bluuebunny/crossref_metadata_2025 huggingface dataset:
Exploration of the relationship between general health-related problems and subclinical coronary artery disease: a cross-sectional study in a general population
Authors: Koopman Moniek Y , van der Ende M Yldau , Reijnders Jorn J W , Willemsen Robert T A , van Bruggen Rykel , Gratama Jan Willem C , Kietselaer Bastiaan L J H , van der Harst Pim , Vliegenthart Rozemarijn
Published: October 2024

Objective

To explore associations between general health-related problems and subclinical coronary artery disease (CAD), determined by CT coronary calcium score (CT-CCS), in a general population.

Design

A cross-sectional design.

Setting

This study was performed in a prospective population-based cohort, examining the health and health-related behaviour of individuals living in the Northern Netherlands.

Participants

The initial cohort comprised 6763 participants ≥45 years of age who underwent CT-scanning. Participants were included for the current analysis if they filled in three validated questionnaires (Symptomatic Checklist-90, Research and Development Survey-36 and Reviving the Early Diagnosis of CardioVascular Diseases questionnaire (RED-CVD)) and did not have a history of cardiovascular disease. The final analysis included 6530 participants.

Primary outcome measure

Backward-stepwise and forward-stepwise logistic regression analyses were performed to determine associations between general health-related problems and subclinical CAD (CCS≥100 and ≥300).

Results

The median age was 53 years (25th, 75th percentile: 48, 58); 57% were women. CRCS≥100 was found in 1236 (19%) participants, 437 (12%) in women and 799 (29%) men and CCS≥300 in 643 (9.9%) participants of which 180 (4.8%) were women and 463 (16.6%) men. In univariate analysis, in women the expectation of health to worsen (OR=1.13, 95% CI: 1.05 to 1.21), and in men reduced exercise intolerance (OR=1.14, 95% CI: 1.06 to 1.23) were associated with CCS≥100. The total RED-CVD score in women (OR=1.06, (95% CI: 1.05 to 1.08) and men (OR=1.07, 95% CI: 1.06 to 1.09), and in men also reduced exercise intolerance (OR=1.15, 95% CI: 1.06 to 1.25) and headache (OR=0.55, 95% CI: 0.38 to 0.79) were associated with CCS≥300. In multivariate analyses, only general health expectation in women was still significantly associated with subclinical CAD (CCS≥300) (OR=1.92, 95% CI: 1.56 to 2.37).

Conclusion

Only a few general health-related problems were associated with the presence of subclinical CAD in the general population, however, these problems showed no strong association. Therefore, using health-related symptoms does not seem useful to pre-select for CT-CCS.

Trial registration number

CCMO Register, NL17981.042.07 and NL58592.042.16.
Clean intermittent catheterisation determinants and caregiver adherence in paediatric patients with spinal dysraphism and spinal cord injury in a paediatric spinal differences clinic: a mixed methods study protocol
Authors: Wickham Azadeh , Russell Cynthia L , Gatti John M
Published: October 2024

Introduction

Clean intermittent catheterisation (CIC) is the standard of care for treating neurogenic lower urinary tract dysfunction (NLUTD), the most common bladder dysfunction in children diagnosed with spinal dysraphism (SD) and spinal cord injury (SCI). Failure to follow the prescribed CIC regimen results in urinary tract infections, incontinence and renal insufficiency. Adherence to CIC is suboptimal, with reported non-adherence rates of 18%–66%. Despite the efficacy of CIC, the research on CIC adherence is not well defined in the literature and even less for caregivers of children on CIC protocols.

Methods

This proposed study aims to identify caregiver CIC adherence and determinants while exploring the personal experiences of performing CIC from the perspective of caregivers of children with NLUTD due to SD and SCI. This cross-sectional, correlational, convergent mixed methods study design in which qualitative and quantitative data will be collected simultaneously will be used to study the level of adherence and the relationship of caregiver determinants to CIC in children with SD and SCI and adherence to the CIC protocol. Convenience sampling will be used to identify 60 adult caregivers who can read and write English or Spanish and have a child diagnosed with SD and SCI who is currently prescribed CIC by a urology provider.

Analysis

The adherence data will be reported as frequency and percentages. A correlation analysis will be computed to assess the association between determinants measured by the Clean Intermittent Catheterization-Caregiver Questionnaire and adherence levels measured with the Intermittent Catheterization Adherence Scale. Thematic analysis will be used to analyse and interpret the interview data. A comparison joint display will be developed to compare quantitative and qualitative data results.

Ethical and dissemination

Institutional review board approval was obtained from the Children’s Mercy Kansas City (Study00003003) and the University of Missouri-Kansas City (#2100185). The study’s main results will be disseminated to caregiver participants, published in peer-reviewed journals and presented at conferences.
Reference equations for DLNO and DLCO in Mexican Hispanics: influence of altitude and race
Authors: Gochicoa-Rangel Laura , De-Los-Santos-Martínez Ada , Reyes-García Alejandro , Martínez-Briseño David , Vargas Mario H , Lechuga-Trejo Irma , Guzmán-Valderrábano Carlos , Torre-Bouscoulet Luis , Zavorsky Gerald Stanley
Published: October 2024

Objectives

This study aimed to evaluate pulmonary diffusing capacity for nitric oxide (DLNO) and pulmonary diffusing capacity for carbon monoxide (DLCO) in Mexican Hispanics born and raised at 2240 m altitude (midlanders) compared with those born and raised at sea level (lowlanders). It also aimed to assess the effectiveness of race-specific reference equations for pulmonary diffusing capacity (white people vs Mexican Hispanics) in minimising root mean square errors (RMSE) compared with race-neutral equations.

