptom onset to first medical contact (FMC) was significantly higher during the second pandemic period as compared with the prepandemic period (47.7% vs 32.0%, OR=1.84, 95% CI 1.18, 2.85). The proportion of patients with STEMI with delayed door-to-balloon (D2B) time was significantly higher during the second pandemic period as compared with the prepandemic period (99.4% vs 92.9%, OR=13.08, 95% CI 1.57, 108.73). Significantly longer mean total ischaemic time (45.85 hours vs 30.29 hours, mean difference=14.56, 95% CI 1.85, 27.28) was observed among patients with STEMI during the second year of the pandemic as compared with the prepandemic period. No significant differences between the prepandemic period and the first pandemic period were found in terms of proportion of patients with STEMI with a delay in time from symptom onset to FMC, delayed D2B time and total ischaemic time. Only Global Registry of Acute Coronary Events risk score (OR=1.04, 95% CI 1.03, 1.05) was a significant predictor of in-hospital mortality in the multivariate analysis.

Conclusions

This study suggests a significant impact of the COVID-19 pandemic on time to treatment among patients with ACS. Health systems need to be well prepared to support effective and timely treatment of patients with ACS during future crisis.
Artificial intelligence-based CT-free quantitative thyroid SPECT for thyrotoxicosis: study protocol of a multicentre, prospective, non-inferiority study
Authors: Oh Dongkyu , Ryoo Hyun Gee , Chung Hyun Woo , Cho Sang-Geon , Kwon Kyounghyoun , Kim Ji Hye , So Young , Moon Jae Hoon , Ahn Soyeon , Lee Won Woo
Published: October 2024

Introduction

Technetium thyroid uptake (TcTU) measured by single-photon emission CT/CT (SPECT/CT) is an important diagnostic tool for the differential diagnosis of Graves’ disease and destructive thyroiditis. Artificial intelligence (AI) may reduce CT-induced radiation exposure by substituting the role of CT in attenuation correction (AC) and thyroid segmentation, thus realising CT-free SPECT. This study aims to compare the diagnostic accuracy for the differential diagnosis of thyrotoxicosis between CT-free SPECT and SPECT/CT.

Methods and analysis

The AI-based CT-free SPECT is a single-blind, multicentre, prospective, non-inferiority, clinical trial with a paired design conducted in the Republic of Korea. Eligible participants are adult (≥19 years old) thyrotoxicosis patients without a previous history of hyperthyroidism or hypothyroidism. Approximately 160 subjects will be screened for quantitative thyroid SPECT/CT using Tc-99m pertechnetate. CT-free thyroid SPECT will be realised using only SPECT data by the trained convolutional neural networks. TcTU will be calculated by SPECT/CT and CT-free SPECT in each subject. The primary endpoint is the accuracy of diagnosing Graves’ disease using TcTU. The trial will continue until 152 completed datasets have been enrolled to assess whether the 95% (two-sided) lower confidence limit of the accuracy difference (CT-free SPECT accuracy—SPECT/CT accuracy) for Graves’ disease is greater than −0.1. The secondary endpoints include the accuracy of diagnosing destructive thyroiditis and predicting the need for antithyroid drug prescription within 1 month of the SPECT/CT.

Ethics and dissemination

The study protocol has been approved by the institutional review board of Seoul National University Bundang Hospital (IRB No. B-2304-824-301), Konkuk University Medical Center (IRB No. 2023-05-022-006) and Chonnam National University Hospital (IRB No. CNUH-2023-108). Findings will be disseminated as reports, presentations and peer-reviewed journal articles.

Trial registration number

KCT0008387, Clinical Research Information Service of the Republic of Korea (CRIS).
Impact of climate change on child outcomes: an evidence gap map review
Authors: Meherali Salima , Aynalem Yared Asmare , Nisa Saba Un , Kennedy Megan , Salami Bukola , Adjorlolo Samuel , Ali Parveen , Silva Kênia Lara , Aziato Lydia , Richter Solina , Lassi Zohra S
Published: October 2024

Background

Climate change and extreme weather events significantly threaten neonatal and child health. This review aims to provide a comprehensive overview of the current evidence on the impact of climate change on child health, using the evidence gap map (EGM) to address knowledge gaps and establish a foundation for evidence-based interventions and future research.

