Academic literature on the topic 'Chrono trigger (Game)'

Introduction This article describes the development and initial clinical testing of an innovative home-based treatment for upper extremity hemiplegia that integrates contralaterally controlled functional electrical stimulation with hand therapy video games. Methods We explored the ability of seven participants with moderate-to-severe hand impairment to self-administer 12 weeks of contralaterally controlled functional electrical stimulation video game therapy at home for 10 h/week and in-lab with a therapist for four h/week. Clinical suitability was assessed by device usage logs, qualitative surveys, and clinical motor and cognitive outcomes. Results Three participants completed the study with > 95% compliance and four did not. Factors linked to incompletion included development of trigger finger in the non-paretic hand, acceptance of a new full-time job, residence relocation, and persistence of drowsiness from anti-spasticity medication. Those who completed the treatment perceived qualitative benefits and experienced gains in motor and cognitive outcomes. Conclusion Individuals with moderate-to-severe chronic post-stroke upper extremity hemiplegia can self-administer contralaterally controlled functional electrical stimulation video game therapy for up to 90 min/day at home. We also identified social and physiological factors that may preclude its use for daily home treatment. Further studies are warranted and are in progress to estimate treatment effect and optimal dose of this intervention.

Abstract The inability of older persons with heart failure (HF) to self-manage has contributed to poor health outcomes. Our team from nursing, digital game design, and mobile computing developed an innovative sensor-controlled digital game (SCDG) called ‘Heart Mountain’ to offer a portable, and enjoyable tool to facilitate engagement in HF self-management. We installed the SCDG application, which featured older adult game avatars on the participants’ smartphones. The SCDG utilized data from an activity tracker and weight scale to trigger game rewards, knowledge content and messages based on participants’ real-time behaviors. In this study we assessed the usability of a SCDG prototype with 10 HF older adults in Central Texas. Observations on the usability of the SCDG app by older adults were noted on a usability heuristics checklist. Acceptance and satisfaction were collected by an open-ended survey guided by Intrinsic Motivation Inventory after a week of playing the game. Participants (60% males, 60% white, ages 63-84) were able to play the game and use the devices after a training session that lasted for 15 minutes. We will present results on participants’ ease of use of the SCDG app, satisfaction with the knowledge content, quizzes and rewards features of the SCDG, and perceptions on acceptance and satisfaction with the SCDG for heart failure self-management. Our project will generate insights on designing digital gaming solutions that are acceptable to older adults and can be applied to improve self-management of chronic diseases like heart failure.

Abstract INTRODUCTION: Macrocytosis (MCV>94fl) is frequently observed at patients suffering from chronic obstructive pulmonary disease (COPD) with or without respiratory insufficiency. Recent studies have demonstrated the role of erythropoietin massive excretion subsequent to hypoxemia as a trigger factor in excessive marrow erythropoiesis. Thus, a large number of immature red cells are released in peripheral blood leading to macrocytosis. AIM: To determine possible correlation between macrocytosis and severity of he disease in patients with COPD. PATIENTS AND METHODS: Thirty eight patients (mean age: 62,16±10,88 years, twenty nine male-Group A and nine female-Group B) with COPD were attended regarding their clinical status for one year, diagnosed according to spirometric classification of COPD based on post-bronchodilator FEV1 (Global Initiative for Chronic Obstructive Lung Disease, 2006). All patients were smokers suffered from mild or moderate COPD (FEV1/FVC <0,70, FEV1≥50% predicted, with PaO2 more than 60mmHg). MCV and hematocrit were measured separately for male and female additionally to the whole sample. Exacerbations considered to be happen when dyspnea or PaO2<60mmHg occurred. Patients with anemia, hematological malignancy, hypothyroidism, heart or renal failure and diabetes mellitus excluded. RESULTS: Mean value for MCV was 98,84±2,66 fl (range:95–107 fl). Average for Group A estimated at 99,52±2,92 (range: 95–107) and for Group B at 96,87±1,40 (range: 95–99). Mean value of exacerbations for both groups in one’s year period was 0,89±0,61 (range :0–2), that was not significantly different from those concerning Group A and Group B (0,79±0,60, 1,22±0,74 respectively). Inverse correlation between MCV and number of exacerbations was statistically significant (r = − 0,43, p<0,01). That correlation was more apparent for Group A (r = −0,45, p<0,01) than Group B (r = −0,35, p<0,05). Mean value of hematocrit was determined at 45,92 ± 3,77 (range: 40–54). Correlation between MCV and Ht was not significant (r=0,2). CONCLUSIONS: An unexpected result revealed considering that elevated MCV in patients with mild to moderate COPD correlates with fewer exacerbations of the disease. A game of statistics or something more important for the pathophysiology of mild COPD?

