Using formal game design methods to embed learning outcomes into game mechanics and avoid emergent behaviour

This paper offers an approach to designing game based learning experiences inspired by the Mechanics-Dynamics-Aesthetics (MDA) model (Hunicke et al, 2004) and the elemental tetrad (Schell, 2008) model for game design. A case for game based learning as an active and social learning experience is presented including arguments from both teachers and game designers concerning the value of games as learning tools. The MDA model is introduced with a classic game- based example and a non-game based observation of human behaviour demonstrating a negative effect of extrinsic motivators (Pink, 2011) and the need to closely align or embed learning outcomes into game mechanics in order to deliver an effective learning experience. The MDA model will then be applied to create a game based learning experience with the goal of teaching some of the aspects of using source code control to groups of Computer Science students. First, clear aims in terms of learning outcomes for the game are set out. Following the learning outcomes the iterative design process is explained with careful consideration and reflection on the impact of specific design decisions on the potential learning experience, and the reasons those decisions have been made and where there may be conflict between mechanics contributing to learning and mechanics for reasons of gameplay. The paper will conclude with an evaluation of results from a trial of computer science students and staff, and the perceived effectiveness of the game at delivering specific learning outcomes, and the approach for game design will be assessed

Driving habits and reaction times on a driving simulation in older drivers with chronic heart failure

Judgement and reaction times during complex tasks like driving may be impaired in older adults with chronic heart failure (HF). This study sought to report the driving habits and reaction times of older patients with HF in a specially designed urban driving simulation. We conducted a prospective observational study in HF patients and controls. Patients in both groups underwent cognitive testing and screening for depression. Current drivers undertook questionnaire regarding driving habits followed by an urban road driving simulation consisting of three laps. Five separate hazards appeared in the third lap without warning. Reaction times and stopping distances to the hazards were calculated. Of 247 patients with HF approached for the study, 124 had already voluntarily stopped driving due to HF (n=92) or other medical conditions (n=32), 60 had never had a license, and 32 declined to participate. Of the 74 controls approached, 1 was not currently driving due to a medical condition, and 46 declined to participate. Patients in both groups had similar levels of cognitive function, mood and driving habits. 30 patients with HF [mean (SD) age 74 (±5) years, median (IQR) NT-proBNP 1510 (546-3084) pg/L] and 26 controls [mean age 73 (±5) years, median NT-proBNP 135 (73-182) pg/L] completed the simulation. During lap 3, there was no difference in the driving speed between patients (mean 22.0 SD 4.5 mph) and controls (mean 21.7 SD3.3 mph; p=0.80). Patients had longer reaction times [median 1.10 (IQR 0.98-1.30) seconds) than controls [median 0.96 (IQR 0.83-1.10) seconds, p=0.02], but there was no difference in stopping distances [patients: median 43.9 (IQR 32.2- 49.5) metres; controls: median 38.1 (IQR 32.3-48.8) metres, p=0.31)]. Many older adults with HF no longer drive. Those who continue to drive appear safe to drive on simulated urban roads

Randomised controlled trial of video clips and interactive games to improve vision in children with amblyopia using the I-BiT system

Background Traditional treatment of amblyopia involves either wearing a patch or atropine penalisation of the better eye. A new treatment is being developed on the basis of virtual reality technology allowing either DVD footage or computer games which present a common background to both eyes and the foreground, containing the imagery of interest, only to the amblyopic eye. Methods A randomised control trial was performed on patients with amblyopia aged 4–8 years with three arms. All three arms had dichoptic stimulation using shutter glass technology. One arm had DVD footage shown to the amblyopic eye and common background to both, the second used a modified shooter game, Nux, with sprite and targets presented to the amblyopic eye (and background to both) while the third arm had both background and foreground presented to both eyes (non-interactive binocular treatment (non-I-BiT) games). Results Seventy-five patients were randomised; 67 were residual amblyopes and 70 had an associated strabismus. The visual acuity improved in all three arms by approximately 0.07 logMAR in the amblyopic eye at 6 weeks. There was no difference between I-BiT DVD and non-I-BiT games compared with I-BiT games (stated primary outcome) in terms of gain in vision. Conclusions There was a modest vision improvement in all three arms. Treatment was well tolerated and safe. There was no difference between the three treatments in terms of primary stated outcomes but treatment duration was short and the high proportion of previously treated amblyopia and strabismic amblyopia disadvantaged dichoptic stimulation treatment

Systemic arterial pressure wave reflections during acute hemorrhage

Objective: To determine the effects of hemorrhage on wave-reflection-induced systolic pressure augmentation in the aorta. Design: Randomized, controlled laboratory experiment. Setting. University research laboratory. Subjects: Twenty-five anesthetized pigs randomized to surgical controls (n = 7), hemorrhage (n = 9, H), and hemorrhage with reinfusion (n = 9, HR). Interventions. Hemorrhage of 1 mL/kg/min over 20 mins followed by observation (H) or reinfusion (HR) of shed blood. Measurements and Main Results. High-fidelity systemic arterial pressure waveforms, from ascending aorta to femoral artery, were transduced and archived digitally using intravascular semiconductor catheter-tipped pressure transducers. Wave-reflection-induced systolic pressure augmentation was determined using the augmentation index in the ascending aorta (Al-aa) and distal descending aorta (Al-da). Pulse wave velocity, wave travel times, and lumped pressure wave reflection sites were also calculated. Al values were positive at baseline with greater decreases in Aid, compared with Al-aa observed following hemorrhage, with negative values achieved for Al-da alone. Al returned to control values following reinfusion. Lumped reflection site positions and pressure contour maps suggested that a single lumped reflection site (lower abdomen/pelvis) at baseline was replaced by two discrete sites (upper abdomen and pelvis) following hemorrhage, which only recovered following reinfusion. Hemorrhage was associated with hemodynamic conditions that favored late return of wave reflection from the trunk and with the absence of significant changes in systemic vascular resistance. Conclusions: Hemorrhage-induced early return of pressure wave reflection from the abdominal vasculature is associated with systolic pressure augmentation in the ascending aorta and has the potential to worsen afterload conditions and decrease coronary artery perfusion and cardiac performance. Hemorrhage-induced splanchnic vasoconstriction causing pressure wave reflection may explain these loading conditions in the ascending aorta, and systolic pressure augmentation may be a more useful guide to left ventricular afterload than systemic vascular resistance

Kaleidomap Visualizations of Cardiovascular Function in Critical Care Medicine

In this paper we consider how the use of Kaleidomaps can facilitate our understanding and interpretation of large complex multivariate medical datasets relating to cardiovascular function in critical care medicine. Kaleidomaps are a new technique for the visualization of multivariate time-series data. They build upon the classic cascade plot and use the curvature of a line to enhance the detection of periodic patterns within multivariate dual-periodicity datasets. Kaleidomaps keep user interaction to a minimum, facilitating the rapid identification of periodic patterns not only within their own variants but also across many different sets of the variants. By linking this technique with traditional line graphs and signal processing techniques, we are able to provide medical experts with a set of visualization tools that permit the combination of medical datasets in their raw form and also with the results of mathematical analysis