Methods

DLNO, DLCO, alveolar volume (VA) and gas transfer coefficients (KNO and KCO) were measured in 392 Mexican Hispanics (5 to 78 years) and compared with 1056 white subjects (5 to 95 years). Reference equations were developed using segmented linear regression (DLNO, DLCO and VA) and multiple linear regression (KNO and KCO) and validated with Least Absolute Shrinkage and Selection Operator. RMSE comparisons between race-specific and race-neutral models were conducted using repeated k-fold cross-validation and random forests.

Results

Midlanders exhibited higher DLCO (mean difference: +4 mL/min/mm Hg), DLNO (mean difference: +7 mL/min/mm Hg) and VA (mean difference: +0.17 L) compared with lowlanders. The Bayesian information criterion favoured race-specific models and excluding race as a covariate increased RMSE by 61% (DLNO), 18% (DLCO) and 4% (KNO). RMSE values for VA and KCO were comparable between race-specific and race-neutral models. For DLCO and DLNO, race-neutral equations resulted in 3% to 6% false positive rates (FPRs) in Mexican Hispanics and 20% to 49% false negative rates (FNRs) in white subjects compared with race-specific equations.

Conclusions

Mexican Hispanics born and raised at 2240 m exhibit higher DLCO and DLNO compared with lowlanders. Including race as a covariate in reference equations lowers the RMSE for DLNO, DLCO and KNO and reduces FPR and FNR compared with race-neutral models. This study highlights the need for altitude-specific and race-specific reference equations to improve pulmonary function assessments across diverse populations.
‘Downhill race for a rainbow jersey’: the epidemiology of injuries in downhill mountain biking at the 2023 UCI cycling world championships—a prospective cohort study of 230 elite cyclists
Authors: Fallon Thomas , Palmer Debbie , Bigard Xavier , Elliott Niall , Lunan Emma , Heron Neil
Published: October 2024

Objectives

This study aims to understand the prevalence, incidence rate, anatomical sites, injury severity and main medical actions carried out during official training and racing by elite downhill mountain biking (DHMTB) riders during the 2023 Union Cycliste Internationale (UCI) Cycling World Championships.

Methods

The participants of this prospective, observational study were elite male and female cyclists competing at the UCI DHMTB World Championships located in the Nevis range in Fort William, Scotland, in 2023. This study followed the injury reporting guidelines established by the International Olympic Committee, which include the Strengthening the Reporting of Observational Studies in Epidemiology—Sports Injury and Illness Surveillance (SIIS) and the cycling-specific extension. Injuries were defined as ‘tissue damage or other derangement of normal physical function due to participation in sports, resulting from rapid or repetitive transfer of kinetic energy requiring medical attention’. All epidemiological data were collected by the local organising committee medical professionals working at the event through an online survey. All data inputted were screened daily by the lead event physician and UCI medical delegate.

Results

Throughout 5 days of the championships, 10.4% of the 230 cyclists sustained at least one injury. The overall injury incidence rate was 3.3 (95% CI 3.1 to 3.5) per 100 rides. The incidence rates were higher in the training 4.3 (95% CI 4.0 to 4.6)/100 rides than in the racing 2.2 (95% CI 2.1 to 2.3)/100 rides. There was a greater incidence of injury in female cyclists in the training 5.8 (95% CI 5.0 to 6.6)/100 rides and racing 4.5 (95% CI 3.9 to 4.9)/100 rides compared with male cyclists. Female cyclists experienced more severe injuries, with an average of 12.6 (±14, 95% CI 5.66 to 19.54) days lost to injury compared with 5.5 (±1.6 95% CI 1.89 to 9.11) seen in male cyclists. The main event medical actions were lifting, immobilisation and helmet removal.

Conclusion

This study provides insights into the risk of injury to athletes within DHMTB. Our findings suggest more focus should be placed on the female DHMTB athlete. Additionally, this study provides unique information about common medical actions required of medical professionals working at DHMTB events and the importance of pre-event scenario training.
Culture of safety in an adult and paediatric emergency department before and after the COVID-19 pandemic
Authors: Beteta Fernández Dolores , Pereda Mas Arturo , Perez Canovas Carlos , Navarro Egea Ana Patricia , Pardo Rios Manuel , Alcaraz-Martinez Julian
Published: October 2024

Background

The WHO recognises patient safety as a serious public health problem. The COVID-19 pandemic affected adult EDs (AEDs) and paediatric EDs (PEDs) differently. We compared the culture of safety in the adult AED and PED before and after the COVID-19 pandemic.

Methods

A quasi-experimental study was performed. In 2019, we conducted a survey using the Spanish-adapted Hospital Survey on Patient Safety Culture open to all staff (doctors, nurses and paediatric residents) in AED and PED. This survey provides scores for 12 separate domains and a global assessment of safety (scale 0–10). The survey was repeated in 2021 after the first wave of the COVID-19 pandemic. After the second survey, the researchers constructed a Pareto Chart (based on the responses from the surveys), demonstrating the most important problems to develop improvement proposals.

