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Why do learning games fail or succeed? Recent evidence suggests that attention forms an important moderator of learning from games. While existing media effects and learning theories acknowledge the role of attentional limits, they fail to account for the specific ways that games as interactive media steer attention. In response, we here develop the Task-Attention Theory of Game Learning. Drawing on current psychological and games research, task-attention theory argues that games as interactive media demand and structure the pursuit of tasks, which ties into distinct attentional mechanisms, namely learned attentional sets which focus attentional selection onto task-relevant features, as well as active sampling: users navigate and manipulate the game to elicit task-relevant information. This active sampling and selection precedes and moderates what information can be learned. We identify task-related game features (mechanics, goals, rewards and uncertainty) and demands (cognitive and perceptual load, pressure) that affect active sampling and attentional selection. We articulate implications and future work for game-based learning research and design, as well as wider media effects, learning, and HCI research.

Background : During the 2020-2021 COVID-19 lockdown, social activities were limited by the government-recommended social distancing guidelines leading to an abundance of mental health issues. Methods : We hypothesized that Twitter sentiment analysis may shed some light on Animal Crossing: New Horizons and its impact on mental health during the COVID-19 pandemic. Results : We found the use social gaming and social media may be used as tools to cope with stress during the COVID-19 pandemic. Conclusions : Further research, including randomized designs and prospective measurements of mental health outcomes related to social gaming behavior are required.

Animal models suggest transitions from non-addictive to addictive behavioral engagement are associated with ventral-to-dorsal striatal shifts. However, few studies have examined such features in humans, especially in internet gaming disorder (IGD), a proposed behavioral addiction. We recruited 418 subjects (174 with IGD; 244 with recreational game use (RGU)). Resting-state fMRI data were collected and functional connectivity analyses were performed based on ventral and dorsal striatal seeds. Correlations and follow-up spectrum dynamic causal model (spDCM) analyses were performed to examine relationships between the ventral/dorsal striatum and middle frontal gyrus (MFG). Longitudinal data were also analysed to investigate changes over time. IGD relative to RGU subjects showed lower ventral-striatum-to-MFG (mostly involving supplementary motor area (SMA)) and higher dorsal-striatum-to-MFG functional connectivity. spDCM revealed that left dorsal-striatum-to-MFG connectivity was correlated with IGD severity. Longitudinal data within IGD and RGU groups found greater dorsal striatal connectivity with the MFG in IGD versus RGU subjects. These findings suggest similar ventral-to-dorsal striatal shifts may operate in IGD and traditional addictions., In order to shed light on the underlying neural mechanisms of internet gaming disorder (IGD), Dong et al collected longitudinal resting-state fMRI data from participants with IGD or those who partake in recreational game use. They demonstrated that, consistent with animal models of addiction, dorsal and ventral striatal functional connectivity shifts appeared to play a potential mechanistic role in IGD.

The game of chess offers a conducive setting to explore basic cognitive processes, including decision-making. The game exercises analytical cause-and-effect thinking skills regardless of the level of play. Moreover, chess portals provide information on the chess games played and serve as a vast database. The numbers of games played thus have the potential to be analyzed comprehensively, including for purposes other than analyzing chess matches only. The primary objective of this study is to develop a methodology for using information obtained from chess games for geospatial social analysis. The assumption is that the methodology will allow for general geographical variation in personality inference in the future, relying on big data from chess databases. Future large-scale studies of the geographical differentiation of personality traits using the developed methodology may be applicable in a number of ways. The results can be used wherever cross-sectional social analyses are needed in the context of personality traits (decision-making) to better understand their geographical background. In turn, the geographical distribution of these traits is accompanied by a range of important social, educational, health, political and economic implications.

Objective: In recent years, there has been an increase in research on the therapeutic effects of exergaming, but there have been few studies on these types of interventions for chronic low back pain. In this study, we hypothesized that the Nintendo Ring Fit Adventure (RFA) exergame would be effective for patients with chronic low back pain, and we conducted a randomized prospective longitudinal study. Materials and Methods: Patients with chronic low back pain were included in this study. Twenty randomly selected patients (9 males and 11 females, mean age 49.3 years) were included in the RFA group, and RFA exergaming was performed once a week for 40 minutes for 8 weeks. Twenty patients (12 males and 8 females, mean age 55.60 years) served as the control group and received oral treatment for 8 weeks. Pain and psychological scores (pain self-efficacy, pain catastrophizing, and kinesiophobia) were measured and analyzed before and after 8 weeks of treatment in both groups. Results: In the RFA group, low back pain, buttock pain, and pain self-efficacy were significantly improved after 8 weeks of RFA exergaming, but there was no significant improvement in lower limb numbness, pain catastrophizing, or kinesiophobia. In the control group, no significant improvement was observed after 8 weeks of oral treatment. Conclusion: RFA exergaming increased pain self-efficacy and reduced pain in patients with chronic low back pain. Future treatment protocols should be developed to improve pain self-efficacy. Approval code: 2894, School of Medicine, Chiba University.

Games have become a popular way of collecting human subject data, based on the premise that they are more engaging than surveys or experiments, but generate equally valid data. However, this premise has not been empirically tested. In response, we designed a game for eliciting linguistic data following Intrinsic Elicitation – a design approach aiming to minimise validity threats in data collection games – and compared it to an equivalent linguistics experiment as control. In a preregistered study and replication (n=96 and n=136), using two different ways of operationalising accuracy, the game generated substantially more enjoyment (d=.70, .73) and substantially less accurate data (d=-.68, -.40) – though still more accurate than random responding. We conclude that for certain data types data collection games may present a serious trade-of between participant enjoyment and data quality, identify possible causes of lower data quality for future research, reflect on our design approach, and urge games HCI researchers to use careful controls where appropriate.