BACKGROUND: Asthma is a common chronic condition. Work-related asthma (WRA) has a large socioeconomic impact and is increasing in prevalence but remains under-recognized. Although international guidelines recommend patient education, no widely available educational tool exists.OBJECTIVE: To develop a WRA educational website for adults with asthma.METHODS: An evidence-based database for website content was developed, which applied evidence-based website design principles to create a website prototype. This was subsequently tested and serially revised according to patient feedback in three moderated phases (one focus group and two interview phases), followed by face validation by asthma educators.RESULTS: Patients (n=10) were 20 to 28 years of age; seven (70%) were female, three (30%) were in university, two (20%) were in college and five (50%) were currently employed. Key format preferences included: well-spaced, bulleted text; movies (as opposed to animations); photos (as opposed to cartoons); an explicit listing of website aims on the home page; and an exploding tab structure. Participants disliked integrated games and knowledge quizzes. Desired informational content included a list of triggers, prevention/control methods, currently available tools and resources, a self-test for WRA, real-life scenario presentations, compensation information, information for colleagues on how to react during an asthma attack and a WRA discussion forum.CONCLUSIONS: The website met the perceived needs of young asthmatic patients. This resource could be disseminated widely and should be tested for its effects on patient behaviour, including job choice, workplace irritant/allergen avoidance and/or protective equipment, asthma medication use and physician prompting for management of WRA symptoms.

Background Serious gaming could support patients in learning to cope with chronic pain or functional somatic syndromes and reduce symptom burdens. Objective To realize this potential, insight is needed into how, why, for whom, and when it works in actual treatment circumstances. Methods Following a realist approach, process evaluations were performed before, during, and after a two-armed, natural quasi-experiment (n=275). A group of patients with interfering chronic pain or fatigue symptoms received a short additional blended mindfulness-based serious gaming intervention during a multidisciplinary rehabilitation program. A control group only received the regular rehabilitation program. During two sessions before and one session after the experiment, expectations about serious gaming processes were discussed in focus groups with local care providers, implementers, and experts. Patients participated in a survey (n=114) and in semistructured interviews (n=10). The qualitative data were used to develop tentative expectations about aspects of serious gaming that, in certain patients and circumstances, trigger mechanisms of learning and health outcome change. Hypotheses about indicative quantitative data patterns for tentative expectations were formulated before inspecting, describing, and analyzing—with regression models—routinely collected clinical outcome data. An updated program theory was formulated after mixing the qualitative and quantitative results. Results Qualitative data showed that a subset of patients perceived improvement of their self-awareness in moments of daily social interactions. These results were explained by patients, who played the serious game LAKA, as a “confrontation with yourself,” which reflected self-discrepancies. Important characteristics of serious gaming in the study’s context included innovation factors of relative advantage with experiential learning opportunity, compatibility with the treatment approach, and the limited flexibility in regard to patient preferences. Perceived patient factors included age and style of coping with stress or pain. Learning perceptions could also depend on care provider role-taking and the planning and facilitating (ie, local organization) of serious gaming introduction and feedback sessions in small groups of patients. Quantitative data showed very small average differences between the study groups in self-reported depression, pain, and fatigue changes (-.07<beta<-.17, all 95% CI upper bounds <0), which were mediated by small group differences in mindfulness (beta=.26, 95% CI .02-.51). Mindfulness changes were positively associated with patient involvement in serious gaming (n=114, beta=.36, P=.001). Acceptance of serious gaming was lower in older patients. Average health outcome changes went up to a medium size in patients that reported lower active coping with stress and lower pain coping before serious gaming. Mindfulness changes and gaming acceptance perceptions covaried with group structure and immediate feedback sessions after serious gaming. Conclusions This study developed transferable insight into how and why serious gaming can facilitate additional learning about coping in order to reduce burdens of chronic pain or fatigue symptoms in certain patients and in actual treatment circumstances. Future studies are needed to continue the development of this fallible theory. Such research will further support decisions about using, designing, allocating, and tailoring serious gaming to optimize important patient health benefits. Trial Registration Netherlands Trial Register NTR6020; https://www.trialregister.nl/trial/5754