Results

The 2019 questionnaire was completed by 125 AED workers and 65 PED workers. The 2021 questionnaire was completed by 79 AED workers and 50 PED workers. The global assessment of safety in the AED was 6.13 points at baseline and increased to 7.58 points (p<0.001) after COVID-19. The global assessment for the PED was 6.8 points at baseline and increased to 7.62 points after COVID-19 (p<0.001). In both services, the dimension that was most favourably assessed was ‘Teamwork in the Service’ while ‘Provision of Staff’ was least favourably assessed. The Pareto charts showed four dimensions contributing more than 50% of negative responses: ‘Provision of staff’ and ‘Hospital Management support for patient safety’ coincided in both services.

Conclusion

The baseline perception of the culture of safety was higher in the PED but improved in both services during the COVID-19 pandemic. Adverse situations can provide an opportunity to improve patient safety culture.
Advancing diagnostics: integrating microRNA profiling and protein markers in ectopic pregnancy detection
Authors: Selvarajan Sathya , Ramalingam Jothi Malar , Senthil Kumar Dhivya
Published: October 2024

Introduction

Ectopic pregnancy (EP) poses significant health risks, particularly in developing nations, necessitating improved diagnostic methods. This study aimed to explore potential biomarkers for EP diagnosis.

Methods

A case–control study was conducted at the Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu. It included 140 EP cases and 140 pregnant controls, aged 19–38 years, attending routine visits. Serum samples were analysed for beta-human chorionic gonadotropin (β-hCG), progesterone, soluble fms-like tyrosine kinase-1 (sFLT-1) and eight microRNAs (miRs).

Results

Differential expression of biomarkers was observed in EP cases. Four miRs (hsa-miR-141, hsa-miR-218, hsa-miR-519d and hsa-miR-873) were downregulated, and four miRs (hsa-miR-223, hsa-miR-517a, hsa-miR-523 and hsa-miR-323-3p) were upregulated. Statistically significant expression fold changes were noted (p<0.05), except for hsa-miR-141 and hsa-miR-218. miR-519d exhibited promising diagnostic potential with the highest specificity (97.1%) and a sensitivity of 47.1%. sFLT-1, as an individual marker, demonstrated a sensitivity of 98.6% and a specificity of 90%. The combination of sFLT-1 and miR-519d significantly enhanced the sensitivity to 100% with a specificity of 87.1%.

Conclusions

The combination of miR-519d and sFLT-1 emerges as a promising diagnostic tool for EP, offering a sensitivity of 100% and a specificity of 87.1%. These findings underscore the potential of biomarker-based approaches in improving EP diagnosis, especially in resource-limited settings. Further validation and clinical implementation studies are warranted to corroborate these findings and enhance EP management strategies.
Depressive symptomatology, NT-proBNP levels and health status in patients with heart failure: a prospective observational study
Authors: Balata Mahmoud , Becher Marc Ulrich , Conrad Rupert
Published: October 2024

Background

Depressive symptoms frequently occur in patients with heart failure (HF). However, research on the relationship between these symptoms and N-terminal pro-brain natriuretic peptide (NT-proBNP), a key biomarker for HF severity and treatment, is scarce and yields inconsistent results.

Aims

This study investigates the relationship among depressive symptomatology, NT-proBNP and health status in a cohort of patients with HF. Additionally, it assesses the impact of depressive symptoms on their clinical outcomes.

Methods

A cohort of 151 patients with HF was followed for 1 year. The Hospital Anxiety and Depression Scale—Depression (HADS-D) Score was used to assess anxiety and depressive symptoms, and NT-proBNP levels were measured. Health status was evaluated using the Kansas City Cardiomyopathy Questionnaire (KCCQ).

Results

Patients with HADS-D scores>5 points showed significantly higher NT-proBNP levels and lower KCCQ scores at baseline. Over the year, changes in HADS-D scores correlated positively with changes in NT-proBNP levels and negatively with changes in KCCQ scores. A baseline HADS-D score>5 points was significantly associated with an increased risk of the composite outcome of all-cause mortality and HF hospitalisation, even after adjusting for baseline characteristics (adjusted hazard ratio (HR): 2.17; 95% CI 1.05 to 4.48; p=0.036).

Conclusions

HADS-D scores are significantly correlated with NT-proBNP levels and health status in patients with HF. A baseline HADS-D score>5 points is significantly associated with an elevated risk for the composite outcome of all-cause mortality and hospitalisation due to HF.
Intratumoral STING agonist reverses immune evasion in PD-(L)1-refractory Merkel cell carcinoma: mechanistic insights from detailed biomarker analyses
Authors: Pulliam Thomas , Jani Saumya , Goff Peter H , Bhakuni Rashmi , Tabachnick-Cherny Shira , Smythe Kimberly , Seaton Brandon W , Tachiki Lisa , Kulikauskas Rima , Church Candice , Koelle David M , Nghiem Paul , Bhatia Shailender
Published: October 2024

Background

Antibodies blocking programmed death (PD)-1 or its ligand (PD-L1) have revolutionized cancer care, but many patients do not experience durable benefits. Novel treatments to stimulate antitumor immunity are needed in the PD-(L)1 refractory setting. The stimulator of interferon genes (STING) protein, an innate sensor of cytoplasmic DNA, is a promising target with several agonists in development. However, response rates in most recent clinical trials have been low and mechanisms of response remain unclear. We report detailed biomarker analyses in a patient with anti-PD-L1 refractory, Merkel cell polyomavirus (MCPyV)-positive, metastatic Merkel cell carcinoma (MCC) who was treated with an intratumoral (IT) STING agonist (ADU-S100) plus intravenous anti-PD-1 antibody (spartalizumab) and experienced a durable objective response with regression of both injected and non-injected lesions.