There is growing concern about mental health problems among juveniles. Evidence shows that adventure-based training can reduce depressive symptoms in school children. However, a rigorous empirical investigation of the effectiveness of such training in enhancing resilience among juveniles has not yet been performed. In this study, a randomized controlled trial was conducted to examine the effectiveness of adventure-based training in enhancing resilience and self-esteem and reducing depressive symptoms among juveniles. Secondary school students from grades 7 to 9 (aged 12-16 years) who attended the Integrated Children and Youth Services Centre in a large public housing estate in Hong Kong from December 20, 2018 to November 25, 2019 were invited to participate in this study. We randomly assigned 228 eligible adolescents to an experimental group (n = 115) that received a 2-day/1-night adventure-based training or a placebo control group (n = 113) that received 2 days of leisure activities organized by the Integrated Children and Youth Services Centre. Data were collected at baseline and 3 and 6 months after the corresponding interventions. The primary outcome was resilience at 6 months. The secondary outcomes were depressive symptoms and self-esteem at 6 months. Compared with the placebo control group, the experimental group showed significantly higher resilience (p = 0.001) and fewer depressive symptoms (p = 0.02) at 6 months, and significantly higher self-esteem at 3 months (p = 0.04), but not at 6 months (p = 0.12). However, the generalizability of the findings is limited as we used a convenience sample.

Reports show that children’s physical activity (PA) levels are related to FMS proficiency; however, whether PA levels directly improve FMS is uncertain. This study investigated the responses of PA levels and FMS proficiency to active play (AP) and guided active play (GAP) interventions. Three community programs (seven-weeks; 4d·wk-1) were randomly assigned to: i) active play (CON); ii) locomotor skills (LOC) guided active play (GAP); and iii) object control skills (OC) GAP groups. Children’s (n = 52; 6.5 (0.9) yr) interventions included continuous and/or intermittent cooperative games focused on either locomotor skills (i.e. blob tag, red-light-green-light) or object control skills i.e., hot potato, racket balloons, 4-way soccer). PA levels (accelerometers) were assessed on 2 of 4 sessions per week throughout the program. The Test of Gross Motor Development-2 (TGMD-2) was used to assess FMS scores. The changes for CON and LOC interventions for locomotor standard scores were -0.83 (2.61) vs. 2.6 (2.64) (α = 0.022), for locomotor percentiles -9.08 (36.7) vs. 20.1 (30.4) (α = 0.033) and for gross motor quotient percentiles -4.3 (30.3) vs. 24.1 (29.6) (α = 0.022). Children’s PA levels averaged 158.6 (6.6) kcal·55min-1 for CON vs. 174.5 (28.3) kcal.55min-1 for LOC (α = 0.089) and 170.0 (20.1) kcal·55min-1 for OC (α = 0.144). Moderate-Vigorous PA was 18.4 (8.0) %, 47.9 (7.8) % (α = 0.000) and 51.9 (6.0) % (α = 0.000) for CON, LOC and OC, while time at sedentary/very light PA was 36.4 (9.8) %, 15.1 (4.9) % (α = 0.000) and 14.9 (15.9) %Sed/VL (α = 0.001) during the 7-week program. The OC intervention showed more upper body movement experiences compared to the LOC program (p = 0.020). A guided active play program using LOC cooperative games showed increases in energy expenditure and %MVPA and improved FMS proficiency, but active play did not. For school-aged children (5-7 yr) guided active play using cooperative games may be an effective strategy to improve FMS and promote health and fitness benefits.

Objective: Lower limb amputation is common in war combat and armed conflict as well as in traumatic settings and presents a challenge for health care providers. The incorporation of advanced techno...

Objective: Evaluation of the effects of exergames in women with fibromyalgia on the impact of the disease—pain threshold and physical variables—compared to performing stretching exercises. Material...

Do people use games to cope with adverse life events and crises? Research informed by self-determination theory proposes that people might compensate for thwarted basic psychological needs in daily life by seeking out games that satisfy those lacking needs. To test this, we conducted a preregistered mixed-method survey study (n = 285) on people’s gaming behaviours and need states during early stages of the COVID-19 pandemic (May 2020). We found qualitative evidence that gaming was an often actively sought out and successful means of replenishing particular needs, but one that could ‘backfire’ for some through an appraisal process discounting gaming as ‘unreal’. Meanwhile, contrary to our predictions, the quantitative data showed a “rich get richer, poor get poorer” pat- tern: need satisfaction in daily life positively correlated with need satisfaction in games. We derive methodological considerations and propose three potential explanations for this contradictory data pattern to pursue in future research.

Microtransactions have become a major monetisation model in digital games, shaping their design, impacting their player experience, and raising ethical concerns. Research in this area has chiefly focused on loot boxes. This begs the question whether other microtransactions might actually be more relevant and problematic for players. We therefore conducted a content analysis of negative player reviews (n=801) of top-grossing mobile and desktop games to determine which problematic microtransactions are most prevalent and salient for players. We found that problematic microtransactions with mobile games featuring more frequent and different techniques compared to desktop games. Across both, players minded issues related to fairness, transparency, and degraded user experience, supporting prior theoretical work, and importantly take issue with monetisation-driven design as such. We identify future research needs on why microtransactions in particular spark this critique, and which player communities it may be more or less representative of.

