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E-polis is a serious digital game designed to gamify sociological surveys studying young people’s political opinions. In this platform game, players navigate a digital world, encountering quests posing sociological questions. Players’ answers shape the city-game world, altering building structures based on their choices. E-polis is a serious game, not a government simulation, aiming to understand players’ behaviors and opinions; thus, we do not train the players but rather understand them and help them visualize their choices in shaping a city’s future. Also, it is noticed that no correct or incorrect answers apply. Moreover, our game utilizes a novel middleware architecture for development, diverging from typical asset-prefab-scene and script segregation. This article presents the data layer of our game’s middleware, specifically focusing on data analysis based on respondents’ gameplay answers. E-polis represents an innovative approach to gamifying sociological research, providing a unique platform for gathering and analyzing data on political opinions among youth and contributing to the broader field of serious games.

Recently there has been a growing interest in employing serious games (SGs) for the assessment and rehabilitation of elderly people with mild cognitive impairment (MCI), Alzheimer's disease (AD), and related disorders. In the present study we examined the acceptability of 'Kitchen and cooking' - a SG developed in the context of the EU project VERVE (http://www.verveconsortium.eu/) - in these populations. In this game a cooking plot is employed to assess and stimulate executive functions (such as planning abilities) and praxis. The game is installed on a tablet, to be flexibly employed at home and in nursing homes. Twenty one elderly participants (9 MCI and 12 AD, including 14 outpatients and 7 patients living in nursing homes, as well as 11 apathetic and 10 non-apathetic) took part in a 1-month trail, including a clinical and neuropsychological assessment, and 4-week training where the participants were free to play as long as they wanted on a personal tablet. During the training, participants met once a week with a clinician in order to fill in self-report questionnaires assessing their overall game experience (including acceptability, motivation, and perceived emotions). The results of the self reports and of the data concerning game performance (e.g., time spent playing, number of errors, etc) confirm the overall acceptability of Kitchen and cooking for both patients with MCI and patients with AD and related disorders, and the utility to employ it for training purposes. Interestingly, the results confirm that the game is adapted also to apathetic patients.

Educational serious games are primarily intended to teach about or train on a subject. However, a serious game must also be catchy for the player to want to play it multiple times and thus learn while playing. The design of educational serious games includes game experts and pedagogical experts that must be able to efficiently communicate to produce a product that is both educationally efficient and fun to play. Although there are some design frameworks to help with this communication, they are usually more conceptual and do not distinguish the fun factor from the learning contents well, making communication difficult. In this paper, a new practical methodology is presented to support the design process of this kind of digital games. This methodology is more all-encompassing because it identifies all the main steps that are needed to define the learning mechanisms in an educational serious game, from topic choice to user experience. It also separates the game’s learning contents from other mechanics used to keep the game fun to play. Finally, some practical examples are shown, illustrating the use of this methodology.

Internet of Things technologies are spurring new types of instructional games, namely reality-enhanced serious games (RESGs), that support training directly in the field. This paper investigates a key feature of RESGs, i.e., user performance evaluation using real data, and studies an application of RESGs for promoting fuel-efficient driving, using fuel consumption as an indicator of driver performance. In particular, we propose a reference model for supporting a novel smart sensing dataflow involving the combination of two modules, based on machine learning, to be employed in RESGs in parallel and in real-time. The first module concerns quantitative performance assessment, while the second one targets verbal recommendation. For the assessment module, we compared the performance of three well-established machine learning algorithms: support vector regression, random forest and artificial neural networks. The experiments show that random forest achieves a slightly better performance assessment correlation than the others but requires a higher inference time. The instant recommendation module, implemented using fuzzy logic, triggers advice when inefficient driving patterns are detected. The dataflow has been tested with data from the enviroCar public dataset, exploiting on board diagnostic II (OBD II) standard vehicular interface information. The data covers various driving environments and vehicle models, which makes the system robust for real-world conditions. The results show the feasibility and effectiveness of the proposed approach, attaining a high estimation correlation (R2 = 0.99, with random forest) and punctual verbal feedback to the driver. An important word of caution concerns users’ privacy, as the modules rely on sensitive personal data, and provide information that by no means should be misused.