Methods

We analyzed pretreatment and post-treatment tumor and peripheral blood samples from our patient with single-cell RNA sequencing, 30-parameter flow cytometry, T cell receptor sequencing, and multiplexed immunohistochemistry. We analyzed cancer-specific CD8 T cells using human leukocyte antigen (HLA)-I tetramers loaded with MCPyV peptides. We also analyzed STING expression and signaling in the tumor microenvironment (TME) of 88 additional MCC tumor specimens and in MCC cell lines.

Results

We observed high levels of MCPyV-specific T cells (12% of T cells) in our patient’s tumor at baseline. These cancer-specific CD8 T cells exhibited characteristics of exhaustion including high TOX and low TCF1 proteins. Following treatment with STING-agonist plus anti-PD-1, IT CD8 T cells expanded threefold. We also observed evidence of likely improved antigen presentation in the MCC TME (greater than fourfold increase of HLA-I-positive cancer cells). STING expression was not detected in any cancer cells within our patient’s tumor or in 88 other MCC tumors, however high STING expression was observed in immune and stromal cells within all 89 MCC tumors.

Conclusions

Our results suggest that STING agonists may be able to work indirectly in MCC via signaling through immune and stromal cells in the TME, and may not necessarily need STING expression in the cancer cells. This approach may be particularly effective in tumors that are already infiltrated by inflammatory cells in the TME but are evading immune detection via HLA-I downregulation.
Numerical modeling assisting in surgical treatment of total anomalous pulmonary venous connection in children
Authors: Jin Jie , Gu Kaiyun , Liang Jiawei , Yu Jing , Fan Xiangming
Published: October 2024

Objective

To develop a model using patient-specific computational fluid dynamics (CFD) to predict the required anastomotic size for total anomalous pulmonary venous connection (TAPVC) surgery and to forecast surgical outcomes.

Methods

Based on clinical data from patients, a CFD model was used to simulate the anastomosis between pulmonary venous confluence and the left atrium. Blood flow velocity, wall shear stress, power loss, and pressure were calculated using numerical algorithms within the model. Various sizes of anastomosis were applied during the simulation. The energy dissipation at the anastomosis was computed from the results and compared with real-world data.

Results

As the simulated anastomotic size increased, blood flow velocity, pulmonary venous pressure, and energy loss decreased. However, when the anastomotic size exceeded 18 mm, the efficiency of energy conversion no longer improved. The realistic and simulated velocities matched well for anastomosis sizes ranging from 15 to 20 mm.

Conclusion

The model can assist surgeons in preoperative planning for determining the anastomotic size in TAPVC surgical treatment.
Quantum computational complexity and symmetry
Authors: Rethinasamy Soorya , LaBorde Margarite L. , Wilde Mark M.
Published: October 2024

Testing the symmetries of quantum states and channels provides a way to assess their usefulness for different physical, computational, and communication tasks. Here, we establish several complexity-theoretic results that classify the difficulty of symmetry-testing problems involving a unitary representation of a group and a state or a channel that is being tested. In particular, we prove that various such symmetry-testing problems are complete for bounded-error quantum polynomial time, quantum Merlin–Arthur (QMA), quantum statistical zero-knowledge, two-message quantum interactive proofs (QIPs), two-message QIPs restricted to entanglement-breaking provers, and QIPs, thus spanning the prominent classes of the QIP hierarchy and forging a nontrivial connection between symmetry and quantum computational complexity. Finally, we prove the inclusion of two Hamiltonian symmetry-testing problems in QMA and quantum Arthur–Merlin, while leaving it as an intriguing open question to determine whether these problems are complete for these classes.
An interpretation of scalars in SO(32)
Authors: Rivero Alejandro
Published: October 2024

We propose an interpretation for the adjoint representation of the SO(32) group to classify the scalars of a generic Supersymmetric Standard Model having just three generations of particles, via a flavour group SU(5). We show that this same interpretation arises from a simple postulate of self-consistence of composites for these scalars. The model looks only for colour and electric charge, and it pays the cost of an additional chiral $$+4/3$$

+
4
/
3

quark per generation.
Kepler’s problem of a two-body system perturbed by a third body
Authors: Abdel-Rahman A. S. , Sabry Youssef A. , Ahmed E. M.
Published: October 2024