Insects have a significant role towards achieving sustainable development, but the decline of insect knowledge outreach efforts is dampening their impact. Revisiting the perspective and approach to entomological literacy is required to respond to the evolving human needs for sustainable living in light of the decline of insect biomass and biodiversity, and entomology. This is also an opportunity to reflect on the interests about insects in the age of video games. Using games for learning and education can be a viable strategy to advance entomological literacy and support the sustainable development goals by potentially lowering the barriers to accessibility, inclusion and participation. The dearth of research into games for entomological literacy presents opportunities for researchers to explore this domain further.

Background and purpose Leadership is a required component of doctor of pharmacy programs. There is opportunity for students to receive instructional education on leadership concepts through serious games. Educational activity and setting First-year pharmacy students (n = 146) participated in a required skills-based leadership lab including a team-based escape room activity. Findings Students reported a statistically significant increase in understanding of leadership concepts and application at the end of the global lab activities (p Summary Escape rooms present a unique opportunity to engage students in active learning and problem solving. A majority of the students found the escape room activity useful and enjoyed the interactive application of leadership concepts. Potential challenges to implementing escape rooms such as time to develop, physical space requirements, supplies, and volunteers to facilitate the experience should be considered prior to implementation. Serious gaming is an emerging pedagogy, and this data supplements existing literature to support use in pharmacy education.

Background and purpose Educational escape rooms assist students with the development of teamwork, augmentation of problem-solving skills, and reinforcement of key course concepts. In this report, we examined the feasibility of creating a bioterror preparedness escape room in a small enrollment pharmacy public health elective course. Educational activity and setting A bioterror preparedness escape room was developed for pharmacy students in a health elective course. The instructional objectives of training students in disaster preparedness were assessed via group readiness assessment tests in the scenario and individual readiness assessment tests after the completion of the activity. Findings Twenty-eight students participated in the escape room activity in groups of 6 to 8 students (n = 4 observations) and all groups escaped. Student performance was higher on the initial attempts of three group readiness assessment tests (88 ± 16.0%, 82 ± 7.1%, 78 ± 12.0%) than in the final individual readiness assessment test (73.4 ± 20.4%). Students indicated that they found the educational escape room to be enjoyable (95.7%) and felt that all members of the team were involved in solving the problems (86.9%). Summary A disaster preparedness educational escape room was designed and implemented in a public health elective for pharmacy students. Findings indicate that the educational escape room format is an effective method for reinforcing course content, however additional improvements could be made to the instructional design to enhance individual student knowledge retention.

Objectives: To evaluate the efficacy of the “GiochiAMO” prevention program on modifying children's knowledge and belief regarding the use and abuse of alcohol and tobacco smoking. Materials and Met...

A recent intervention, the Step it UP! game (Galbraith & Normand, 2017), consists of an interdependent group contingency to increase student physical activity. In addition, previous research demonstrated that adult interaction may reinforce physical activity (Larson et al., 2014). We extended research on the Step it UP! game by comparing the effects of no game, Step it UP! game, and Step it UP! game plus adult interaction on the number of steps taken by participants in a third-grade classroom during recess. Overall, 19 of the 25 participants took more steps during the Step it UP! game plus adult interaction compared to the Step it UP! game and no-game recesses. Furthermore, 20 participants preferred the Step it UP! game plus adult interaction. Results suggest that adult interaction can enhance the effects of the Step it UP! game to increase physical activity.

Background Abundant clinical studies have suggested that emotion dysregulation seems to be the essential pathogenesis for Internet gaming disorder (IGD). However, the neural mechanism of emotion regulation for IGD is still unclear. Methods Subjective evaluation and fMRI data were collected from 50 subjects (IGD: 24; recreational game user (RGU): 26) while they were performing an emotion reappraisal task. We collected and compared their brain features during emotion processing of different visual stimuli. Results Higher activation in the left dorsal anterior cingulate cortex (dACC), right ventral ACC, left claustrum and bilateral insula was observed in participants with IGD during emotion reappraisal relative to that of the RGU participants. In addition, generalized psychophysiological interaction analysis also showed that IGD participants had stronger functional connectivity between the right insula and bilateral dorsolateral prefrontal cortex (DLPFC) than the RGU participants. Conclusions The results suggest that IGD participants could not down-regulate their negative emotional experiences as efficiently as the RGU participants, although they engaged more cognitive resources. These results reveal the special neural circuits of emotion dysregulation in IGD individuals and provide new neural perspective for the intervention of IGD.

Background This study aimed to compare the effects of a designed program based on games situations with those of a conventional one, the Adapted Physical Education (APE) program, on the fundamental movement skills (FMS) in children with Down Syndrome (DS), aged 6 to 10. Methods Twenty-eight children (13 girls and 15 boys; age 8.84 ± 1.06) with DS participated in this study. The participants were divided into two groups as the experimental group (EG) with 13 children (3 girls and 10 boys) and the control group (CG) composed with 15 children (10 girls and 5 boys). The EG participated in a conceived training program based on games situations along 10 weeks, while the CG took part in an APE conventional program based on football, long Jump and sprint adapted exercises. The FMS (locomotor and object control skills) were evaluated using the Gross Motor Development-2 Test at pretraining and posttraining for both groups. Results The results revealed that both programs improve significantly locomotor skills with significantly better improvement in the EG. However, a significant object control skills improvement was observed only among the EG. Conclusions In light of our findings, a training program based on adapted games situations during 10 weeks may be recommended for FMS improvement, specifically object control skills.