Method

From inception, academic databases (such as MEDLINE, EMBASE, Global Health, CINAHL and Scopus) and grey literature were systematically searched. We included climate change-related studies involving children aged 0–5 worldwide. Covidence facilitated a rigorous screening process, and we conducted a critical appraisal. Two independent reviewers handled screening and data extraction. Eligible studies underwent coding and extraction using Evidence for Policy and Practice Information (EPPI) reviewer software. The EGM was constructed using EPPI Mapper, and comprehensive findings were presented through live links and figures.

Result

We identified 196 studies, comprising 59.2% children and 40.8% neonates, with diverse research approaches, including 94% quantitative studies. There has been a notable increase in research publications over the past 5 years. Evidence is heavily concentrated in Asia (93 studies) and Africa (47 studies). The most frequently studied exposures are those related to extreme climate events, followed by drought and floods. However, there are gaps in the study of extreme cold and storms. The significant outcomes comprised preterm birth (55 studies), low birth weight (27 studies), malnutrition (59 studies) and diarrhoeal diseases (28 studies). Evidence on mental health problems and congenital disabilities receives relatively less attention.

Conclusion

This EGM is crucial for researchers, policymakers and practitioners. It highlights knowledge gaps and guides future research to address the evolving threats of climate change to global child health.

Trial registration number

INPLASY202370086
A qualitative study exploring the experiences of advanced clinical practitioner training in emergency care in the South West of England, United Kingdom
Authors: Ablard Suzanne , Kuczawski Maxine , O'Keeffe Colin , Sampson Fiona C , Mould Jedidah , Mason Suzanne M
Published: October 2024

Background

Attempting to improve emergency care (EC) advanced clinical practitioner (ACP) training, Health Education England (HEE) South West (SW) implemented a pilot, whereby emergency departments (ED) were provided with enhanced funding and support to help ED consultants deliver teaching and supervision to EC ACPs to ensure more timely completion of EC ACP training compared with previous cohorts training in the region.

We explored the experiences of trainee EC ACPs and consultant EC ACP leads working in EDs, which had implemented the new regional pilot.

Methods

We used a qualitative design to conduct semi-structured interviews with trainee EC ACPs and consultant EC ACP leads across five EDs that had implemented the HEE SW pilot. Interview data were analysed thematically.

Results

Twenty-five people were interviewed. We identified four themes: (1) the master’s in advanced practice could be better aligned with the Royal College of Emergency Medicine credentialling e-portfolio; (2) EC ACP training needs some flexibility to reflect the individual—‘one size does not fit all’; (3) supervision and teaching were recognised as important but requires significant staff capacity that is impacted by external pressures and (4) unclear role expectations and responsibilities hinder role transition and impact role identity.

It was notable that EC ACPs primarily spoke about the development of their clinical skills both academically and within the workplace, despite there being other skills mentioned in the multiprofessional framework for advanced practice (leadership and management, education and research).

Conclusion

A clear supervision structure with protected time allocated for teaching and assessment of clinical skills within the ED is essential to facilitate trainee EC ACP progression. However, increasing demands on EDs make this a challenging goal to achieve. Role identity issues continue to persist despite the introduction of new guidance designed to provide more clarity around the ACP role.
Heart failure and major haemorrhage in people with atrial fibrillation
Authors: Jones Nicholas R , Smith Margaret , Lay-Flurrie Sarah , Yang Yaling , Hobbs FD Richard , Taylor Clare J
Published: October 2024

Background

Heart failure (HF) is not included in atrial fibrillation (AF) bleeding risk prediction scores, reflecting uncertainty regarding its importance as a risk factor for major haemorrhage. We aimed to report the relative risk of first major haemorrhage in people with HF and AF compared with people with AF without HF (‘AF only’).

Methods

English primary care cohort study of 2 178 162 people aged ≥45 years in the Clinical Practice Research Datalink from January 2000 to December 2018, linked to secondary care and mortality databases. We used traditional survival analysis and competing risks methods, accounting for all-cause mortality and anticoagulation.

Results

Over 7.56 years median follow-up, 60 270 people were diagnosed with HF and AF of whom 4996 (8.3%) had a major haemorrhage and 36 170 died (60.0%), compared with 8256 (6.4%) and 34 375 (27.2%), respectively, among 126 251 people with AF only. Less than half those with AF were prescribed an anticoagulant (45.6% from 2014 onwards), although 75.7% were prescribed an antiplatelet or anticoagulant. In a fully adjusted Cox model, the HR for major haemorrhage was higher among people with HF and AF (2.52, 95% CI 2.44 to 2.61) than AF only (1.87, 95% CI 1.82 to 1.92), even in a subgroup analysis of people prescribed anticoagulation. However, in a Fine and Gray competing risk model, the HR of major haemorrhage was similar for people with AF only (1.82, 95% CI 1.77 to 1.87) or HF and AF (1.71, 95% CI 1.66 to 1.78).

