Design and Instantiation of an Interactive Multidimensional Ontology for Game Design Elements – a Design and Behavioral Approach

While games and play are commonly perceived as leisure tools, focus on the strategic implementation of isolated gameful elements outside of games has risen in recent years under the term gamification. Given their ease of implementation and impact in competitive games, a small set of game design elements, namely points, badges, and leaderboards, initially dominated research and practice. However, these elements reflect only a small group of components that game designers use to achieve positive outcomes in their systems. Current research has shifted towards focusing on the game design process instead of the isolated implementation of single elements under the term gameful design. But the problem of a tendency toward a monocultural selection of prominent design elements persists in-game and gameful design, preventing the method from reaching its full potential. This dissertation addresses this problem by designing and developing a digital, interactive game design element ontology that scholars and practitioners can use to make more informed and inspired decisions in creating gameful solutions to their problems. The first part of this work is concerned with the collation and development of the digital ontology. First, two datasets were collated from game design and gamification literature (game design elements and playing motivations). Next, four explorative studies were conducted to add user-relevant metadata and connect their items into an ontological structure. The first two studies use card sorting to assess game theory frameworks regarding their suitability as foundational categories for the game design element dataset and to gain an overview of different viewpoints from which categorizations can be derived. The second set of studies builds on an explorative method of matching dataset entries via their descriptive keywords to arrive at a connected graph. The first of these studies connects items of the playing motivations dataset with themselves, while the second connects them with an additional dataset of human needs. The first part closes with the documentation of the design and development of the tool Kubun, reporting on the outcome of its evaluation via iterative expert interviews and a field study. The results suggest that the tool serves its preset goals of affording intuitive browsing for dedicated searches and serendipitous findings. While the first part of this work reports on the top-down development process of the ontology and related navigation tool, the second part presents an in-depth research of specific learning-oriented game design elements to complement the overall research goal through a complementary bottom-up approach. Therein, two studies on learning-oriented game design elements are reported regarding their effect on performance, long-term learning outcome, and knowledge transfer. The studies are conducted with a game dedicated to teaching correct waste sorting. The first study focuses on a reward-based game design element in terms of its motivatory effect on perfect play. The second study evaluates two learning-enhancing game design elements, repeat, and look-up, in terms of their contribution to a long-term learning outcome. The comprehensive insights gained through the in-depth research manifest in the design of a module dedicated to reporting research outcomes in the ontology. The dissertation concludes with a discussion on the studies’ varying limitations and an outlook on pathways for future research

Gameful Learning for a More Sustainable World

Municipal waste sorting is an important but neglected topic within sustainability-oriented Information Systems research. Most waste management systems depend on the quality of their citizens pre-sorting but lack teaching resources. Thus, it is important to raise awareness and knowledge on correct waste sorting to strengthen current efforts. Having shown promising results in raising learning outcomes and motivation in domains like health and economics, gamification is an auspicious approach to address this problem. The paper explores the effectiveness of gameful design on learning outcomes of waste sorting knowledge with a mobile game app that implements two different learning strategies: repetition and elaboration. In a laboratory experiment, the overall learning outcome of participants who trained with the game was compared to that of participants who trained with standard analogue non-game materials. Furthermore, the effects of two additional, learning-enhancing design elements – repetition and look-up – were analyzed. Learning outcome in terms of long-term retention and knowledge transfer were evaluated through three different testing measures two weeks after the training: in-game, through a multiple-choice test and real-life sorting. The results show that the game significantly enhanced the learning outcome of waste sorting knowledge for all measures, which is particularly remarkable for the real-life measure, as similar studies were not successful with regard to knowledge transfer to real life. Furthermore, look-up is found to be a promising game design element that is not yet established in IS literature and therefore should be considered more thoroughly in future research and practical implementations alike

Gameful Learning for a More Sustainable World – Measuring the Effect of Design Elements on Long-Term Learning Outcomes in Correct Waste Sorting