Bivariate associations of problem gambling with participation in particular game types often decrease when adjusting for demographics or consumption behavior (e.g., number of game types played). A summary of 14 peer-reviewed studies showed inconsistencies as well as conceptual and methodological challenges. The aim of this study was to expand previous research by a combination of (1) sophisticated feature-engineering, which disaggregates gambling intensity into facets within and beyond a game type of interest, and (2) the application of mediation models. Data comprised last year gamblers of three merged cross sectional Icelandic gambling surveys of 2007, 2011, and 2017 (N = 4422). For each of 15 game types (12-month time frame), a parallel multiple mediation model was applied to disaggregate bivariate associations of last year game type participation and problem gambling (Problem Gambling Severity Index) by six mediating mechanisms: (1) demographic problem gambling propensity, (2) number of game types played, (3) gambling frequency within the type, (4) maximum gambling frequency across all types beyond, (5) usual spending within the type, (6) maximum usual spending across all types beyond. Games showed two distinct profiles via which mediator they mostly impacted problem gambling: Electronic gaming machines offline, scratch cards offline, live betting online, and poker offline as well as online impacted problem gambling mostly via gambling frequency within, whereas all other types mostly impacted via the number of game types played. The applied mediation models answer the question by which mechanism game types impact problem gambling in a more exhaustive way than previous research.

Contains fulltext : 221403.pdf (Publisher’s version ) (Closed access) Objective: The present study investigated whether a health game can be used to affect children's implicit attitudes toward food (IAsTF) and subsequent snack choices. Materials and Methods: The health game used was based on an evaluative conditioning paradigm. The experiment followed a between-subjects design with two conditions (health game vs. control), N = 79 (12.42 years +/- 1.64, body mass index: 25.06 +/- 7.40). IAsTF were assessed at baseline and postintervention using an implicit association test (IAT). Baseline IAT scores were used to categorize IAsTF as healthy (favoring fruits) versus unhealthy IAsTF (favoring chocolates). In addition, three digital snack choices were recorded. Results: No main effect of condition on posttest IAsTF was found. However, baseline IAsTF moderated the effect of condition on posttest IAsTF; participants with less healthy baseline IAsTF playing the health game had healthier posttest IAsTF compared to those playing the control game. Regarding the snack choices, participants playing the health game favored fruit over chocolate in one of the snack choices. Baseline IAsTF did not moderate the effect of condition on snack choices. Conclusion: Tentative support was found that health games can be used to improve IAsTF, in particular among participants with less healthy ones at baseline. 11 p.

Health interventions that use serious games have become increasingly popular. However, many of these games have been designed with few immersive game features which would improve users' engagement with the persuasive messages. To address this issue, researchers have incorporated narrative elements in games to facilitate message processing and enhance behavioral change. There have been theoretical debates about whether narratives benefit these interventions; empirical evidences for their effects are slightly mixed. This meta-analysis provides a deeper understanding of the overall impact of narrative game-based interventions on health-related behaviors and their psychological determinants. Combining the results from 22 studies, this meta-analysis found that narrative game-based interventions were effective in changing behaviors, knowledge, self-efficacy, and enjoyment. These effects were moderated by factors such as the genre of the game, the genre of the story, group play, and participant age. Implications of the findings and suggestions for future design of narrative game-based interventions were discussed.

Machine learning classification models for accelerometer data are potentially more accurate methods to measure physical activity in young children than traditional cut point methods. However, existing algorithms have been trained on laboratory-based activity trials, and their performance has not been investigated under free-living conditions. PURPOSE: This study aimed to evaluate the accuracy of laboratory-trained hip and wrist random forest and support vector machine classifiers for the automatic recognition of five activity classes: sedentary (SED), light-intensity activities and games (LIGHT_AG), walking (WALK), running (RUN), and moderate to vigorous activities and games (MV_AG) in preschool-age children under free-living conditions. METHODS: Thirty-one children (4.0 ± 0.9 yr) were video recorded during a 20-min free-living play session while wearing an ActiGraph GT3X+ on their right hip and nondominant wrist. Direct observation was used to continuously code ground truth activity class and specific activity types occurring within each class using a bespoke two-stage coding scheme. Performance was assessed by calculating overall classification accuracy and extended confusion matrices summarizing class-level accuracy and the frequency of specific activities observed within each class. RESULTS: Accuracy values for the hip and wrist random forest algorithms were 69.4% and 59.1%, respectively. Accuracy values for hip and wrist support vector machine algorithms were 66.4% and 59.3%, respectively. Compared with the laboratory cross validation, accuracy decreased by 11%-15% for the hip classifiers and 19%-21% for the wrist classifiers. Classification accuracy values were 72%-78% for SED, 58%-79% for LIGHT_AG, 71%-84% for MV_AG, 9%-15% for WALK, and 66%-75% for RUN. CONCLUSION: The accuracy of laboratory-based activity classifiers for preschool-age children was attenuated when tested on new data collected under free-living conditions. Future studies should train and test machine learning activity recognition algorithms using accelerometer data collected under free-living conditions.

Objective: An estimated 100 million Americans have diabetes, undiagnosed diabetes, a high risk of being diagnosed with diabetes, or prediabetes. Many complications can arise if diabetes is poorly managed. Hence, the need for adequate knowledge, skills, and ability to care for oneself, known as diabetes self-care management, is needed to reduce complication rates. We used an interactive platform that incorporates principles of gamification to enhance user engagement to enhance diabetes knowledge. The purpose of this descriptive pilot study was to discover what adult patients with diabetes thought about this novel educational approach to diabetes education. Materials and Methods: We collected focus group data from participants at a diabetes clinic after they played an interactive diabetes trivia game, on our software platform (Kaizen Education). Transcripts were coded and common themes were identified. Results: We conducted 9 focus groups that included 33 adult (age >18) participants who had diabetes. An overarching theme of play/gaming as a form of learning was apparent, and after analyzing the coding several themes emerged, including preferences and desired environments (clinic and home) for learning, desired players (including family, significant others), and a good balance of question difficulty. Conclusions: Participants were overwhelmingly positive about gamified education and felt empowered to lead discussions with their health care providers about diabetes self-care education, in a sense “flipping” the traditional clinic patient education paradigm. These results suggested that a flipped clinic approach could be beneficial, empowering, and engaging for patients.

