Search Results (212)

Non-alcoholic fatty liver disease affects approximately thirty percent of the global population, yet public awareness remains dangerously low among young adults facing occupational risk factors. This study introduces the Fatty Liver Awareness Game (FLAG), an educational serious game designed to improve liver health literacy among software engineering students at the University of Guayaquil. While evaluated with this specific sample, FLAG is intended for the broader target population of young adults in developing nations who face occupational sedentary risk and limited access to preventive health education. Through a controlled experiment with fifty participants randomly assigned to game-based or traditional lecture instruction, the game demonstrated superior effectiveness, with a twenty-percentage-point advantage in post-test scores and a seventy-two percent reduction in incorrect responses compared to fifty percent in the lecture group. The large effect size (Cohen’s d = 1.43) and reduced performance variability among game participants indicate that interactive, feedback-rich learning environments can outperform passive instruction for this population and content domain. While the present design does not isolate the contribution of individual game elements—such as narrative framing, explanatory feedback, or mini-game interleaving—the results establish FLAG as a replicable model for digital health interventions targeting underserved populations at critical developmental junctures. Future component analyses are needed to determine which specific design features drive the observed advantages. Full article

This article offers a formal analysis of the paradoxes, dilemmas and strategic interactions explored in Liu Cixin’s trilogy The Three-Body Problem. Several games, such as the survival game, the deterrence game, the first contact game, and the big bang game, provide the foundations of cosmic sociology. Full article

The impact of oncological diseases extends far beyond the clinical patient, profoundly affecting the mental health of caregivers, family members, and volunteers who navigate complex emotional landscapes of grief, anxiety, and trauma. While the domain of digital health has seen a proliferation of serious games aimed at pediatric patient education and treatment adherence, the specific perspective of the “second-order patient”, the caregiver or survivor, remains significantly under-explored. The primary objective of this study is to systematically review the current state of interactive narratives in oncology, palliative care, and grief support, identifying research gaps to inform the broader design space of empathy-driven serious games. Following the PRISMA guidelines, 31 articles were selected from an initial query of 116 records. Interventions were categorized into Serious Games, Games, and Gamification. The analysis reveals a critical thematic transition: early interventions relied heavily on biological “battle” metaphors to empower patients, whereas the current literature advocates for “thanatosensitive” designs that foster empathy. However, a distinct research gap persists regarding narratives that explore post-loss meaning reconstruction and the hospital volunteer experience. Synthesizing these findings, this paper establishes an evidence-based theoretical framework demonstrating a significant opportunity for games that prioritize dialogue and emotional processing over traditional winning conditions. As a practical application of these findings, we also briefly outline the conceptualization of a prototype simulating a widower’s experience volunteering in a palliative ward, shifting the ludic focus from defeating a disease to navigating loss. Full article

Single-player role-playing games (RPGs) combine two promises that do not always align: delivering a compelling narrative experience (world, characters, choices, and consequences) while sustaining a demanding ludic trajectory in which players face obstacles, master systems, and progress over time. This Systematic Literature Review (SLR) synthesizes existing evidence on the evolution of narrative and challenge in single-player RPGs from a player-centered perspective, with particular attention paid to immersion, engagement, flow, and perceived agency. A multi-database search strategy was conducted across Google Scholar, Scopus, IEEE Xplore, and the ACM Digital Library using query strings targeting narrative/agency, challenge and dynamic difficulty adjustment (DDA), adaptive difficulty, and the historical evolution of RPG narrative design, following a Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)-reported selection flow and Rayyan-supported screening. From 423 identified records, duplicates and non-eligible records were removed through staged screening, yielding 43 reports sought for retrieval; because six were not accessible in full text at consolidation, the synthesis was conducted on 37 full-text articles. The findings indicate (i) a predominance of work on narrative and agency, where agency is framed as a design effect rather than merely the presence of explicit branching choices; (ii) a recent rise in challenge/adaptation research, frequently tied to flow, fairness, and differentiated player profiles; and (iii) the emergence of artificial intelligence (AI)-driven approaches, including non-player character (NPC) systems, combat AI, reinforcement learning, and large language model (LLM)-based narrative control, which amplify core design trade-offs between narrative coherence and perceived agency. Beyond synthesizing a dispersed body of literature, the review contributes an integrated player-centered analytical framework that brings together narrative, challenge, and player experience, while also highlighting the need for more consistent measurement practices, stronger comparative designs, and longer-term empirical work in single-player RPG research. Full article