Infection caused by extracellular single-celled trypanosomes triggers a lethal chronic wasting disease in livestock and game animals. Through screening of 10 Trypanosoma evansi field isolates, exhibiting different levels of virulence in mice, the current study identifies an experimental disease model in which infection can last well over 100 days, mimicking the major features of chronic animal trypanosomosis. In this model, despite the well-controlled parasitemia, infection is hallmarked by severe trypanosomosis-associated pathology. An in-depth scRNA-seq analysis of the latter revealed the complexity of the spleen macrophage activation status, highlighting the crucial role of tissue resident macrophages (TRMs) in regulating splenic extramedullary erythropoiesis. These new data show that in the field of experimental trypanosomosis, macrophage activation profiles have so far been oversimplified into a bi-polar paradigm (M1 vs M2). Interestingly, TRMs exert a double-sided effect on erythroid cells. On one hand, these cells express an erythrophagocytosis associated signature. On another hand, TRMs show high levels of Vcam1 expression, known to support their interaction with hematopoietic stem and progenitor cells (HSPCs). During chronic infection, the latter exhibit upregulated expression of Klf1, E2f8, and Gfi1b genes, involved in erythroid differentiation and extramedullary erythropoiesis. This process gives rise to differentiation of stem cells to BFU-e/CFU-e, Pro E, and Baso E subpopulations. However, infection truncates progressing differentiation at the orthochromatic erythrocytes level, as demonstrated by scRNAseq and flow cytometry. As such, these cells are unable to pass to the reticulocyte stage, resulting in reduced number of mature circulating RBCs and the occurrence of chronic anemia. The physiological consequence of these events is the prolonged poor delivery of oxygen to various tissues, triggering lactic acid acidosis and the catabolic breakdown of muscle tissue, reminiscent of the wasting syndrome that is characteristic for the lethal stage of animal trypanosomosis.

Abstract Background Wave surfing will debut in the next Olympic Games and is increasingly popular as a sport. Chronic shoulder complaints are frequently reported amongst surfers, though literature researching its pathophysiology and prevention is scarce. This article provides an overview of the current literature, proposes a potential pathogenesis and a potential physiotherapeutic prevention program for surf-induced shoulder complaints. Methods A systematic review was performed considering the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for articles regarding kinematic analysis of the surf paddling movement. Data sources were Embase, MEDLINE (PubMed) and Research gate. We included case series and cohort studies that originally studied or described the paddle movement made by wave surfers, studies that reported on kinesiologic analysis with nerve conduction studies and studies on 3D motion analysis of the shoulder while paddling. Results Eight original articles were included that analysed the shoulder movement in paddling surfers. Muscles that are active during paddling are mainly internal rotators and muscles that are involved in shoulder flexion. Internal rotators are active in propelling the surfer through the water, though external rotator strength is only used while the arm is out of the water. Discussion In surfers with shoulder complaints, external rotation range of motion and external rotation strength are impaired. Scapulothoracic dyskinesis may occur and subacromial pain syndrome may coincide. Further research should address potential pectoralis minor shortening, which may lead to aberrant scapular tilt and lateral rotation of the scapula. The surfer’s shoulder is characterised by external rotation deficit, as opposed to internal rotation deficit in the thrower’s shoulder, and it differs substantially from shoulder complaints in swimmers. Therefore, a specific prevention or rehabilitation protocol for surfers is required. Decreased thoracic extension may thereby alter the risk of scapular dyskinesis and hence increase the risk of impingement around the shoulder joint. A potential physiotherapeutic prevention programme should address all these aspects, with the main goal being to increase external rotator strength and to stretch the internal rotators. Conclusion There is a high incidence of chronic surf-induced shoulder complaints in surfers. Symptoms may arise due to imbalanced training or scapular dyskinesis, which may subsequently trigger subacromial pain. Physiotherapeutic prevention should include stretching of the internal rotators, external rotator training and optimisation of thoracic extension and scapulothoracic movement.