Conclusions

People with HF and AF are at increased risk of major haemorrhage compared with those with AF only and current prediction scores may underestimate the risk of haemorrhage in HF and AF. However, people with HF and AF are more likely to die than have a major haemorrhage and therefore an individual’s expected prognosis should be carefully considered when predicting future bleeding risk.
Coastal Synechococcus strains can exploit low-oxygen habitats
Authors: Śliwińska-Wilczewska Sylwia , Savoie Mireille , Campbell Douglas A.
Published: October 2024

We found that Phycoerythrin-rich Synechococcus achieved faster growth rates (µ), across the spectral bandwidths from 405 to 730 nm, under 2.5 µmol/L [O2], characteristic of oxygen minimum zones (OMZs), than under 250 µmol/L [O2], whereas phycocyanin-rich strain showed generally similar µ under 2.5 and 250 µmol/L [O2]. For phycocyanin- and phycoerythrin-rich Synechococcus, µ showed also positive linear responses to both phycobiliproteins:chlorophyll a, and to cumulative diel PSII electron flux, although the relations vary across strain and [O2]. Electron transport downstream of Photosystem II was generally higher for both phycocyanin- and phycoerythrin-rich strains under 250 µmol/L [O2], since cyanobacteria show strong capacity for electron flow away from PSII to O2, particularly under excess excitation. Even though electron transport was faster under 250 µmol/L [O2], the phycoerythrin-rich strain showed a higher growth yield of electron transport under 2.5 µmol/L [O2]. Phycoerythrin-rich Synechococcus are currently typically found at greater depths, and lower light, than are phycocyanin-rich strains, but we suggest that the phycoerythrin-rich strains are actually limited to lower light by an interaction between light and full air-saturated [O2]. In expanding OMZs phycoerythrin-rich strains will likely exploit higher light niches, across a wider spectral range.
Crustal stress near the Yakutat microplate collision from probabilistic earthquake focal mechanisms
Authors: Gosselin Jeremy M. , Biegel Katherine M. , Dettmer Jan , Gilbert Hersh , Colpron Maurice , Enkelmann Eva
Published: October 2024

Earthquake source characteristics provide a valuable constraint on crustal stress and regional plate tectonics. Earthquake source studies in Yukon and northern British Columbia have been limited by sparse seismic network coverage. In this work, we leverage recent seismic network improvements to estimate focal mechanisms for small- and moderate-magnitude ( M > 2.0) earthquakes from P-wave first-motion polarity data. We invert these data within a probabilistic framework to rigorously quantify mechanism uncertainties. Subsequently, probabilistic earthquake focal mechanisms are used as input for inversions for the orientation of principal stress axes, and stress shape ratio, for spatial windows throughout the region. We implement a novel, data-driven approach to propagate focal mechanism uncertainty in stress inversion. Our results improve the spatial coverage of existing earthquake focal mechanisms and enable an orogenic-scale study of crustal stress near the Yakutat–North America collision. Overall, the region is characterized by a transpressive stress regime. Maximum horizontal compressive stress orientations exhibit a pattern orthogonal to the Yakutat collision syntaxis. Stress inversion results also reveal an abrupt change in orientation east-to-west, which we interpret as a change in stress regime across the Fairweather–Connector–Totschunda fault system that is likely related to coupling between the subducting Yakutat slab and North America. This work improves our understanding of potential earthquake hazards in southwestern Yukon and the surrounding region.
What in Earth? Analyses of Canadian soil populations of Aspergillus fumigatus
Authors: Korfanty Greg , Kazerouni Arshia , Dixon Mykaelah , Trajkovski Micheala , Gomez Paola , Xu Jianping
Published: October 2024