Fallujah, by Jonathan Holmes (2007), is one of the archetypal examples of verbatim theatre, which addresses the truths of the Iraq War through dramatised eyewitness accounts and documentation reconstructions. Sketched in the Second Battle of Fallujah, the play reveals moral, political, and epistemological aspects of how modern warfare is presented. This article hinges on the postmodern theory of Jean-François Lyotard—especially the concepts of language games, paralogy, and the differend—to discuss the play Fallujah as a subversion of official grand narratives of the Iraq War. Through the use of testimonial intertextuality, irony and fragmentation, Holmes builds a multidimensional tableau of discourse contradictions in which truth is relative, and legitimacy is constantly deferred. The play turns into a meta-discursive critique of Western power dynamics, challenging the manner in which the knowledge is created, distributed, and twisted in the name of liberation and humanitarianism. Further, the article examines both dramaturgical and aesthetic techniques that lend truthfulness to Holmes’ concept of the verbatim approach as it dislocates the truth in relation to war and victimhood. The results help us comprehend the role of modern theatre in the reconstruction of the cultural memory and morality in the post-war era. The article concludes that Fallujah is a vivid example of postmodern theatrical resistance, an ethical and artistic response to commodity violence and the obliteration of lived suffering. Full article

Background: Global positioning system (GPS) technology is widely used to quantify external training load (ETL) in youth soccer. Despite its extensive application in training and match contexts, considerable heterogeneity is present in the selection, definition, and interpretation of GPS-derived variables, limiting comparability between studies and practical implementation by coaches. Objective: This narrative review aimed to summarize and critically evaluate the current literature on GPS-based ETL monitoring in youth soccer players, with a focus on commonly used variables, methodological considerations, and practical applications in training and match contexts. Methods: A narrative literature search was conducted using PubMed, SPORTDiscus, and Scopus databases. Peer-reviewed studies published in English between the years of 2012 and 2025 were included. Data were extracted on participant characteristics, GPS technology, monitored ETL variables, and contextual settings. Results: The 34 reviewed studies primarily reported total distance (TD; m), high-speed running distance (HSR; m), sprint distance (SD; m), distance per minute (m·min⁻¹), peak speed (km·h⁻¹), and acceleration- and deceleration-based (ACC, DEC; count) ETL variables. Substantial variability was observed in speed thresholds, acceleration definitions, and data processing methods. Positional roles, training formats (e.g., small-sided games), and seasonal phase influenced ETL demands, although methodological inconsistencies limited cross-study comparisons. Conclusion: GPS technology provides valuable insights into the ETL demands of youth soccer. The lack of standardized variable definitions and thresholds remains a major limitation. Greater methodological consistency and clearer reporting standards are required to enhance the practical usefulness of GPS monitoring for coaches in youth soccer. Full article

Background: Technology such as telerehabilitation, virtual reality, robotics, and wearable systems are reshaping pediatric physiotherapy. While evidence remains fragmented, there is little guidance on how these approaches can be integrated into coherent, family-centered care pathways. Objective: To develop the Digital Pediatric Physiotherapy Framework (DPPF) based on a systematic review of randomized evidence on digital interventions in pediatric physiotherapy. Methods: Several databases were searched for randomized trials published after 1 January 2020, including PubMed, Web of Science Core Collection, and Google Scholar. The included studies assessed the results of physiotherapist-delivered or physiotherapist-supervised digital interventions in children and adolescents aged 18 and younger. Population, intervention, outcome, implementation, and safety data were extracted. Considering the substantial heterogeneity of the findings, they were synthesized narratively. Cochrane RoB 2 was used to assess risk of bias, and GRADE was used to evaluate certainty of evidence. Results: Twenty-nine trials involving 1196 participants were included. Most studies examined virtual reality and gaming-based interventions, with fewer evaluating telerehabilitation/tele-exercise and robotic or wearable technologies. Digital interventions were most often directed at body-function and activity-level outcomes, while participation outcomes were less frequently studied. The strongest evidence supported short-term benefits in balance, gross motor function, upper-limb activity, pain, and selected fitness outcomes, particularly in children with cerebral palsy. Evidence for telerehabilitation and robotic or wearable approaches was more limited but generally promising. Implementation, equity, cost, and long-term outcomes were rarely reported. No eligible trial directly evaluated electronic patient-reported outcome measures, digital triage, or clinical decision support as stand-alone interventions. Conclusions: Digital interventions have the potential to strengthen pediatric physiotherapy, particularly for short-term motor and functional outcomes. The proposed DPPF provides an implementation-informed structure to guide future research, pathway design, and more purposeful integration of digital health into pediatric rehabilitation practice. Full article