This article is Part 11 of the author’s linear elastic glucose behavior study. It focuses on a deeper investigation regarding the specific glucose coefficient of GH.p-modulus, which involves the influence of the neuro-communication between the stomach, brain, and liver pertaining to the postprandial plasma glucose (PPG) production amount (see Reference 6). When a person consumes a meal in a liquid state such as egg drop soup, the stomach would “trick” or “trigger” the brain to recognize the arrival of fluids, then it issues a marching order to the liver to produce a lesser amount of PPG. Due to the smaller value of carb intake and the mathematical definition of the incremental PPG, the value of GH.p-modulus must be raised to a higher value in order to achieve a high prediction accuracy for egg meals, especially for solid egg meals with the same small intake amount of carbs/sugar. This article provides the background data, observed physical phenomena, and mathematical derivations to interpret and prove these higher values of GH.p-modulus for egg meals. By using two different time periods, it also demonstrates the strong linkage between GH.p-modulus and the patient’s overall diabetes status, either it is improving (through a dropped GH.p-modulus) or worsening (through a raised GH.p-modulus). Here is the step-by-step explanation of the predicted PPG equation from the six clinical cases using linear elastic glucose theory as described in References 9 through 18: (1) Baseline PPG equals to 97% of FPG value, or 97% * (weight * GH.f-Modulus). (2) Baseline PPG plus increased amount of PPG due to food, i.e. plus (carbs/sugar intake amount * GH.p-Modulus). (3) Baseline PPG plus increased PPG due to food, and then subtracts reduction amount of PPG due to exercise, i.e. minus (post-meal walking k-steps * 5). (4) The Predicted PPG equals to Baseline PPG plus the food influences, and then subtracts the exercise influences. The linear elastic glucose equation is: Predicted PPG =(0.97 * GH.f-modulus * Weight) +(GH.p-modulus * Carbs&sugar) - (post-meal walking k-steps * 5) Where Incremental PPG =Predicted PPG - Baseline PPG + Exercise impact GH.f-modulus = FPG / Weight GH.p-modulus =ncremental PPG / Carbs intake This article uses the neuro-scientific experiment results of two physical states of egg meals to further investigate the two glucose coefficients, in particular the GH.p-modulus value and meaning. The GH.p-modulus is not only the direct result of lifestyle difference (diet and exercise) but also includes the status difference of the chronic diseases (baseline PPG via weight and FPG). It also reflects the general health state of pancreatic beta cells of a particular patient which can be described by the fasting plasma glucose (FPG) level. In addition, it further contains the neuroscience of communication model between the brain and stomach regarding the amount of glucose production or glucose release in response to a specific message of the timing of the food’s entry and the physical state of the stomach and intestine. This neurology viewpoint makes the GH.p-modulus even more complex. Nevertheless, the linear elastic glucose theory still applies to the special case of the neuro-scientific egg meals, even though it creates a much higher GH.p-modulus value that can be considered as one of the boundary cases in this linear elasticity study. With the neuro-scientific case study, it is clear that this linear elastic glucose behavior is much more complicated than the classical engineering elasticity theory because the engineering inorganic materials do not change for a long period of time. The human body is made from organic living cells. For example, blood contains millions of organic living red blood cells with an average lifespan of 115 to 120 days and liver cells that last about 300 to 500 days. In addition, the glucose production and release are controlled by the brain. The glucose level is further regulated by insulin (a type of hormone) produced by the pancreas which is also controlled by the brain. The communication between the brain and nervous system can throw a curve ball into the glucoses game making this research work not only more complicated but also more interesting.