Aspergillus fumigatus is a globally distributed mold and a major cause of opportunistic infections in humans. Because most infections are from environmental exposure, it is critical to understand environmental populations of A. fumigatus. Soil is a major ecological niche for A. fumigatus. Here, we analyzed 748 soil isolates from 21 locations in six provinces and one territory in Canada. All isolates were genotyped using nine microsatellite markers. Due to small sample size and/or close proximities for some local samples, these isolates were grouped into 16 local geographic and ecological populations. Our results indicated high allelic and genotypic diversities within most local and provincial populations. Interestingly, low but statistically significant genetic differentiations were found among geographic populations within Canada, with relatively similar proportions of strains and genotypes belonging to two large genetic clusters. In Hamilton, Ontario, and Vancouver, BC, where two and three ecological populations were analyzed, respectively, we found limited genetic difference among them. Most local and provincial populations showed evidence of both clonality and recombination, with no population showing random recombination. Of the 748 soil isolates analyzed here, two were resistant to triazole antifungals. We discuss the implications of our results to the evolution and epidemiology of A. fumigatus.
UNIQUENESS RESULTS BASED ON DELTA FRACTIONAL OPERATORS FOR CERTAIN BOUNDARY VALUE PROBLEMS
Authors: MOHAMMED PSHTIWAN OTHMAN , AGARWAL RAVI P. , BALEANU DUMITRU , ABDELJAWAD THABET , YOUSIF MAJEED A. , ABDELWAHED MOHAMED
Published: October 2024

This paper primarily lies in presenting existence and uniqueness analysis of boundary fractional difference equations of a special Riemann–Liouville operators classes. To this end, we first develop Green’s function to the corresponding fractional boundary value problems and provide boundary conditions to find the constants. Then we study the existence of solutions and we examine the bounded of their solutions. Eventually, two numerical examples are given to demonstrate the efficiency and uniqueness behavior of the boundary value problem. Furthermore, such fractional problems can typically be converted to a direct fractional problem with certain boundary or initial conditions in transport in porous media.
Increasing density and viscosity of light non-aqueous phase liquids are indicators of natural source zone depletion
Authors: Smith Jonathan W. N. , Hinojosa Emiliano , Hill Alan F. M.
Published: October 2024

Natural source zone depletion (NSZD) acts to reduce the mass and/or toxicity of light non-aqueous phase liquids (LNAPL) in the shallow subsurface. Several indirect measurement techniques are commonly used to estimate LNAPL mass depletion based on CO
2
generation by hydrocarbon mineralization, heat production by exothermic biodegradation processes, and subsurface gas concentration gradients.

This paper presents data on LNAPL density and viscosity and shows changes that result from NSZD processes. Increasing trends in LNAPL density and viscosity were observed that provided a qualitative line-of-evidence for NSZD. When LNAPL density and viscosity were combined with contemporaneous LNAPL chemistry analysis it was possible to correlate changes in the physical properties to depletion of alkanes from the LNAPL in a manner that would inform a quantitative NSZD assessment. LNAPL density and viscosity measurements are relatively cheap and reproducible, and increasing trends in LNAPL density and viscosity provide additional lines-of-evidence for NSZD.
Tectonostratigraphic models of an extensional back-arc basin: inferences for the evolution of the Pannonian Basin System
Authors: Balázs Attila , Oravecz Éva , Bartha Attila , Fodor László , Magyar Imre , Sztanó Orsolya
Published: October 2024

The subsidence history and sedimentary architecture of extensional basins are controlled by the interplay between tectonics, mantle dynamics and climatic variations. Observations from outcrop to regional seismic scales coupled with numerical modelling techniques, including basin-scale stratigraphic, crustal-scale tectonic and mantle-scale subduction models, contribute to the quantification of basin evolution. Here, we review and discuss both tectonic and stratigraphic applications of such models and compare them with observations from the Pannonian Basin system of Central Europe. We show that diachronous localization of back-arc extension, crustal thinning, asthenospheric upwelling and subsequent thermal relaxation are superimposed on an overall slow plate convergence. These processes result in contrasting subsidence and uplift patterns and a variable heat flow evolution in different parts of the basin system. The crustal stress-field of the sub-basins does not always reflect their contrasting vertical motions. Extensional deformation generally migrates from the basin margins towards the basin centre. Structural inversion is localized along hot and weak inherited zones from the Middle Miocene to Present. Tectonic subsidence focuses sedimentation along deep depocentres, sourced by exhumed footwalls and from the neighbouring orogens. The overall post-rift sediment progradation is influenced by inherited bathymetries from the preceding syn-rift stage and by enhanced differential vertical motions.
Auditory, Visual, or Both? Comparing Visual and Auditory Representations of Game Elements in a Gamified Image-Tagging Task
Authors: Schubhan Marc , Altmeyer Maximilian , Rogers Katja , Degraen Donald , Lessel Pascal , Krüger Antonio
Published: October 2024