A significant gap exists in the knowledge and procedural skills of medical graduates when it comes to managing emergencies. In response, highly immersive virtual reality (VR)-based learning environments have been developed to train clinical competencies. However, robust evidence on how VR-based methods affect both short- and long-term learning outcomes, as well as physiological and perceived stress, remains limited. This study aimed to assess the effectiveness of VR-based simulation training, augmented with automated feedback, compared with video seminars at improving emergency medical competency among medical students. Furthermore, the study investigated the relationship between learning outcomes and physiological stress markers. The evaluation of participants' perceived stress and estimated learning success was also performed to provide a more comprehensive insight into VR's potential role in emergency training. In total, 72 senior medical students underwent VR-based emergency training (intervention) or viewed video seminars (control) on 2 topics (acute myocardial infarction and exacerbated chronic obstructive pulmonary disease) in an intraindividual crossover design. Levels of applied knowledge were assessed objectively by open-response tests pre- and postintervention and after 30 days. In addition, 2 electrodermal activity markers representing physiological stress response were measured during VR sessions using a wearable sensor. Participants also rated their estimated learning success and perceived stress. They also completed self-ratings of perceived stress and estimated learning success. Short-term knowledge gains were comparable between the VR (mean 26.6%, SD 15.3%) and control (mean 27.2%, SD 16%) condition. However, VR training produced significantly higher long-term knowledge gains (VR: mean 17.8%, SD 15.1% vs control: mean 11.9%, SD 18%; difference: -5.9, 95% CI -11.5 to -0.4). Overall retention scores were likewise higher for VR (mean 75.4%, SD 12.5%) than for video-based learning (mean 69.0%, SD 14.5%), a difference that was more pronounced in the myocardial infarction scenario. Participants rated the VR format as significantly more effective (mean 4.83, SD 0.41, on a 5-point scale) than the video seminar (mean 3.44, SD 1.00). While physiological stress markers increased during VR sessions, their correlation with knowledge gains was weak and negative. No significant relationship was detectable between perceived stress and objective learning outcomes. VR-based simulation training with automated feedback may offer long-term learning advantages over a traditional video seminar in emergency-medicine education. Given the time constraints and resource limitations of clinical education, self-moderated VR-based learning may represent a valuable addition to conventional training methods. Future research could investigate the learning effects of VR scenarios regarding the retention of practical skills, as well as the impact of repeated or team-based scenarios.

EmergenCSim is a novel researcher-developed serious game (SG) with an embedded scoring and feedback tool that reproduces an obstetric operating room environment. The learner must perform general anesthesia for emergent cesarean delivery for umbilical cord prolapse. The game was developed as an alternative teaching tool because of diminishing real-world exposure of anesthesiology trainees to this clinical scenario. Traditional debriefing (facilitator-guided reflection) is considered to be integral to experiential learning but requires the participation of an instructor. The optimal debriefing methods for SGs have not been well studied. Electronic feedback is commonly provided at the conclusion of SGs, so we aimed to compare the effectiveness of learning when an in-person debrief is added to electronic feedback compared with using electronic feedback alone. We hypothesized that an in-person debriefing in addition to the SG-embedded electronic feedback will provide superior learning than electronic feedback alone. Novice first-year anesthesiology residents (CA-1; n=51) (1) watched a recorded lecture on general anesthesia for emergent cesarean delivery, (2) took a 26-item multiple-choice question pretest, and (3) played EmergenCSim (maximum score of 196.5). They were randomized to either the control group that experienced the electronic feedback alone (group EF, n=26) or the intervention group that experienced the SG-embedded electronic feedback and an in-person debriefing (group IPD+EF, n=25). All participants played the SG a second time, with instructions to try to increase their score, and then they took a 26-item multiple-choice question posttest. Pre- and posttests (maximum score of 26 points each) were validated parallel forms. For groups EF and IPD+EF, respectively, mean pretest scores were 18.6 (SD 2.5) and 19.4 (SD 2.3), and mean posttest scores were 22.6 (SD 2.2) and 22.1 (SD 1.6; F1,49=1.8, P=.19). SG scores for groups EF and IPD+EF, respectively, were-mean first play SG scores of 135 (SE 4.4) and 141 (SE 4.5), and mean second play SG scores of 163.1 (SE 2.9) and 173.3 (SE 2.9; F1,49=137.7, P<.001). Adding an in-person debriefing experience led to greater improvement in SG scores, emphasizing the learning benefits of this practice. Improved SG performance in both groups suggests that SGs have a role as independent, less resource-intensive educational tools.

