Gamification for low-literates: Findings on motivation, user experience, and study design

This study investigated the effects of the gamification elements of scaffolding, score and hints on the user enjoyment and motivation of people of low literacy. In a four-condition within-subjects experiment, participants performed mental spatial ability tests with the aforementioned elements. Quantitative results were inconclusive, but post-test interviews provided insights on the limited effectiveness of the gamification elements. Complex questionnaire wording, high task difficulty, and an improperly situated task environment all contributed to ceiling effects in the influence of scaffolding. Score was found to be ineffective without proper contextualization connecting the numerical score to clearer performance measures. Finally, the underused hints functionality has indicated the need for adequate ‘mixed initiative’ support

Randomized controlled clinical trial on the efficacy of a novel antimicrobial chewing gum in reducing plaque and gingivitis in adolescent orthodontic patients

Objectives Chewing gums containing antiseptics or other antimicrobial substances may be effective in reducing plaque and gingivitis. Therefore, the aim of this randomized placebo-controlled clinical trial was to investigate the efficacy of a novel antimicrobial chewing gum containing essential oils (cinnamon, lemon, peppermint) and extracts on reduction of dental plaque and gingivitis as well as on oral health-related quality of life (OHRQoL) in adolescent orthodontic patients. Materials 52 patients (11-22 years of age) were randomly assigned to use a test chewing gum (COVIDGUM, Clevergum) or a commercially available control chewing gum over a period of 10 days. Approximal plaque index (API), papillary bleeding index (PBI) and an OHRQoL questionnaire for children (COHIP-G19) were assessed at baseline (BL), after 10 days (10d) and 30 days (30d). In addition, oral health and oral hygiene related questions of the COHIP-G19 questionnaire were evaluated separately in subscales at each timepoint. Data were analyzed using non-parametrical statistical procedures (α = 0.05). Results API and PBI decreased significantly over time from BL to 10d and from BL to 30d in both groups, without significant differences between the groups. In both groups, the COHIP-G19 score, oral health subscale and oral hygiene subscale decreased significantly over time. Regarding the oral hygiene subscale, the test group showed significantly better scores at 30d (p = 0.011). Conclusion Both chewing gums performed similarly effective in terms of reducing plaque accumulation and gingival inflammation and improving OHRQoL. Clinical relevance Chewing gums without antimicrobial ingredients may be sufficient to decrease plaque accumulation and gingival inflammation

Social and Ecological Characteristics of an Expanding Natural Resource Industry: Aloe Harvesting in South Africa

Sustainable harvesting practices are important for conserving plant species and their habitats; but also the livelihoods of those that depend on them. Aloe ferox, a valuable natural resource harvested for its leaves, is the focus of a recent rural development initiative in the Eastern Cape of South Africa. This has the potential to benefit poor residents through a high value, sustainable, export market. We characterize the social and ecological components of the system, in order to evaluate the potential for effective natural resource management. We interviewed aloe tappers to obtain information on their dependence on the A. ferox industry and harvesting practices. We assessed the harvesting pressure on A. ferox populations, sampling plants at three plots positioned along each of four transects at distances of 1.5 km, 3.45 km, and 7 km from the factory, grouping plants into two size classes: small (height 0.5m). We investigated the influence of proximity to the factory and plant size class on the likelihood and intensity of harvest. The majority of aloe tappers were women, unemployed and in receipt of government welfare grants, and the main reason for harvesting A. ferox was to generate a cash income for their daily needs. Training guidelines did not appear to be followed, with aloe tappers leaving on average 6 leaves, rather than the recommended 18-20 leaves, allowing insufficient time to pass between harvesting episodes and harvesting outside of the prescribed wetter periods. In line with training guidelines aloe tappers were targeting larger plants; however, against recommendations, smaller plants were also regularly harvested. Harvesting pressure decreased with increasing distance from the factory. We discuss requirements to ensure A. ferox is harvested at sustainable levels in the region, particularly in light of a possible regional roll out of the program, and provide recommendations for regulating use and better training.</p

Empagliflozin in Patients with Chronic Kidney Disease

Background The effects of empagliflozin in patients with chronic kidney disease who are at risk for disease progression are not well understood. The EMPA-KIDNEY trial was designed to assess the effects of treatment with empagliflozin in a broad range of such patients. Methods We enrolled patients with chronic kidney disease who had an estimated glomerular filtration rate (eGFR) of at least 20 but less than 45 ml per minute per 1.73 m(2) of body-surface area, or who had an eGFR of at least 45 but less than 90 ml per minute per 1.73 m(2) with a urinary albumin-to-creatinine ratio (with albumin measured in milligrams and creatinine measured in grams) of at least 200. Patients were randomly assigned to receive empagliflozin (10 mg once daily) or matching placebo. The primary outcome was a composite of progression of kidney disease (defined as end-stage kidney disease, a sustained decrease in eGFR to &lt; 10 ml per minute per 1.73 m(2), a sustained decrease in eGFR of &amp; GE;40% from baseline, or death from renal causes) or death from cardiovascular causes. Results A total of 6609 patients underwent randomization. During a median of 2.0 years of follow-up, progression of kidney disease or death from cardiovascular causes occurred in 432 of 3304 patients (13.1%) in the empagliflozin group and in 558 of 3305 patients (16.9%) in the placebo group (hazard ratio, 0.72; 95% confidence interval [CI], 0.64 to 0.82; P &lt; 0.001). Results were consistent among patients with or without diabetes and across subgroups defined according to eGFR ranges. The rate of hospitalization from any cause was lower in the empagliflozin group than in the placebo group (hazard ratio, 0.86; 95% CI, 0.78 to 0.95; P=0.003), but there were no significant between-group differences with respect to the composite outcome of hospitalization for heart failure or death from cardiovascular causes (which occurred in 4.0% in the empagliflozin group and 4.6% in the placebo group) or death from any cause (in 4.5% and 5.1%, respectively). The rates of serious adverse events were similar in the two groups. Conclusions Among a wide range of patients with chronic kidney disease who were at risk for disease progression, empagliflozin therapy led to a lower risk of progression of kidney disease or death from cardiovascular causes than placebo