Background Neuromuscular imbalance will lead to loading asymmetry in sporting activities. This asymmetry is related to leg dominance, which has been associated with increased risk of anterior cruciate ligament (ACL) injury. Therefore, potential biomechanical differences between legs are important. However, little attention has been paid to the biomechanical details of leg dominance. The purpose of the present study was to clarify the relationship between leg dominance and knee biomechanics in females with different activity level during dynamic athletic tasks. Methods A total of 23 female collegiate (mean age = 19.6 ± 1.4 years, mean body mass index = 21.5 ± 0.9) and 19 recreational athletes (mean age = 20.7 ± 1.1 years, mean body mass index = 20.5 ± 1.7) were enrolled. Tegner activity scores of the collegiate and recreational athletes were 9 and 7, respectively. Knee kinematic and kinetic asymmetries between the dominant (DL) and non-dominant (NDL) legs during the landing phase of drop vertical jump (DVJ) were assessed using three-dimensional motion analysis in collegiate and recreational athletes separately. Statistical comparison was done using two-tailed paired t test between DL and NDL in each athlete. Results The peak knee abduction angle was significantly larger on the DL than on the NDL in collegiate athletes. Knee abduction angle at initial contact (IC), peak knee abduction angle, knee internal rotation angle at IC, and peak knee internal rotation angle were significantly larger on the NDL than on the DL in recreational athletes. Moreover, peak knee abduction moment within 40 ms from IC was larger on the NDL than on the DL in recreational athletes, while the moment was not significantly different in collegiate athletes. Conclusions From the present study, the relationship between leg dominance and knee biomechanics was totally different in females with different activity level. Specifically, asymmetry of the knee abduction angle between limbs was opposite between female recreational and collegiate athletes. According to previous literatures, abduction and internal rotation angles as well as abduction moment were key issues for mechanism of non-contact ACL injury. Therefore, the NDL in female recreational athletes was associated with increased risk of ACL injury.

Objectives Playing analog games may be associated with better cognitive function but, to date, these studies have not had extensive longitudinal follow-up. Our goal was to examine the association between playing games and change in cognitive function from age 11 to age 70, and from age 70 to 79. Method Participants were 1,091 nonclinical, independent, community-dwelling individuals all born in 1936 and residing in Scotland. General cognitive function was assessed at ages 11 and 70, and hierarchical domains were assessed at ages 70, 73, 76, and 79 using a comprehensive cognitive battery of 14 tests. Games playing behaviors were assessed at ages 70 and 76. All models controlled for early life cognitive function, education, social class, sex, activity levels, and health issues. All analyses were preregistered. Results Higher frequency of playing games was associated with higher cognitive function at age 70, controlling for age 11 cognitive function, and the majority of this association could not be explained by control variables. Playing more games was also associated with less general cognitive decline from age 70 to age 79, and in particularly, less decline in memory ability. Increased games playing between 70 and 76 was associated with less decline in cognitive speed. Discussion Playing games were associated with less relative cognitive decline from age 11 to age 70, and less cognitive decline from age 70 to 79. Controlling for age 11 cognitive function and other confounders, these findings suggest that playing more games is linked to reduced lifetime decline in cognitive function.

While most animals play, only humans play games. As animal play serves to teach offspring important life-skills in a safe scenario, human games might, in similar ways, teach important culturally relevant skills. Humans in all cultures play games; however, it is not clear whether variation in the characteristics of games across cultural groups is related to group-level attributes. Here we investigate specifically whether the cooperativeness of games covaries with socio-ecological differences across cultural groups. We hypothesize that cultural groups that engage in frequent inter-group conflict, cooperative sustenance acquisition, or that have less stratified social structures, might more frequently play cooperative games as compared to groups that do not share these characteristics. To test these hypotheses, we gathered data from the ethnographic record on 25 ethnolinguistic groups in the Austronesian language family. We show that cultural groups with higher levels of inter-group conflict and cooperative land-based hunting play cooperative games more frequently than other groups. Additionally, cultural groups with higher levels of intra-group conflict play competitive games more frequently than other groups. These findings indicate that games are not randomly distributed among cultures, but rather relate to the socio-ecological settings of the cultural groups that practice them. We argue that games serve as training grounds for group-specific norms and values and thereby have an important function in enculturation during childhood. Moreover, games might server an important role in the maintenance of cultural diversity. Introduction Children’s play Games Possible drivers of cooperative goal structures - Interdependence in foraging. - Intra- and inter-group conflict. Lack of social stratification Methods - Games - Cultural covariate data - Statistical analyses Results - Descriptive statistics - Cultural variables and goal structures Discussion Conclusion

The faculty of language allows humans to state falsehoods in their choice of words. However, while what is said might easily uphold a lie, how it is said may reveal deception. Hence, some features of the voice that are difficult for liars to control may keep speech mostly, if not always, honest. Previous research has identified that speech timing and voice pitch cues can predict the truthfulness of speech, but this evidence has come primarily from laboratory experiments, which sacrifice ecological validity for experimental control. We obtained ecologically valid recordings of deceptive speech while observing natural utterances from players of a popular social deduction board game, in which players are assigned roles that either induce honest or dishonest interactions. When speakers chose to lie, they were prone to longer and more frequent pauses in their speech. This finding is in line with theoretical predictions that lying is more cognitively demanding. However, lying was not reliably associated with vocal pitch. This contradicts predictions that increased physiological arousal from lying might increase muscular tension in the larynx, but is consistent with human specialisations that grant Homo sapiens sapiens an unusual degree of control over the voice relative to other primates. The present study demonstrates the utility of social deduction board games as a means of making naturalistic observations of human behaviour from semi-structured social interactions.