Positive self-esteem predicts happiness and well-being and serves as a protective factor for favorable mental health. Scholarly gaming within the school setting may serve as a channel to deliver a mental health curriculum designed to improve self-esteem. This study aims to evaluate the impact of a scholarly gaming curriculum with and without an embedded preventive mental health curriculum, Mental Health Moments (MHM), on adolescents' self-esteem. The scholarly gaming curriculum and MHM were developed by 3 educators and a school-based health intervention expert. The scholarly gaming curriculum aligned with academic guidelines from the International Society for Technology Education, teaching technology-based career skills and video game business development. The curriculum consisted of 40 lessons, delivered over 14 weeks for a minimum of 120 minutes per week. A total of 83 schools with previous gaming engagement were invited to participate and 34 agreed. Schools were allocated to +MHM or -MHM arms through a matched pairs experimental design. The -MHM group received the scholarly gaming curriculum alone, whereas the +MHM group received the scholarly gaming curriculum plus MHM embedded into 27 lessons. MHM integrated concepts from the PERMA framework in positive psychology as well as the Collaborative for Academic, Social, and Emotional Learning (CASEL) standards in education, which emphasize self-awareness, self-management, social awareness, relationship skills, and responsible decision-making. Participants in the study were students at schools offering scholarly gaming curricula and were enrolled at recruitment sites. Participants completed a baseline and postintervention survey quantifying self-esteem with the Rosenberg Self-Esteem Scale (score range 0-30). A score <15 characterizes low self-esteem. Participants who completed both baseline and postintervention surveys were included in the analysis. Of the 471 participants included in the analysis, 235 received the -MHM intervention, and 236 received the +MHM intervention. Around 74.9% (n=353) of participants were in high school, and most (n=429, 91.1%) reported this was their first year participating in scholarly gaming. Most participants were male (n=387, 82.2%). Only 58% (n=273) reported their race as White. The average self-esteem score at baseline was 17.9 (SD 5.1). Low self-esteem was reported in 22.1% (n=104) of participants. About 57.7% (n=60) of participants with low self-esteem at baseline rated themselves within the average level of self-esteem post intervention. When looking at the two groups, self-esteem scores improved by 8.3% among the +MHM group compared to no change among the -MHM group (P=.002). Subgroup analyses revealed that improvements in self-esteem attributed to the +MHM intervention differed by race, gender, and sexual orientation. Adolescents enrolled in a scholarly gaming curriculum with +MHM had improved self-esteem, shifting some participants from abnormally low self-esteem scores into normal ranges. Adolescent advocates, including health care providers, need to be aware of nontraditional educational instruction to improve students' well-being.