One of the most important problems in basic physics and astronomy is studying the motion of planets, satellites, and other celestial bodies. The solution to the two-body problem enables astronomers to predict the orbits of the Moon, satellites, and spaceships around the Earth. The general analytic solution for the three-body problem stands unsolved except in some special cases. This reduces the problem to a two-body problem. In this work, the authors present a closed-form approach to the three-body problem theoretically and numerically based on particle–particle vector analysis. The theoretical approach, which is based on the real Moon–Sun–Earth problem information, illustrates the perturbation of the Moon in the Sun–Earth problem and shows an expected orbital motion with a perturbation in the Sun–Earth orbit due to the revolution of the Moon. The numerical investigation uses the same information to study the same problem and calculate the angular momentums of each pair of objects. The two solutions show good agreement with the well-known Earth-Moon and Sun–Earth momentums. The Moon–Sun orbit is close to an elliptic shape with angular momentum of about 3.27 × 1038 J.s. This approach is the key to future studies for n-body problem solutions.
Towards a theory of steady-state solidification process with a quasi-equilibrium two-phase region
Authors: Makoveeva Eugenya V. , Koroznikova Irina E. , Glebova Alexandra E. , Ivanov Alexander A. , Alexandrova Irina V. , Bulycheva Svetlana V. , Alexandrov Dmitri V. , Toropova Liubov V.
Published: October 2024

The process of directional crystallization in the presence of a quasi-equilibrium two-phase region located between the solid material and the liquid phase is studied theoretically. The mathematical model of the process is based on heat and mass transfer equations in the solid, liquid and two-phase regions, as well as boundary conditions at the phase interfaces “solid phase” – “two-phase region” and “two-phase region” – “liquid phase”, which are moving with a constant velocity. The process of directional crystallization is given by fixed temperature gradients in the solid and liquid phases, which determine a constant velocity of melt solidification. An exact analytical solution of the nonlinear problem with two moving boundaries of phase transformation is obtained, which is based on the transition to a new independent variable, the solid phase fraction, when integrating the nonlinear heat and mass transfer equations in the two-phase region. As a result of solving the problem, the distributions of temperature and concentration of dissolved impurity, the solid phase fraction in a two-phase region, the laws and velocities of motion of its interphase boundaries are determined. It is analytically shown that the impurity concentration and temperature in the two-phase region are only the functions of solid phase fraction, which, in turn, depends on the spatial coordinate. Analysis of the obtained solutions shows that the solid phase fraction in a two-phase region can be both a decreasing and increasing function of the spatial coordinate, which is directed from the solid material to the melt. This determines the internal structure of two-phase region, its permeability, average interdendritic spacing, distribution of dissolved impurity, crystallization velocity and laws of two-phase region boundaries.
FAULT CLASSIFICATION EXPERT SYSTEM FOR WIND TURBINE BLADE IMAGE DATABASES USING CONVOLUTIONAL NEURAL NETWORKS
Authors: AGUILERA RICARDO CARREÑO , BAUTISTA DANIEL PACHECO , ORTIZ MIGUEL PATIÑO , PÓRTELA JOSÉ RAFAEL DORREGO , OLIVA VICTOR IVÁN MORENO , ORTIZ JULIÁN PATIÑO
Published: October 2024

Detection and maintenance of wind turbine blades are essential, as they are constantly exposed to a hostile environment and are easily damaged. Defective repairs, lightning damage, and damaged dust guards are the most common faults found in our database. These faults decrease the performance of the wind generator. Although visual site inspections are common, they are inefficient due to long downtime periods. This document proposes a systematically designed expert system for the classification of visual faults from a database of typical faults in a wind farm in the Isthmus of Tehuantepec region, México. Convolutional neural networks are used for this purpose.
A 7-Year Retrospective Review of Flexor Sheath Infections
Authors: RIYAT Harjoat , MORRIS Holly , CHEADLE Caroline , LEATHERBARROW Amanda , RAE Dupinderjit Singh , JOHNSON Nick
Published: October 2024

Background: Flexor sheath infections require prompt diagnosis, and management with intravenous antibiotics and/or surgical washout followed by hand therapy. Complication rates as high as 38% have been reported. Our unit takes a relatively conservative approach to the management of flexor sheath infections and select patients are managed non-surgically via our outpatient antibiotic service where they are clinically reviewed and receive a once daily dose of intravenous antibiotics. The aim of this study is to determine if outpatient management of flexor sheath infections was associated with an increased risk of complications compared to those admitted as an inpatient.

Methods: A retrospective review was carried out with all patients clinically diagnosed with flexor sheath infection who were seen at our unit between January 2014 and December 2020. Age, gender, co-morbidities, cause of infection, management and subsequent complications were recorded.

Results: A total of 128 patients with flexor sheath infections were treated. And 68% were male. Mean age was 50.4 years. A trend towards fewer presentations each year with animal bites, foreign bodies and penetrating trauma as the main cause of infection was noted. And 89% (n = 114) required admission with the other 11% (n = 14) treated as an outpatient. And 77% (n = 98) underwent surgical washout. And 6% (n = 8) suffered a complication.

Conclusions: While flexor sheath washout continues to be standard practice, 23% of patients were safely managed with intravenous antibiotics and 11% purely via an outpatient service.