Abstract Introduction/Background Intraarticular corticosteroid injection is an important therapeutic approach in paediatric rheumatology that results in targeted treatment of joint inflammation with minimal systemic side effects. In younger patients general anaesthetic is required but older children are generally able to tolerate the procedure well with Entonox. Entonox (a mixture of nitrous oxide and oxygen) provides mild analgesia and promotes relaxation. Nitrous oxide is a greenhouse gas, (nearly 300 times more potent than carbon dioxide) and enters the atmosphere after being exhaled by a patient. Therefore, a more environmentally responsible option is required and virtual reality is a potential option. Description/Method Virtual Reality (VR) is a computer-generated environment with scenes and objects that appear real, making the participant feel immersed in their surroundings. This environment is perceived through a device known as a Virtual Reality headset or helmet. This simulated experience can be similar to or completely different from the real world. Applications of virtual reality are expanding and no longer just include entertainment via video games. VR now has many medical applications. After practicing with a virtual reality system for six weeks, people with Parkinson's disease demonstrated improved obstacle negotiation and balance. Oxford VR’s social engagement program designed to help patients overcome anxious social avoidance is now available on the NHS. It applies cognitive behavioural therapy (CBT) techniques within an immersive virtual reality setting. Virtual reality headsets have been purchased by the play therapy team at Southampton Children’s Hospital. The paediatric rheumatology team was able to utilise one for a 10-year-old boy who required a left knee intraarticular corticosteroid injection. He had the procedure previously with Entonox and although tolerated it was anxious throughout resulting in trepidation at the prospect of a repeat procedure. Consent for a trial with virtual reality headset was obtained as well as consent to video the procedure. An accompanying iPad enabled the health professionals to be able to see the same images as the young person was experiencing enabling them to give relevant comments. The young person remained fully immersed in their virtual reality throughout the procedure and was not able to see what was occurring in ‘real life’. They tolerated the procedure perfectly with no movement of the leg and no verbal reaction. The only noticeable response observed from re-watching the video was the intake of a couple of deep breaths. Immediately after the young person provided verbal feedback: “That was amazing!” Discussion/Results Side effects of Entonox are short lasting and include nausea and light-headedness. Some young people cannot tolerate the sensation of feeling out of control with one diabetic patient likening it to experiencing a hypoglycaemic episode and requesting to discontinue. A study using functional magnetic resonance imaging of healthy patients using VR while exposed to a painful stimulus showed greater than 50% reduction in pain-related brain activity. Cochrane review in 2019 in VR distraction for acute pain in children was non confirmatory and concluded there is a need for larger studies in this area. It is postulated that interacting with immersive VR might divert attention, leading to a slower response to incoming pain signals. The minimum age limitation for VR gaming is seven but there is no clear consensus on the age recommendation of VR headsets. Reported side effects of VR include headaches, eye strain, dizziness and nausea. These are triggered by the vergence-accommodation conflict. If a child is susceptible to motion sickness they will likely experience virtual motion sickness. There was an increase in myopia with the rise of personal handheld devices. As VR screens are very close to the eyes this has raised concern. The American Academy of Ophthalmology state that staring at a VR screen (or any digital device) without breaks may cause eye fatigue due to blinking less often resulting in eye dryness. However, they also comment that although there are no long-term studies there is no reason to be concerned that VR headsets will damage eye development, health or function. As VR is in its infancy the long-term effects remain unknown. Regular breaks are recommended. As with other digital devices the “20-20-20” rule may be applied: every 20 minutes, adjusting gaze to look at an object at least 20 feet away, for at least 20 seconds. Key learning points/Conclusion Due to the environmental impact an alternative to Entonox is urgently required to support young people during invasive procedures. It is important that as many children as possible are able to avoid the risks associated with general anaesthetic. Virtual reality was very successful in enabling a young person to have a positive experience of a intraarticular corticosteroid injection having previously been anxious about this treatment. The encouraging feedback provided by this patient provides support for continued trial in other patients and also other procedures such as blood tests and subcutaneous medication administration in needle phobic patients. Although the long-term effects of VR on children are currently unknown the short time of exposure required for accompanying a clinical procedure is unlikely to have a long term impact. However, as always for any new therapeutic intervention, it will be important to continue to monitor the outcomming research with awareness that the VR exposure during medical interventions may not be the only VR experience and very likely not the only digital device the child is exposed to. The ongoing research into various medical applications including mental health suggests that virtual reality could also become a useful adjunct to paediatric chronic pain management in the future.

The focuses of this paper are narrative structures and mythological elements in the video game Chrono Trigger. A qualitative method was used to code the game world's seven eras into themes of symbolism, quest-themes, and, characters. These themes were compared with Northrop Frye's archetypal myth theory from Anatomy of Criticism. The results show that each age relates to a season and moves due to the player's influence according to a cyclical pattern. Six out of seven epochs show high correlation to Frye's archetypal model whereas options such as to discard the main hero illustrates the player's control. The seventh era pictures a more female symbolism than the male dominant template proposed by Frye. A hypothesis is presented with the concept of a fluent surface which argues that the player manipulates the basic story to build a personal narrative. Furthermore, the hypothesis emphasizes that the specific game mechanics stimulates the player's sensitivity to the narrative elements when constructing an individual ideal story.