In gamification users show increased motivation and engagement towards tasks. So far, this effect has mostly been empirically tested based on the visual depiction of game elements, while research on the use and addition of auditory aspects is sparse. In this work we investigate the effect of different modalities of game elements (auditory, visual, audiovisual) on user experience, perception and performance in a gamified image-tagging task. We approached this via an online validation survey to find suitable sound effects (N=50), a main quantitative study (N=109) and a qualitative semi-structured interview (N=9). Our results show that while visual gamification increases performance, auditory and audiovisual gamification had no effect. However, they were shown to have an influence on the user's flow state. Our qualitative follow-up study shed light on underlying reasons and revealed each modality has its own drawbacks and advantages and that combining both visual and auditory aspects was preferred by participants.
Changing Climate Change Mental Models Through Game-Based Learning: A Controlled Experiment Involving Cognitive Mapping
Authors: Fernández Galeote Daniel , Sicevic Nevena , Legaki Nikoletta-Zampeta , Hamari Juho
Published: October 2024

Climate change is one of humankind's grand challenges, and how we think about it influences how we perceive its risks and act. Understanding people's mental models of climate change (that is, how they internally represent it) and potentially challenging and changing them can be a fruitful avenue towards engagement. However, our understanding of how games can affect climate change mental models is limited, especially in the lack of control conditions with comparable content. In this experiment, participants created cognitive maps of climate change before and after experiencing an immersive VR game, a desktop PC game, or a text with graphs. We show that all conditions improved the quality, focus, and systems orientation of cognitive maps, but no significant differences were found between groups. The intervention effectively increased the salience of issues such as health and biodiversity impacts, even though changes were limited in scope. The game was on average more enjoyable than the text, with the VR version significantly more so than the other two conditions. The findings suggest that games can be a viable and attractive communication and learning method where engagement is a struggle. We provide avenues for future research and, especially, game design in this area.
Discussing the Protagonist Role of Students in Game-Based Learning
Authors: Weixelbraun Petra F. , Göbl Barbara , Steinböck Matthias , Duvivié Mirjam , Kayali Fares
Published: October 2024

In the ongoing process of the digital transformation of society, corresponding competencies are required from children more than ever. The concept of computational empowerment (CE) promotes confident and reflective engagement with digital technology, which often falls short in formal education. This work outlines how both entertainment and serious games can be used to support the cause of CE and what opportunities they offer for more empowering learning in school settings. The use of digital games appears to be a promising way to connect with the lifeworld of young people and thus offering a low-threshold and differentiated starting point. In this context, the focus should be placed on a stronger establishment of the protagonist role to empower students to engage with digital technologies in depth.

In the
Serious Game Changers
project, students created their own educational modules on specific Sustainable Development Goals (SDGs) using digital games and creating new artifacts as learning objects through remixing game elements. In this project, students should be empowered to become active participants by designing with the help of commercial and serious games. Thus giving them their own voice in future (formal) educational settings and promoting future skills in order to make them self-confident 'protagonists' of their surroundings.
Harmful Design in User-Generated Games and its Ethical and Governance Challenges: An Investigation of Design Co-Ideation of Game Creators on Roblox
Authors: Zhang Zinan , Moradzadeh Sam , Gui Xinning , Kou Yubo
Published: October 2024

An increasing number of game platforms, such as Roblox, enable game creators to develop user-generated games (UGGs). Yet, these platforms often come under scrutiny for hosting UGGs that contain harmful content, ranging from sexually explicit material to Nazi-themed roleplay. Limited attention has been paid to how harmful UGGs are ideated by game creators. To address this question, we studied an online Roblox creator community, where Roblox creators collectively engage in design ideation to brainstorm design ideas for UGGs. Through an inductive thematic analysis, we found three primary ways where Roblox creators' design ideation becomes risky, including how Roblox creators generate risky game design ideas, navigate through policy boundaries to develop these ideas, and share strategies of bypassing moderation. Based on our findings, we discuss ethical and governance challenges facing user-generated games. We propose design implications to support game creators in developing ethical game design ideas and safe game designs.
"I'm a Solo Developer but AI is My New Ill-Informed Co-Worker": Envisioning and Designing Generative AI to Support Indie Game Development
Authors: Panchanadikar Ruchi , Freeman Guo
Published: October 2024