Level of Evidence: Level IV (Therapeutic)
Ah-Aloud Method to Comprehend Time-Series Emotion Observation During Gameplay: An Initial Investigation with Japanese Speakers
Authors: Yamagishi Takeru , Yasunaka Yuki , Takayama Eri , Nomaru Takashi , Komatsu Takanori , Watanabe Keita
Published: October 2024

Emotional dimensions significantly impact user experience (UX) and are essential in assessing interactions in entertainment systems. However, relying solely on subjective post-event indicators fails to capture dynamic emotional changes during the system experience. Kawashima and Watanabe introduced the "ah-aloud" method, enabling real-time emotion observation by having participants vocalize "ah" during system experiences. However, this method remains conceptual and preliminary, lacking in specific experimental procedures, analysis methods, and utilization guidelines. Our study delineates the requirements for practical "ah-aloud" application and validates its potential for game experience assessment. Consequently, the "ah-aloud" method demonstrates the potential for observing time-series emotional changes during gameplay. Based on these findings, we deliberated its utility for system evaluation and reliability as an evaluation experiment.
Aiming, Pointing, Steering: A Core Task Analysis Framework for Gameplay
Authors: Hougaard Bastian Ilsø , Knoche Hendrik
Published: October 2024

Underneath their compelling audiovisual surface, games require players to carry out mundane interaction work, such as pointing, typing, or steering. However, many of these underlying building blocks are not defined rigorously, hampering synthesis and analysis. We elaborate on the origin of tasks within human-computer interaction (HCI) and define tasks' relationship to game terminology (game mechanics, goals, and actions). Our proposed framework draws on systemic-structural theory of activity to aid systematic analysis and exploration of game design by mapping gameplay to abstract core tasks. The framework contains four task tools, applicable when 1) uncovering design properties, 2) designing experimental manipulation, 3) creating behavioral measurements, and 4) describing gameplay in literature reviews of game genres and design techniques. We evaluated our framework as a lens to design purposeful games in three case studies within a scientific education. We invite researchers and practitioners to employ the framework as a microscope, to describe and design games rigorously.
Balancing Playability and Historical Accuracy in Game Design - Developing the Struve Geodetic Arc Mobile Game
Authors: Mustonen Sanni , Paananen Siiri , Eckhoff Emma , Colley Ashley
Published: October 2024

Numerous digital games and media with historical themes aim to educate or engage audiences with heritage. When developing a historical video game, some of the most critical design decisions are centered around finding the balance between an accurate presentation of historical facts and engaging gameplay. This paper examines the game developer's role in selecting and presenting historical content through a case study of a mobile game development process. The design choices and developers' positions related to using historical facts are examined through thematic analysis of interview data and game design documents. Recurring themes in the data reveal a constant interplay between game features and historical content, supported by historical knowledge and technology. In small teams, individual developers often make crucial design decisions while performing multiple roles. As key findings, we report that the resourcing and timing of historical research significantly impacts developers' decisions, and note varying degrees of interest in historical accuracy within the development team.
Diverse Perspectives: An Inclusive Serious Game for (International) Students
Authors: Peters Rit Geertje , Volk Anja , Hauptmann Hanna
Published: October 2024

Universities have increasingly diverse student populations. While a greater variety of students' backgrounds, skills and abilities exist, this does not necessarily mean they have more inclusive interactions. A lack of inclusive interactions can cause negative biases against people who are different from oneself. One strategy to mitigate bias is exposure to situations where students encounter social dilemmas with others and are stimulated to reflect on their interactions. These experiences could be simulated within a serious game as a safe learning environment. Moreover, serious games allow the player to broaden their mental perspective by showing the world through the eyes of others. This paper presents the design and evaluation of the serious game called
Diverse Perspectives.
This visual novel with multiple endings captures social dilemmas and allows the player to view them from a different angle through perspective switches. We evaluate
Diverse Perspectives
with quantitative (
N
= 32) and qualitative measures on attitude towards diversity and gaming experience measured with the Shortened Version of the Miville-Guzman Universality-Diversity Scale and the Game Experience Questionnaire. Participants indicate they find the perspective switch helpful as it creates an understanding of the other person's view.
From Novelty to Clinical Practice: Exploring VR Exergames with Physical Therapists
Authors: Chiu Maria , Tochilnikova Elina , Harteveld Casper
Published: October 2024

The COVID-19 pandemic, the rise of telehealth and virtual medicine, and the increased accessibility of commercial VR headsets have created opportunities to revitalize the physical therapy field and introduce more innovative tools to complement traditional practice. Researchers are actively exploring the intersection of VR, exergames, and gamified exercise to create new products that can improve both provider efficiency and patient care. This study builds on that momentum by delving into the perspectives of practitioners. We interviewed eight physical therapists after letting them experience a state-of-the-art VR exercise product (i.e.,
Supernatural VR
). Participants loved the game and were most optimistic about the mental benefits of using VR exergames alongside traditional PT, but cautioned the lack of feedback and expert guidance that could lead to misuse and further injury. Regarding the future integration of VR and PT, participants were cautiously optimistic and offered design feedback and recommendations, with warnings regarding the potential barriers to innovating clinical practice.
Echoes of Player Experience: A Literature Review on Audio Assessment and Player Experience in Games
Authors: Nunes Caio , Darin Ticianne
Published: October 2024