There are only a few reports on Go-induced epilepsy. We hereby report a case of Go-induced epilepsy and its ictal electroencephalography (EEG) findings, and treatment. A 71-year-old man reported to our hospital for seizures that lasted for several minutes after he had played Go for approximately an hour. Ictal EEG showed focal to bilateral tonic-clonic seizures of right parietal origin. He was administered levetiracetam 500 mg before the games, and he participated without seizures for more than a year. Go-induced epilepsy is considered to have a focal onset, and it may be controlled with antiepileptic drugs before the games.

Cognitive stimulation may be beneficial in slowing the progression of mild neurocognitive disorder (NCD), but the results of existing research are inconsistent. Furthermore, there are no long-term interventions nor individual (one-on-one) interventions applied by professionals. Objetive. The aim of this study was to assess the efficacy of a long-term individual cognitive stimulation intervention on people with mild NCD.A pre-post test design with a non-equivalent control group was conducted. A total of 82 participants with mild NCD were assigned to a cognitive stimulation intervention group or to a control group. The intervention consisted of 88 individual format sessions of approximately 45 minutes, twice per week. Independent evaluators assessed cognition, depressive symptomatology and autonomy level in activities of daily living at pre-intervention, intra-intervention (6 months) and post-intervention (12 months).At intra- and post-intervention, significant improvement on cognition and depressive symptomatology in the intervention group compared to the control group were found. Younger participants and those with better cognitive function and status in pre-intervention achieved better results. Adherence to the intervention was high.Results suggest the efficacy of long-term individual cognitive intervention in people with mild NCD, which could delay the progression towards a major NCD.Efecto de la intervención de estimulación cognitiva individual de larga duración para personas con trastorno neurocognitivo leve.Introducción. La estimulación cognitiva puede ser beneficiosa para ralentizar la progresión del trastorno neurocognitivo (TNC) leve, pero los resultados de las investigaciones existentes son inconsistentes. Además, no existen intervenciones a largo plazo ni intervenciones individuales (uno a uno) aplicadas por profesionales. Objetivo. El objetivo de este estudio fue evaluar la eficacia de una intervención de estimulación cognitiva individual de larga duración para personas con TNC leve. Pacientes y métodos. Se llevó a cabo un diseño pretest-postest con un grupo control no equivalente. Un total de 82 participantes con TNC leve fueron asignados a un grupo de intervención de estimulación cognitiva o a un grupo control. La intervención consistió en 88 sesiones de formato individual de aproximadamente 45 minutos, dos veces por semana. Evaluadores independientes evaluaron la cognición, la sintomatología depresiva y el nivel de autonomía en las actividades de la vida diaria en la preintervención (línea base), la intraintervención (seis meses) y la postintervención (12 meses). Resultados. En la intra- y la postintervención, se encontró una mejora significativa en la cognición y la sintomatología depresiva en el grupo de intervención en comparación con el grupo control. Los participantes más jóvenes y los que tenían una mejor función y estado cognitivo en la preintervención obtuvieron mejores resultados. La adhesión a la intervención fue alta. Conclusiones. Los resultados sugieren la eficacia de una intervención cognitiva individual de larga duración para personas con TNC leve, que podría retrasar la progresión hacia un TNC mayor.

There is a positive relationship between children’s movement competence and physical activity, with a further relationship established between physical activity and childhood obesity. The Movement Oriented Games Based Assessment (MOGBA) is a delivery and assessment intervention designed to improve children’s complex movement skills, based on principles of motor development and assessment theories. MOGBA aims to improve children’s movement competence, physical fitness and self-perceptions (physical and game) and increase children’s moderate-to-vigorous physical activity (MVPA). MOGBA is to be used in the ‘Made to Play’ initiative, involving 105 sports and activity programs across 21 countries, involving over 25 million children. A multi-site cluster randomized controlled trial will take place across three global sites (UK, Ireland and Australia). Each site will recruit eight primary schools (four experiment, four control) with each school providing two separate classes of children from age ranges 8–12 years (Site n = ~300, total n = 904). After baseline assessments, schools will be randomly allocated to an experimental or wait-list control group. Following two half-day workshops, trained facilitators will deliver the MOGBA intervention for 9 weeks. The main intervention components include delivery of 14 games-based activities with associated assessments of children’s movement and differentiation to meet children’s needs by manipulating space, effort and relationships. The primary outcome of the trial is to improve children’s’ movement competence (The Dragon Challenge), with secondary outcomes of improving children’s’ in-activity and leisure-time MVPA (5-day accelerometer), physical fitness (standing long jump and push ups) and self-perceptions (physical and game). Data will be analysed using multilevel modelling approaches. The MOGBA intervention has been designed to improve children’s movement competence and scalable interventions based on MOGBA could be applied across programs within the Made to Play initiative, globally. The trial is registered at the Australia New Zealand Clinical Trial Registry (ACTRN12619001320145p, 27 Sep 2019).