Indie game developers are often defined as game developers who are typically not employed by or affiliated with tech giants or large gaming companies/publishers. Although people may decide to "go indie" for various purposes, indie game development has become a crucial part of the global gaming culture. However, this community is now facing unprecedented tensions as generative AI technologies are shifting how games can be designed, produced, and experienced. Through a qualitative analysis of 3,091 online posts and comments from subreddits and Facebook groups for indie game developers, we offer an in-depth investigation of how indie game developers perceive and envision the multifaceted role of generative AI in their creative practices. Our empirical investigation reveals that generative AI both promotes and harms indie game developers' endeavors to innovate the traditional game production model, which further influences the nature and workflow of creativity in game development. We also propose three principles for designing future generative AI technologies to improve indie developers' work while mitigating potential risks, harm, and negative impacts of AI. We hope that this study can help design and develop future generative AI technologies to foster and sustain more democratic and inclusive practices in game development rather than replacing human creators.
"I Found it Cathartic": Exploring Empathy and Mental Health Awareness in Psychological Horror Video Games
Authors: Tomé Filipe , Pires Ana , Jiskrová Anna , Saial Ana , Campos Pedro F.
Published: October 2024

Horror video games have often been criticized for their negative and unrealistic depiction of mental health, primarily through their portrayal of characters with mental illnesses. Such representations can perpetuate stigma and misconceptions about mental health issues. However, there has recently been a growing interest in accurate portrayals of these characters and how playing these video games could also elicit empathy and mental health awareness. In our study, we explored how a psychological horror game such as Silent Hill 2 could foster empathy and mental health awareness through individual interviews with 11 participants. Our findings revealed that participants gained a deeper understanding of mental health issues and empathy towards characters struggling with mental illnesses by interacting and controlling them. Participants had a greater attachment to the characters' inner struggles and their gameplay was experienced as cathartic. Moreover, our findings highlighted the potential of psychological horror to serve as a platform for character-driven narratives, showcasing how engagement with such games elicited empathy among participants. We contribute to an exploratory understanding that can assist game designers and writers in crafting narratives within the Psychological Horror genre that foster empathy and mental health awareness.
Players, Take (Self-)Care: Bringing Humanistic Psychology into a Game Jam about Mental Health
Authors: Spors Velvet , Kaufman Imo
Published: October 2024

Game jams are collective events that bring people together to think about, make and play games. As collaborative encounters built on community, game jams create unique interpersonal possibilities. Tapping into this relational potential, we integrated elements of humanistic psychology and the person-centred approach into a game jam: We engaged 19 participants in the making of games for self-care and mental health, over the course of a week, as a remote event hosted by the National Videogame Museum, UK. We go on to thematically analyse our shared discussions to unpack the jam as a mutual sense-making activity between facilitators and participants, demonstrating how the jam functioned as a space in which the status quo of mental health could be negotiated; contributing to the jam's sense of community, and generation of caring, novel designs. Finally, we outline two design opportunities for game designers, developers and researchers that seek to engage with the experiential nature of game jams
care-fully.
Playing for a Better Future: How Animal Avatars Influence the Attitude of Players
Authors: Emmerich Katharina , Krekhov Andrey , Krüger Jens
Published: October 2024

Digital games allow us to adopt the avatar's perspective and experience the (virtual) world from another point of view. The positive effects of such role swaps are well-documented in contexts such as combating racial or ethnic biases. Our work expands this research direction by considering animal avatars: We hypothesize that playing as an animal can improve our attitude towards wildlife and nature. In particular, this manuscript contributes a first systematic study on the effects of animal avatars on players' implicit attitudes towards animals. Our study (N = 78) employs two commercial games featuring different animal avatars, Endling - Extinction is Forever and Bee Simulator, and compares the results of implicit association tests administered before and after gameplay. Our findings confirm significant positive effects of the games on players' implicit associations with foxes and bees. Together with several interesting insights regarding player-avatar relationships and avatar identification, our work paves the groundwork for games contributing positively to societal change.
Pseudo-Scientist:
Towards Narrative Interventions for Imposter Syndrome
Authors: Grasse Katelyn M. , Junius Nic , Weatherwax Kevin , Sisodiya Shweta , Martin Amanda , Carstensdottir Elin
Published: October 2024