Municipal waste sorting is an important but neglected topic within sustainability-oriented Information Systems research. Most waste management systems depend on the quality of their citizens pre-sorting but lack teaching resources. Thus, it is important to raise awareness and knowledge on correct waste sorting to strengthen current efforts. Having shown promising results in raising learning outcomes and motivation in domains like health and economics, gamification is an auspicious approach to address this problem. The paper explores the effectiveness of gameful design on learning outcomes of waste sorting knowledge with a mobile game app that implements two different learning strategies: repetition and elaboration. In a laboratory experiment, the overall learning outcome of participants who trained with the game was compared to that of participants who trained with standard analogue non-game materials. Furthermore, the effects of two additional, learning-enhancing design elements – repetition and look-up – were analyzed. Learning outcome in terms of long-term retention and knowledge transfer were evaluated through three different testing measures two weeks after the training: in-game, through a multiple-choice test and real-life sorting. The results show that the game significantly enhanced the learning outcome of waste sorting knowledge for all measures, which is particularly remarkable for the real-life measure, as similar studies were not successful with regard to knowledge transfer to real life. Furthermore, look-up is found to be a promising game design element that is not yet established in IS literature and therefore should be considered more thoroughly in future research and practical implementations alike

Association of Cardiometabolic Disease With Cancer in the Community

BACKGROUND: Obesity and cardiometabolic dysfunction have been associated with cancer risk and severity. Underlying mechanisms remain unclear. OBJECTIVES: The aim of this study was to examine associations of obesity and related cardiometabolic traits with incident cancer. METHODS: FHS (Framingham Heart Study) and PREVEND (Prevention of Renal and Vascular End-Stage Disease) study participants without prevalent cancer were studied, examining associations of obesity, body mass index (BMI), waist circumference, visceral adipose tissue (VAT) and subcutaneous adipose tissue depots, and C-reactive protein (CRP) with future cancer in Cox models. RESULTS: Among 20,667 participants (mean age 50 years, 53% women), 2,619 cancer events were observed over a median follow-up duration of 15 years. Obesity was associated with increased risk for future gastrointestinal (HR: 1.30; 95% CI: 1.05-1.60), gynecologic (HR: 1.62; 95% CI: 1.08-2.45), and breast (HR: 1.32; 95% CI: 1.05-1.66) cancer and lower risk for lung cancer (HR: 0.62; 95% CI: 0.44-0.87). Similarly, waist circumference was associated with increased risk for overall, gastrointestinal, and gynecologic but not lung cancer. VAT but not subcutaneous adipose tissue was associated with risk for overall cancer (HR: 1.22; 95% CI: 1.05-1.43), lung cancer (HR: 1.92; 95% CI: 1.01-3.66), and melanoma (HR: 1.56; 95% CI: 1.02-2.38) independent of BMI. Last, higher CRP levels were associated with higher risk for overall, colorectal, and lung cancer (P < 0.05 for all). CONCLUSIONS: Obesity and abdominal adiposity are associated with future risk for specific cancers (eg, gastrointestinal, gynecologic). Although obesity was associated with lower risk for lung cancer, greater VAT and CRP were associated with higher lung cancer risk after adjusting for BMI

Severity-adjusted evaluation of liver transplantation on health outcomes in urea cycle disorders

Purpose: Liver transplantation (LTx) is performed in individuals with urea cycle disorders when medical management (MM) insufficiently prevents the occurrence of hyperammonemic events. However, there is a paucity of systematic analyses on the effects of LTx on health-related outcome parameters compared to individuals with comparable severity who are medically managed. Methods: We investigated the effects of LTx and MM on validated health-related outcome parameters, including the metabolic disease course, linear growth, and neurocognitive outcomes. Individuals were stratified into “severe” and “attenuated” categories based on the genotype-specific and validated in vitro enzyme activity. Results: LTx enabled metabolic stability by prevention of further hyperammonemic events after transplantation and was associated with a more favorable growth outcome compared with individuals remaining under MM. However, neurocognitive outcome in individuals with LTx did not differ from the medically managed counterparts as reflected by the frequency of motor abnormality and cognitive standard deviation score at last observation. Conclusion: Whereas LTx enabled metabolic stability without further need of protein restriction or nitrogen-scavenging therapy and was associated with a more favorable growth outcome, LTx—as currently performed—was not associated with improved neurocognitive outcomes compared with long-term MM in the investigated urea cycle disorders.</p

Copy Number Variation and Transposable Elements Feature in Recent, Ongoing Adaptation at the Cyp6g1 Locus