This study employs a reflexive autoethnography, guided by flow and place attachment theory, to examine how gaming experiences influence attachments to virtual environments and inspire real-world travel intentions. Data comprise reflexive journal notes written over a 10-month period after playing multiple video games and analysed using reflexive thematic analysis following a hybrid deductive–inductive approach. The analysis identified eight themes across three dimensions: temporal immersion, escapism, narrative immersion, and self-expression under flow; emotional, cognitive, and behavioural attachment under place attachment; and place-induced travel intention as the behavioural outcome. The findings establish flow as a critical antecedent to the development of place attachment within virtual environments. Consistent with emerging scholarship, the study confirms that attachment formation does not require physically tangible places; rather, it can emerge through digitally mediated presence and interaction, indicating that virtual environments are capable of eliciting place attachment. More significantly, it demonstrates that these virtual attachments can fluidly extend toward real places depicted in games, revealing a cross-environmental continuity in attachment processes. The integrated framework thus contributes a novel theoretical proposal linking flow, virtual and real place attachment, and tourism behaviour, an area that remains conceptually fragmented and empirically underdeveloped. Full article

While recent game research explores culture and Orientalism, a significant gap remains regarding Sinologism. Gu proposed Sinologism based on Orientalism, laying the theoretical foundation for this study. Utilizing the analytical framework of Chapman and Šisler, this study examines the characteristics of Sinologism within and outside the game, including its scenes, characters, items, abilities, skills, and narrative style. The cultural practice of Black Myth: Wukong exemplifies the complex dynamics described by “Sinologism.” Operating within the globalized framework of the video game industry, it negotiates with Western perspectives while, to a certain extent, challenging established Orientalist modes of representation. However, this study argues that its success is not a result of “complicit” strategies that merely replicate dominant paradigms. Instead, it represents a reconstruction of “cultural subjectivity.” By combining high production values with familiar ARPG conventions, the game makes culturally dense elements more legible to international audiences, encouraging engagement with indigenous cultural logic rather than defaulting to externally imposed interpretive frames. Accordingly, Black Myth: Wukong stands as a paradigmatic case, illustrating how Chinese developers attempt to negotiate agency within an asymmetrical Sino-Western structure to seek autonomous expression amidst structural constraints. Full article

Newsgames integrate journalism and digital game design to communicate news through interactive storytelling. This study examines how narrative journalism can function as a design framework for newsgames by exploring how its storytelling techniques—such as characterisation, scene construction, and narrative structure—can inform the design of interactive journalistic experiences while maintaining factual integrity. Using a narrative literature review, the research synthesises scholarship from journalism studies, narrative theory, and game studies to analyse how narrative structures and gameplay systems shape the communication of news in digital games. The paper proposes a conceptual model that integrates narrative journalism and newsgames with Symbolic Interaction Theory (SIT) and the Values at Play (VAP) heuristic, providing a theoretical framework for interactive journalistic storytelling. Within this framework, gameplay operates as a narrative structure through which players engage with journalistic content by interacting with simulated environments, characters, and decision-making processes. The analysis indicates that the communicative capacity of newsgames depends on how journalistic information is embedded within gameplay mechanics and narrative systems, where interactivity, player agency, and ethical design shape how audiences interpret complex social and political issues. The study concludes that newsgames function as interactive narrative systems of journalism, in which gameplay serves as a storytelling mechanism that enables audiences to engage with news through participation and interpretation. By positioning narrative journalism as a design framework for interactive news experiences, this research contributes a theoretical foundation for analysing and developing narrative-driven newsgames. Full article