Player Experience (PX) in video games is a multifaceted construct encompassing affective, perceived, and subjective dimensions. While extensively explored in Human-Computer Interaction (HCI) and games user research studies, the practical evaluation of PX, especially concerning audio elements, remains challenging. This paper presents a Literature Review (LR) (n=26), which addresses the gap in the literature related to audio in PX evaluation, unveiling trends and issues. We used Creswell's methodology for LR, exploring three major research questions that investigate the approaches, instruments, and methodologies used to evaluate audio in digital games, the constructs of player experience related to audio assessment, and the challenges faced by researchers in this context. Our findings underscores challenges in the generalization of study outcomes, audio personalization and variation and audio-games evaluation. This work strives to bridge the gap between research and practice, fostering a deeper understanding of the intricate relationship between audio and PX in games.
Exploring the Role of Action Mechanics in Game-Based Stress Recovery
Authors: Alves Heinze Rafael , Mandryk Regan L. , Klarkowski Madison
Published: October 2024

Digital games can provide effective recovery from stress, with players turning to a variety of genres-including those with game mechanics that can be considered stressors themselves, i.e., action mechanics. We examine whether action mechanics undermine or facilitate game-based recovery by exposing participants (n=60) to a stress induction, and then having them play a roguelike game in one of three conditions: Combat-Required, Combat-Optional, and Combat-Free. We assess experience through self-report and observed physiological responses. Our findings suggest that gameplay-irrespective of action mechanic intensity-supports the recovery process through the pathways of experienced psychological detachment, control, dominance, and pleasure. Additionally, action mechanics were perceived by participants as particularly promising for mastery recovery experiences-but undermine the recovery pathways of relaxation, as corroborated by experienced arousal and subjective stress. Physiological measures corroborate subjective self-report. We contend that video games featuring action mechanics represent a promising strategy for stress recovery, and may be particularly beneficial in the re-assertion of mastery.
Folk Models of Loot Boxes in Video Games
Authors: Wen Jinhe , Zhang Zhongyang , Tran Tuan M. , Mu Lianrui , Rahman Tauhidur , Jin Haojian
Published: October 2024

Regulations require video games to provide transparency regarding loot box odds to keep players informed, leading many games to disclose probabilities in various ways; yet, the extent of players' comprehension of loot box mechanics remains unclear. We performed a content analysis on 80 online posts to understand players' perceptions of loot box odds in two popular video games (Genshin Impact and Honkai: Star Rail). We then conducted semi-structured interviews with 24 players to explore the causes of these folk models across more games. Utilizing a bottom-up open coding approach, we created a taxonomy of folk models players have about loot boxes. We found that participants generally possessed inaccurate mental models of how loot boxes work, and they wanted game companies to enhance loot box transparency in three areas of probability disclosures: granularity, longitude, and scope.
Hexed by Pressure: How Action-State Orientation Explains Propensity to Choke in Super Hexagon
Authors: Johanson Colby , Poeller Susanne , Klarkowski Madison , Mandryk Regan L.
Published: October 2024

Many videogames require players to perform under pressure; however, not all players respond equivalently to pressure: why are some players more likely to tilt (lose control during play) or choke (perform poorly relative to their ability) whereas others seem to thrive under pressure? Given the importance of both emotion regulation in tilting and optimal arousal in achieving optimal performance, we propose that individual differences in ability to down-regulate negative affect under stress--known as failure-related action-state orientation (fASO)--could explain propensity to choke under pressure. We conducted an online between-subjects experiment (N=144) in which we measured baseline performance in Super Hexagon (day 1), then exposed participants to a stress induction (i.e., PASAT-C) or had them play a low-intensity bubble-popping game before playing again (day 2). Under stress, players higher in fASO performed better relative to their baseline in terms of average time alive and stalled progress; whereas, without stress, players lower in fASO performed better on both measures. Traits reflective of proposed explanations for choking (i.e., reinvestment, attentional control) did not influence performance under pressure. The ability to down-regulate negative affect and overcome setbacks is a useful theoretical lens to explore why some players choke under pressure, whereas others thrive.
How To Tame a Toxic Player? A Systematic Literature Review on Intervention Systems for Toxic Behaviors in Online Video Games
Authors: Wijkstra Michel , Rogers Katja , Mandryk Regan L. , Veltkamp Remco C. , Frommel Julian
Published: October 2024

Toxic behavior is known to cause harm in online games. Players regularly experience negative, hateful, or inappropriate behavior. Interventions, such as banning players or chat message filtering, can help combat toxicity but are not widely available or even comprehensively studied regarding their approaches and evaluations. We conducted a systematic literature review that provides insights into the current state of interventions literature, outlining their strengths and shortcomings. We identified 36 interventions and qualitatively analyzed their approaches. We describe the types of toxicity being addressed, the entities through which they act, the methods used by intervention systems, and how they are evaluated. Our results provide guidance for future interventions, outlining a design space based on known systems. Furthermore, our findings highlight gaps in the literature, e.g., a sparsity of empirical evaluations, and underexplored areas in the design space, enabling researchers to explore novel directions for future interventions.
Human-AI Collaboration in Cooperative Games: A Study of Playing Codenames with an LLM Assistant
Authors: Sidji Matthew , Smith Wally , Rogerson Melissa J.
Published: October 2024