Objective: The sudden disruption of university teaching caused by the coronavirus disease 2019 (COVID-19) pandemic has forced universities to switch to online teaching. It is vital for graduating medical students to learn about COVID-19 because they are likely to treat COVID-19 patients after graduation. We developed a COVID-19 lesson for medical students that used either an online lecture or a serious game that we designed. The aim of this study is to explore the effectiveness of a serious game versus online lectures for improving medical students' COVID-19 knowledge. Materials and Methods: From our university's database of knowledge scores, we collected the prelesson, postlesson, and final test knowledge scores of the students who participated in the lesson and conducted a retrospective comparative analysis. Results: An analysis of scores concerning knowledge of COVID-19 from prelesson and postlesson tests shows that both teaching methods produce significant increases in short-term knowledge, with no statistical difference between the two methods (P > 0.05). The final test scores, however, show that the group of students who used the game-based computer application scored significantly higher in knowledge retention than did the online lecture group (P = 0.001). Conclusion: In the context of the disruption of traditional university teaching caused by the COVID-19 pandemic, the serious game we designed is potentially an effective option for online medical education about COVID-19, particularly in terms of its capacity for improved knowledge retention.

Background Neurodegenerative diseases are sporadic hereditary conditions characterized by progressive dysfunction of the nervous system. Among the symptoms, vestibulopathy is one of the causes of discomfort and a decrease in quality of life. Hereditary spastic paraplegia is a heterogeneous group of hereditary degenerative diseases involving the disorder of a single gene and is characterized by the progressive retrograde degeneration of fibers in the spinal cord. Objective To determine the benefits of vestibular rehabilitation involving virtual reality by comparing pre intervention and post intervention assessments in individuals with hereditary spastic paraplegia. Methods In this randomized controlled clinical trial from the Rebec platform RBR-3jmx67 in which allocation concealment was performed and the evaluators be blinded will be included. The participants will include 40 patients diagnosed with hereditary spastic paraplegia. The interventions will include vestibular rehabilitation with virtual reality using the Wii® console, Wii-Remote and Wii Balance Board (Nintendo), and the studies will include pre- and post intervention assessments. Group I will include twenty volunteers who performed balance games. Group II will include twenty volunteers who performed balance games and muscle strength games. The games lasted from 30 minutes to an hour, and the sessions were performed twice a week for 10 weeks (total: 20 sessions). Results This study provides a definitive assessment of the effectiveness of a virtual reality vestibular rehabilitation program in halting the progression of hereditary spastic paraplegia, and this treatment can be personalized and affordable. Conclusion The study will determine whether a vestibular rehabilitation program with the Nintendo Wii® involving virtual reality can reduce the progressive effect of hereditary spastic paraplegia and serve as an alternative treatment option that is accessible and inexpensive. Rebec platform trial: RBR-3JMX67.

Background A UK dermatology curricula review has suggested that undergraduate delivery relies on lectures and is subject to clinical and staffing pressures. Many UK undergraduate students feel less than adequately prepared to manage dermatological conditions, and misconceptions about dermatology are common. Educators have called for innovative solutions, including small group teaching. Escape rooms are games requiring teams to solve puzzles to escape from a room. Aim To assess the impact of an escape room game on perceptions of dermatology among undergraduate medical students. Methods Students were invited to an escape room to consolidate lessons taught in a previous lecture. Students were first asked to complete a questionnaire about their preferred learning environments, perceptions of dermatology and confidence in content. Following the escape room event, these questions were revisited. Focus groups were then held to explore themes raised. Results In total, 16 students took part in the escape room sessions and in 3 focus groups. Feedback was strongly positive, with 100% of students expressing 'strongly agree' on whether they enjoyed the session. Qualitative data were coded for themes of accessibility, variety of taught content and awareness. The majority (94%) of students stated the escape room made them want to experience more dermatology. Conclusion Prejudices about dermatology exist among medical students, and may act as a barrier to perceived accessibility to the specialty. Escape rooms can provide a shift to a more learner-centred approach, which may aid in combating these negative perceptions. They may act as an enjoyable means of consolidating lecture-based and clinical teaching, and require minimal resources.

AI now masters six-player poker Computer programs have shown superiority over humans in two-player games such as chess, Go, and heads-up, no-limit Texas hold'em poker. However, poker games usually include six players—a much trickier challenge for artificial intelligence than the two-player variant. Brown and Sandholm developed a program, dubbed Pluribus, that learned how to play six-player no-limit Texas hold'em by playing against five copies of itself (see the Perspective by Blair and Saffidine). When pitted against five elite professional poker players, or with five copies of Pluribus playing against one professional, the computer performed significantly better than humans over the course of 10,000 hands of poker. Science , this issue p. 885 ; see also p. 864

The aim of this study was to gain insight into how online gaming can teach medical students about interprofessional collaborative practice and promote their development of interprofessional competencies prior to clerkship. This prospective cohort study involved third year medical students from the Schulich School of Medicine and Dentistry in London, Ontario, Canada who participated in the 'Circles of Care'© online board game. A total of 97 student reflections were obtained and subjected to conventional qualitative descriptive content analysis. The transcribed data were analyzed question by question and line by line. Themes evolved from four questions: (1) What surprised you the most about teamwork from this learning activity, (2) What did you learn about collaborative teamwork, (3) What will you take away from this learning event to use in your practice, and (4) Please comment on the value of using a game such as this one to develop your collaborative team practice. A total of seven themes emerged including: "Gaining insights", "What worked and what did not", "Openness to learning", "Comfort in sharing with others", "Commitment and skepticism", "Being a seeker", and "Continuum of value to learning and practice". Analysis of the student reflections illustrated the potential of using an online-based game to effectively introduce and teach interprofessional competencies to medical students.