Imposter syndrome (IS) is a mental state that can severely inhibit a person's productivity and well-being. Although IS is extremely common (especially in high achievers, e.g., academics), few studies offer effective modes of support and recovery. In response, we introduce the application of relatable narrative as a way to help people overcome IS. We present a randomized group comparison study exploring the impact of various design factors -- specifically, choice-based interactivity and character relatability -- on our story's capacity to engage and impact 107 STEM undergraduates. Almost all participants enthusiastically endorsed the story as a valuable learning experience, and a majority reported positive impacts to mood and feelings of relatedness to peers. We discuss 1) how our specific digital story design can support positive changes in mental health at both individual and institutional levels and 2) how our findings can inform efficient design of interactive narrative content for educational applications.
Questions without Answers: Enjoyment of Irresolution in Mystery Player Experience
Authors: Kärnä Emmi L. K. , Väkevä Jaakko , Rautalahti Heidi , Lindqvist Janne
Published: October 2024

Mysteries are an engaging form of fiction, capturing audiences with curiosity, uncertainty, and ambiguity. However, mysteries in games have presented a challenge for research since the word mystery may be understood as 1) detective mysteries with clear-cut answers or 2) as mysteries which are unsolvable and incomprehensible. This paper focuses on the latter kind of mysteries. To investigate what constitutes a mystery player experience, in what ways mystery games provide answers to players and how to design these games, we inspected five mystery games through a formalist game analysis by a player-researcher. We discovered (1) how the mystery player experience was characterised by enjoyment of irresolution, state of not receiving clear-cut answers to a mystery, (2) how a mystery condition, a state of wonder and fascination, promoted openness, and (3) how interpretation management represented the doing in the mystery player experience. To our surprise, although the player was driven to find answers to mysteries, the eventual irresolution was an enjoyable experience to the player. We conclude that all mysteries need not be answered during the game, and the experience can be enjoyable because of this.
Sketchar: Supporting Character Design and Illustration Prototyping Using Generative AI
Authors: Ling Long , Chen Xinyi , Wen Ruoyu , Li Toby Jia-Jun , LC RAY
Published: October 2024

Character design in games involves interdisciplinary collaborations, typically between designers who create the narrative content, and illustrators who realize the design vision. However, traditional workflows face challenges in communication due to the differing backgrounds of illustrators and designers, the latter with limited artistic abilities. To overcome these challenges, we created Sketchar, a Generative AI (GenAI) tool that allows designers to prototype game characters and generate images based on conceptual input, providing visual outcomes that can give immediate feedback and enhance communication with illustrators' next step in the design cycle. We conducted a mixed-method study to evaluate the interaction between game designers and Sketchar. We showed that the reference images generated in co-creating with Sketchar fostered refinement of design details and can be incorporated into real-world workflows. Moreover, designers without artistic backgrounds found the Sketchar workflow to be more expressive and worthwhile. This research demonstrates the potential of GenAI in enhancing interdisciplinary collaboration in the game industry, enabling designers to interact beyond their own limited expertise.
That's the way I (dis-)like it! - Effect of Gamer Types and Competitiveness in VR Exergaming
Authors: Lange-Nawka Dominik , Wünsche Burkhard , Thompson Samuel E. R.
Published: October 2024

In response to growing global concerns surrounding sedentary lifestyles among adults, the imperative to motivate physical activity has driven the exploration of Virtual Reality (VR) exergames as a promising solution. Personality traits, particularly competitiveness, can play a pivotal role in influencing individuals' motivation to engage in either competitive or non-competitive versions of the same exergame. While existing studies have primarily focused on sports-related competitive orientations, they have overlooked the potential gain in information from gaming-related personality traits. This research addresses this gap by using a modified gaming-related competitiveness questionnaire and evaluating a VR cycling exergame featuring solo, self-competition and virtual opponent cycling conditions in a controlled user study with 38 participants. Empirical findings reveal a notable difference in self-rated competitiveness between the two domains of sports and gaming, and significant correlations between some gamer-types and motivation. These findings highlight the importance of these personality types during exergaming and their potential efficacy for personalisation to increase motivation.
You Are Tilted!: Leveraging Tabletop Gaming to Manage Tilt and Strengthen Team Dynamics in Esports
Authors: Cho Yeonhee , Newman Michele , Pitt Caroline , Yip Jason C. , Lee Jin Ha
Published: October 2024