The increased transcription of the Cyp6g1 gene of Drosophila melanogaster, and consequent resistance to insecticides such as DDT, is a widely cited example of adaptation mediated by cis-regulatory change. A fragment of an Accord transposable element inserted upstream of the Cyp6g1 gene is causally associated with resistance and has spread to high frequencies in populations around the world since the 1940s. Here we report the existence of a natural allelic series at this locus of D. melanogaster, involving copy number variation of Cyp6g1, and two additional transposable element insertions (a P and an HMS-Beagle). We provide evidence that this genetic variation underpins phenotypic variation, as the more derived the allele, the greater the level of DDT resistance. Tracking the spatial and temporal patterns of allele frequency changes indicates that the multiple steps of the allelic series are adaptive. Further, a DDT association study shows that the most resistant allele, Cyp6g1-[BP], is greatly enriched in the top 5% of the phenotypic distribution and accounts for ∼16% of the underlying phenotypic variation in resistance to DDT. In contrast, copy number variation for another candidate resistance gene, Cyp12d1, is not associated with resistance. Thus the Cyp6g1 locus is a major contributor to DDT resistance in field populations, and evolution at this locus features multiple adaptive steps occurring in rapid succession

Comorbidity and dementia: a scoping review of the literature.

BACKGROUND: Evidence suggests that amongst people with dementia there is a high prevalence of comorbid medical conditions and related complaints. The presence of dementia may complicate clinical care for other conditions and undermine a patient's ability to manage a chronic condition. The aim of this study was to scope the extent, range and nature of research activity around dementia and comorbidity. METHODS: We undertook a scoping review including all types of research relating to the prevalence of comorbidities in people with dementia; current systems, structures and other issues relating to service organisation and delivery; patient and carer experiences; and the experiences and attitudes of service providers. We searched AMED, Cochrane Library, CINAHL, PubMed, NHS Evidence, Scopus, Google Scholar (searched 2012, Pubmed updated 2013), checked reference lists and performed citation searches on PubMed and Google Scholar (ongoing to February 2014). RESULTS: We included 54 primary studies, eight reviews and three guidelines. Much of the available literature relates to the prevalence of comorbidities in people with dementia or issues around quality of care. Less is known about service organisation and delivery or the views and experiences of people with dementia and their family carers. There is some evidence that people with dementia did not have the same access to treatment and monitoring for conditions such as visual impairment and diabetes as those with similar comorbidities but without dementia. CONCLUSIONS: The prevalence of comorbid conditions in people with dementia is high. Whilst current evidence suggests that people with dementia may have poorer access to services the reasons for this are not clear. There is a need for more research looking at the ways in which having dementia impacts on clinical care for other conditions and how the process of care and different services are adapting to the needs of people with dementia and comorbidity. People with dementia should be included in the debate about the management of comorbidities in older populations and there needs to be greater consideration given to including them in studies that focus on age-related healthcare issues

Improving Nursing Home Care through Feedback On PerfoRMance Data (INFORM): Protocol for a cluster-randomized trial

Background Audit and feedback is effective in improving the quality of care. However, methods and results of international studies are heterogeneous, and studies have been criticized for a lack of systematic use of theory. In TREC (Translating Research in Elder Care), a longitudinal health services research program, we collect comprehensive data from care providers and residents in Canadian nursing homes to improve quality of care and life of residents, and quality of worklife of caregivers. The study aims are to a) systematically feed back TREC research data to nursing home care units, and b) compare the effectiveness of three different theory-based feedback strategies in improving performance within care units. Methods INFORM (Improving Nursing Home Care through Feedback On PerfoRMance Data) is a 3.5-year pragmatic, three-arm, parallel, cluster-randomized trial. We will randomize 67 Western Canadian nursing homes with 203 care units to the three study arms, a standard feedback strategy and two assisted and goal-directed feedback strategies. Interventions will target care unit managerial teams. They are based on theory and evidence related to audit and feedback, goal setting, complex adaptive systems, and empirical work on feeding back research results. The primary outcome is the increased number of formal interactions (e.g., resident rounds or family conferences) involving care aides – non-registered caregivers providing up to 80% of direct care. Secondary outcomes are a) other modifiable features of care unit context (improved feedback, social capital, slack time) b) care aides’ quality of worklife (improved psychological empowerment, job satisfaction), c) more use of best practices, and d) resident outcomes based on the Resident Assessment Instrument – Minimum Data Set 2.0. Outcomes will be assessed at baseline, immediately after the 12-month intervention period, and 18 months post intervention. Discussion INFORM is the first study to systematically assess the effectiveness of different strategies to feed back research data to nursing home care units in order to improve their performance. Results of this study will enable development of a practical, sustainable, effective, and cost-effective feedback strategy for routine use by managers, policy makers and researchers. The results may also be generalizable to care settings other than nursing homes. Trial registration ClinicalTrials.gov Identifier: NCT02695836 . Date of registration: 24 February 201