Stimulating leisure activities are considered as possible protective factors against dementia and cognitive decline in older adults, particularly due to the enhancement of cognitive reserve. This study tested the effectiveness of board game activities improving the cognitive function of older adults in adult day care centers. This was a quasi-experimental study. A purposive sampling strategy was used to select 82 subjects who were aged 65 and above with intact mental functions and currently residing in adult day care centers. 41 subjects who participated in a selection of 12 board game activities were assigned to the experimental group and 41 subjects who adhered to their ordinary activities were allocated to the control group. Structured questionnaires of the board game programs were used for data collection. The board game programs showed promising effects in the cognitive function of older adults living in adult day care centers. A possible beneficial effect of board game playing on the risk of dementia could be mediated by a less cognitive decline in older adults. Board game activities may benefit the cognitive function of older adults. Incorporating board game activities into social work care may help develop long-term care into a more diverse, unique and innovative direction.

ObjectiveGamification is a non-evaluation and competition-based training methodology with high emotional involvement. The goal of this study was to evaluate gamification methodology as compared with other existing methodologies when teaching cardiopulmonary resuscitation (CPR) to secondary school students.Methods489 secondary school students from two high schools in Spain participated in this randomised-block quasi-experimental study in February 2018. The students were classified into different groups. Each group received CPR training with a different methodology: GAM (gamification-based training as a compulsory but non-tested academic activity to learn by playing in teams, with instructor and visual feedback); EVA (training based on subsequent evaluation as a motivational incentive, with instructor and visual feedback); VFC (visual feedback complementary, training based on a non-compulsory and non-tested academic activity, with instructor and visual feedback); TC (traditional complementary, training based on a non-compulsory and non-tested academic activity, with instructor feedback). After a week, each student performed a 2 min hands-only CPR test and quality of CPR was assessed. Visual feedback in training and CPR variables in test were provided by the QCPR Instructor App using a Little Anne manikin, both from Laerdal (Norway).ResultsGAM (89.56%; 95% CI 86.71 to 92.42) methodology resulted in significantly higher scores for CPR quality than VFC and TC (81.96%; 95% CI 78.04% to 85.88% and 64.11%; 95% CI 58.23 to 69.99). GAM (61.77%; 95% CI 56.09 to 67.45) methodology also resulted in significantly higher scores for correct rate than VFC and TC (48.41%; 95% CI 41.15% to 55.67% and 17.28%; 95% CI 10.94 to 23.62). 93.4% of GAM methodology participants obtained >50 mm of compression mean depth which was a significantly higher proportion than among students in VFC and TC (78.0% and 71.9%). No differences between GAM and EVA were found. A confidence level of 95% has been assigned to all values.ConclusionsGAM methodology resulted in higher CPR quality than non-tested methods of academic training with instructor feedback or visual feedback. Gamification should be considered as an alternative teaching method for Basic Life Support (BLS) in younger individuals.

Background and purpose Today's pharmacists must be “team-ready.” While team-based learning is ubiquitous in pharmacy education, little data exists for fostering team-building skills in healthcare education. This study evaluates the effect of an escape room-themed team-building exercise on pharmacy student experiences and perceptions of working in teams using StrengthsFinder 2.0 as a framework. Educational activity and setting Second and third professional year pharmacy students were divided into teams of four to five. Each team competed in a puzzle-based simulated “escape room”. Students completed pre- and post-surveys regarding perceptions of working in teams and team dynamics after reviewing their StrengthsFinder 2.0 results. Quantitative data were analyzed using descriptive statistics and a related-samples McNemar test for statistical significance. Qualitative data from open-ended questions were analyzed to determine common themes among student answers. Findings Of the 137 enrolled students, 127 participated in the activity and surveys. Sixty percent of teams successfully completed the activity on time. All but one statement (“I am an integral member of the team”) showed a statistically significant increase in those strongly agreeing or agreeing pre- to post-exercise. The largest shift was seen for the statement “I enjoy working in a team environment”. Thematic analysis of qualitative data revealed that students felt harnessing their individual talents made the teams stronger. Summary This exercise positively impacted student perceptions of working in teams. Further research should determine the effect of pre-requisite team-building exercises on team-based learning outcomes.

OBJECTIVE: Choosing inappropriate or unethical actions in games is referred to as dark play. For a serious game on delirium for medical students, we aimed to investigate the potential differences between dark play and normal play on game effectiveness regarding abilities in advising care, learning motivation and engagement, and attitude toward delirious patients. Furthermore, we aimed to explore the use of different game features between the two types of play on empathy, self-efficacy, and consequences of care.METHODS: We performed a two-arm randomized controlled trial including an exploratory qualitative approach with 157 medical students, who played the serious game "The Delirium Experience." Participants were randomly allocated to either the dark play or normal play group. Participants had to give three recommendations for taking care of delirious patients, and complete both the Delirium Attitude Scale, and Learning Motivation and Engagement Questionnaire to study game effectiveness. To explore game features, open questions were asked.RESULTS: We did not find difference between the two types of play in game effectiveness. "Patient's and nurse's perspective" seem to be an important game feature for being able to empathize with a patient in both groups. To support self-efficacy, "practice how to care" and "feedback in the game" were important in both study groups. "Being able to see the importance of good interaction with the patient" was reported important for self-efficacy in the dark play group, whereas this was "seeing the consequences of care" in the normal play group.CONCLUSIONS: There seems to be no change to game effectiveness when providing players the opportunity to use dark play in a serious game. A realistic view of another person's perspective could be an important game feature to increase empathy.