Tilt, characterized by heightened frustration, is a prevalent issue in esports, significantly impacting team dynamics and player well-being. Traditional Human-Computer Interaction (HCI) solutions often focus on individual strategies, overlooking the team-based nature of esports. This study introduces 'TILTED', a tabletop game co-designed with youth esports players, aimed at fostering open communication and empathy to collectively manage tilt. Findings from four user testing sessions with collegiate esports teams reveal that team-based interventions like 'TILTED' can enhance team cohesion and provide effective strategies for emotional regulation. The game facilitates understanding and empathy among teammates for managing emotions and maintaining a positive team atmosphere. Our research underscores the importance of resetting strategies and shared mental models in helping to mitigate tilt and offers design implications for future team-based interventions to enhance team dynamics and tilt management strategies as a team.
Text-and-Image Learning Transformer for Cross-Modal Person Re-Identification
Authors: Wu Tinghui , Zhang Shuhe , Chen Dihu , Hu Haifeng
Published: October 2024

Text-based person re-identification aims to find the target person from a large pedestrian gallery with the given natural language description. Previous works mainly focus on embedding salient textual and visual representations in a common latent space by utilizing the dual-path structure or parameter-shared network. However, they still lack the ability to effectively extract fine-grained unimodal features as well as fuse the cross-modal data, leading to the increase of misaligned cases. To settle these issues, we propose a text-and-image implicit learning Transformer (TILT) to eliminate textual anisotropy and enhance the cross-modal alignment from both domains based on the bi-direction multi-modal encoders. Specifically, we apply the pre-trained multi-modal embedding module to overcome the unimodal anisotropy problem with contrastive learning, and map fine-grained features with dual encoder in bi-directional masking. Then, we design the cross-modal interaction encoder to comprehensively mine implicit cross-modal relations by reconstructing masked tokens, and fuse rich multi-modal knowledge in a common space. In addition, the cross-modal similarity matching module is proposed to optimize the intra-domain classification and decrease the inter-domain divergence. Extensive experiments are conducted on three public benchmarks CUHK-PEDES, ICFG-PEDES, and RSTPReid to verify the effectiveness of our proposed framework. Results prove that our model outperforms state-of-the-art methods on all metrics.
The Future of Misuse Detection
Authors: Neumann Peter G. , Lindqvist Ulf
Published: October 2024

From lessons learned to new directions.
Learning-based Artificial Intelligence Artwork: Methodology Taxonomy and Quality Evaluation
Authors: Wang Qian , Dai Hong-Ning , Yang Jinghua , Guo Cai , Childs Peter , Kleinsmann Maaike , Guo Yike , Wang Pan
Published: October 2024

With the development of the theory and technology of computer science, machine or computer painting is increasingly being explored in the creation of art. Machine-made works are referred to as artificial intelligence (AI) artworks. Early methods of AI artwork generation have been classified as non-photorealistic rendering, and, latterly, neural style transfer methods have also been investigated. As technology advances, the variety of machine-generated artworks and the methods used to create them have proliferated. However, there is no unified and comprehensive system to classify and evaluate these works. To date, no work has generalized methods of creating AI artwork including learning-based methods for painting or drawing. Moreover, the taxonomy, evaluation, and development of AI artwork methods face many challenges. This article is motivated by these considerations. We first investigate current learning-based methods for making AI artworks and classify the methods according to art styles. Furthermore, we propose a consistent evaluation system for AI artworks and conduct a user study to evaluate the proposed system on different AI artworks. This evaluation system uses six criteria: beauty, color, texture, content detail, line, and style. The user study demonstrates that the six-dimensional evaluation index is effective for different types of AI artworks.
Optimal Illumination Distance Metrics for Person Re-Identification in Complex Lighting Conditions
Authors: Wang Chao , Wang Zhongyuan , Hu Ruimin , Wang Xiaochen , Zhou Wen
Published: October 2024

Person re-identification is extensively applied in public security and surveillance. However, environmental factors like time and location often lead to varying lighting conditions in captured pedestrian images, significantly impacting identification accuracy. Current approaches mitigate this issue through lighting transformation techniques, aiming to normalize images to a standard lighting condition for consistent person re-identification results. Yet, these methods overlook the fact that different content may hold distinct identification values under diverse lighting conditions. To address this, we conducted an analysis on the identification distance between images of the same or different pedestrians under pre-defined lighting conditions. From this analysis, we introduce the concept of optimal lighting: a condition where the distance between image pairs is minimized compared to other lighting scenarios. We propose utilizing this optimal lighting distance in the image retrieval process for final ranking. Our study, validated on synthetic datasets Market-IA and Duke-IA, demonstrates that optimal lighting is independent of image texture information. Each image pair exhibits a unique optimal lighting, yet consistently shows a minimum distance value.