Slowness in voluntary movements is a hallmark of Parkinson disease (PD); yet, objective measurement outside clinical settings is limited. Serious games represent a promising alternative to extract motor performance metrics during interactions. However, evidence on the effectiveness of these games in discriminating motor performance between individuals with and those without PD is still scarce. This study aimed to objectively assess slowness using the RehaBEElitation serious game, based on in-game estimated measurements. The study included 15 individuals with mild to moderate PD (Hoehn and Yahr I-III), assessed in both ON and OFF medication states, and 15 age- and gender-matched healthy controls (10 men and 5 women; mean 66.27, SD 9.13 years; range 45-82 years). All participants played each phase of the game on the easiest level. Slowness was evaluated by detecting the voluntary movement of the gyroscope signals using the singular spectrum analysis method. The response time (RT) and angular velocity (AV) of the participants while playing RehaBEElitation were estimated. Group-level comparisons were performed to investigate the presence of slowness patterns across conditions. The Kruskal-Wallis test and Wilcoxon signed rank test with Bonferroni correction were used to confirm the differences between groups, and the effect size was estimated using eta square (η2). Spearman correlation analyses were conducted to examine associations between the RT and AV and the Movement Disorder Society-Unified Parkinson's Disease Rating Scale (MDS-UPDRS) motor items. Groups were age-homogeneous (P>.05). Participants with PD had significantly higher scores on MDS-UPDRS Part III in the OFF state compared to the ON state of medication (mean difference 2.86, 95% CI 2-12; P<.05). RT was generally shorter and AV higher in controls than in participants with PD. In the PD group, RT decreased and AV increased from OFF to ON states, reflecting an improvement in motor performance. Significant differences in RT were observed between groups in all phases of the game, with effect sizes ranging from small to moderate (η2=0.0239-0.0650). AV differed markedly between groups in phase 4, with a large effect size (η2=0.404). Correlation analyses revealed weak positive associations between RT and MDS-UPDRS items, while AV showed strong negative correlations with each motor item and the summary score for bradykinesia. This study proposes a new method to assess slowness in PD by using inertial sensor data to extract objective motor measures (RT and AV) during a serious game, allowing continuous and quantitative evaluation beyond traditional clinical scales and tests. The findings demonstrate that RT and AV extracted from gameplay can detect slowness-related motor differences, supporting the RehaBEElitation serious game as an alternative and objective digital biomarker, with potential applications in both clinical and home-based monitoring of symptom progression.

The creation of digital educational games often lacks strong user-centered design despite available frameworks, which tend to focus on technical and instructional aspects. This paper presents the Empathic Design Thinking Framework (EDTF), a structured methodology tailored to digital educational game creation. Rooted in human–computer interaction (HCI) principles, the EDTF integrates continuous co-design and iterative user research from ideation to deployment, involving both learners and instructors throughout all phases; it positions empathic design (ED) principles as an important component of HCI, focusing not only on identifying user needs but also on understanding users’ lived experiences, motivations, and frustrations. Developed through design science research, the EDTF offers step-by-step guidance, comprised of 10 steps, that reduces uncertainty for novice and experienced designers, developers, and HCI experts alike. The framework was validated in two robust phases. First, it was evaluated by 60 instructional game experts, including designers, developers, and HCI professionals, using an adapted questionnaire covering dimensions like clarity, problem-solving, consistency, and innovation, as well as standardized scales such as UMUX-Lite for perceived ease of use and usefulness and SUS for perceived usability. This was followed by in-depth interviews with 18 experts to understand the feasibility and conceptualization of EDTF applicability. The strong validation results highlight the framework’s potential to guide the design and development of educational games that take into account HCI principles and are usable, efficient, and impactful.

Serious games for learning have received increased attention in recent years. However, empirical studies on students’ gaming experiences throughout the developmental process of serious games and discussions regarding game design are missing. The aims of the present study were to analyze students’ gaming experiences while playing four consecutive versions of the Number Navigation Game (NNG)—a mathematical game-based learning environment focusing on flexibility and adaptivity with whole-number arithmetic; and to provide an extensive review of the NNG developmental and design process over 3 years with focus on how and why the design decisions were made, and how those choices affected students’ gaming experiences. The study employed a mixed-methods design of quantitative and qualitative research. The Game Experience Questionnaire about eight core game experience dimensions was answered by different groups of students at primary schools in Finland in three different experiments after students played four versions of the NNG from 2014 to 2016. Six semi structured interviews related to students’ game experiences, preferences and game features of the latest version of NNG were conducted. Overall, results indicate that improvement in game’s usability and clarity in the user interface has positive impacts on students’ game experiences. Furthermore, there seems to be a clear advantage in having better aesthetics and value in improving extrinsic elements that could contribute to maintain players’ enthusiasm and situational interest in serious games.