Playing partial information, restricted communication, cooperative (PIRCC) games with humans have proven challenging for AI, due to our reliance on social dynamics and sophisticated cognitive techniques. Yet, recent advances in generative AI may change this situation through new forms of human-AI collaboration. This paper investigates how teams of players interact with an AI assistant in the PIRCC game Codenames and the impact this has on cognition, social dynamics, and player experience. We observed gameplay and conducted post-game focus groups with 54 participants across ten groups. Each group played three rounds of Codenames, with an AI assistant supporting Cluegivers. We found the AI assistant enhanced players' convergent and divergent thinking, but interfered with formation of team mental models, highlighting a tension in the use of AI in creative team scenarios. The presence of the AI challenged many players' understanding of the 'spirit of the game'. Furthermore, the presence of the AI assistants weakened social connections between human teammates, but strengthened connections across teams. This paper provides an empirical account of an AI assistant's effect on cognition, social dynamics, and player experience in Codenames. We highlight the opportunities and challenges that arise when designing hybrid digital boardgames that include AI assistants.
Like It or Not: Exploring the Impact of (Dis)liked Background Music on Player Behavior and Experience
Authors: Schubhan Marc , Karra Sridhar , Altmeyer Maximilian , Krüger Antonio
Published: October 2024

Entertainment media, including video games, utilize background music (BGM) to enhance ambiance and gameplay, with a growing trend of players replacing in-game audio with personal music for potentially improved gameplay. Yet, research has not systematically investigated the connection between liked or disliked BGM and player behavior and experience. With our work, we make this step by letting users play the popular and well-researched game Tetris with BGM of their choice, and go one step further by adding music to the game that they specifically dislike, as this direction has been neglected thus far, but could prove interesting to target certain player behavior or experience. In our lab-study (N=31) we found that liked BGM increased engagement with the game and enhanced player experience, while disliked music reduced immersion. These findings suggest that music preferences should be taken into greater account in game design, e.g. by offering more options for BGM customization.
Low Latency Feedback: Contrasting Training Outcomes of Immediate versus Delayed Feedback in Speedrunning Super Mario Bros.
Authors: Bikas Ioannis , Pfau Johannes , Muender Thomas , Malaka Rainer
Published: October 2024

With the rise of popularity and societal importance of video games, trends of grinding play for excessive amounts of time to improve proficiency becomes more and more common. This bears not only physical and mental health risks, but has already shown to be detrimental for skill acquisition, defeating its purpose in the first place. For the sake of health promotion, well-being, and the advancement of self-regulated learning, we specifically investigate the impact of detailed feedback on player performance. As research about comparable activities in related domains suggest inconclusive implications for when feedback in video game learning should be presented, we particularly explore the impact of delivering immediate versus delayed feedback, during or after play. Using (n = 30) participants and the well-investigated Super Mario Bros., we communicate insights in favor for deploying feedback immediately when polishing one's video game related skills such as in speedrunning.
Method of Electrical Muscle Stimulation to Improve Hand-eye Coordination Training in Gaming
Authors: Zhou Shuo , Segawa Norihisa
Published: October 2024

Hand-eye coordination refers to the harmonization between visual information and hand movements. In this coordination, the information perceived by the eyes is used to guide the movements of the hands. In many games, hand-eye coordination is important for the player's experience. However, when players are faced with an unfamiliar activity, it can be a challenge to develop hand-eye coordination in a short period. This study proposes a method for hand-eye coordination training in gaming using Electrical Muscle Stimulation (EMS). By employing EMS, it is possible to enhance attention distribution during bilateral hand movements and improve hand-eye coordination, potentially enabling individuals to train hand coordination skills in a shorter period. To test the feasibility and effectiveness of our method, we first tested participants for attentional switching while wearing the EMS device to ensure that it did not negatively affect participants. Sixteen participants were then trained in hand-eye coordination with and without EMS, and the effects of the training were tested in a customized game and a real music game. The results showed that participants trained with EMS showed more significant improvements in scores and accuracy than those without EMS in both the custom game and the real game. We also conducted a retained effect experiment, which confirmed that participants retained the training effect one week after training. Thus, our study shows the possibility of using EMS as a new medium for training hand-eye coordination in games.
"More than just a game, it's an app that builds awareness around Mental Health": Mental Health Stigma Reduction Using Games for Change
Authors: Anvari Soraya S. , Hammer Jessica , Wehbe Rina R.
Published: October 2024

Although the significance of Mental Health (MH) is becoming increasingly more accepted worldwide, the level of MH Literacy (MHL) remains low. Individuals often find it uncomfortable to discuss this crucial topic. Unwillingness to discuss MH can be a result of the stigma surrounding the topic which results in misconceptions, discrimination, and reluctance to seek help or talk openly about MH challenges. Educating individuals about MH and encouraging open discussions are key to reducing stigma. Games have proven their effectiveness for diverse learning purposes. Our goal in this paper is to assess the potential of games and digital displays for MHL education and stigma reduction by incorporating MH educational content into a mobile game with different learning strategies and a large public display to create a community. We compare the pre and post-MHL of users before and after playing our game and the results show an improvement in the MHL of participants. Our paper contributes to game design approaches by identifying mechanisms for educating individuals about MH and our results indicate that the game helps reduce stigma through the use of large displays.