Background/Objectives: Simulation-based education often lacks personalization, focusing on technical competence rather than individual student profiles. This protocol describes a study designed to evaluate whether adapting gamified narratives to nursing students’ personality profiles has the potential to support academic performance in obstetrics. This study aims to validate the integration of psychometric profiling and AI as a sustainable strategy for personalized clinical training. Methods: A cluster-randomized controlled longitudinal pilot trial will be conducted at the University of Atlántico Medio. The protocol has been submitted for registration at ClinicalTrials.gov (Registration Pending). Thirty-eight second-year nursing students meeting inclusion criteria (excluding repeaters or those with prior specialized training) will be assigned by natural practice to either a control group (generic gamification) or an experimental group (gamification adapted according to Player Personality and Dynamics Scale profiles using AI-generated content). The intervention comprises four clinical simulation sessions focusing on pregnancy and childbirth, which are managed via the Wix platform. The primary outcome is academic performance, measured as “Learning Gain” (post-test scores minus pre-test scores). Secondary outcomes include student satisfaction measured via the Gameful Experience Scale. Data will be analyzed using Mann–Whitney U tests to compare overall efficacy and intragroup evolution. To minimize observer bias, knowledge assessments will utilize automated, objective scoring, and participants will be blinded to the study hypothesis. Expected Outcomes: The study aims to establish the technical and pedagogical feasibility of integrating AI-adapted narratives into nursing curricula. It is anticipated that the personalized approach will show positive trends in learning gains and engagement patterns, providing a baseline for larger multicenter trials. Conclusions: This protocol presents a framework for “Precision Education” in nursing, shifting from “one-size-fits-all” simulations to student-centered adaptive training. The use of Generative AI makes such personalization sustainable and cost-effective for health science faculties. Full article

In the context of immersive technologies deeply integrated into the cultural tourism industry, immersive cultural tourism has become an important means of heritage revitalization. Immersive experience is both a crucial consumer element and a key indicator for evaluating the attractiveness of cultural tourism landscapes. This study evaluates the post-use experience of the cultural tourism landscape of Xidajie Street in Baoding from the perspective of tourist immersion. Through a literature review, investigation of typical immersive districts, and expert interviews, we extract immersive cultural tourism landscape evaluation criteria based on a depth model of immersion, focusing on three dimensions: narrative, enclosure, and interaction. Subjective perception data from tourists is then collected through a survey, and IPA (Importance–Performance Analysis) is employed to identify the strengths and weaknesses of Xidajie’s cultural tourism landscape. The results show that Xidajie excels in spatial environment shaping and historical preservation, but has room for improvement in cultural narrative extension, contextual immersion, and interactive experiences. Therefore, strategies are proposed to enhance the cultural IP, establish a complete narrative structure, create authentic enveloping environments, and enrich interactive games to build a high-quality online and offline immersive cultural tourism landscape. This aims to promote the renewal of Xidajie and the dynamic transmission of Baoding’s local culture. Full article

Background: Video gaming is a highly prevalent leisure activity globally, with complex associations across multiple health domains. Methods: This narrative review critically appraised the existing literature identified through targeted searches of PubMed and Google Scholar to synthesise evidence on associations between video gaming and psychosocial stress, physical activity, sleep quality, eating behaviour, and diet quality. Theoretical, biological, and psychosocial mechanisms underlying these relationships were examined, and methodological limitations and research gaps were identified. Results: The relationships between video gaming and health outcomes appear bidirectional and context dependent. While video gaming may provide short-term stress relief and social connection, frequent or prolonged gaming may be associated with sedentary behaviour, physical inactivity, impaired sleep quality, disrupted eating patterns, and poorer diet quality. These associations may vary by age, sex, gaming duration, timing, content, and motivational drivers. Gaming-related cognitive absorption and physiological arousal may influence appetite regulation, sleep onset, and stress responses, while temporal displacement and environmental factors, such as food availability and marketing exposure, also contribute. Conclusions: An integrated biopsychosocial framework is proposed to describe the interconnected pathways through which video gaming may influence health, incorporating biological arousal, psychological immersion, and social and environmental contexts. Significant gaps remain, including the scarcity of longitudinal studies, limited consideration of moderating factors, and inconsistent measurement of gaming behaviours. Addressing these gaps is essential for refining public health surveillance and supporting the development of evidence-based strategies that promote healthy gaming behaviours while preserving potential psychosocial benefits. Full article

This work investigates whether open-weight large language models can automatically generate runnable and educationally faithful serious games in a constrained, text-only interactive-fiction (IF) setting. The target games are station-based single-player serious games for knowledge assessment, implemented as IF in a structured, machine-readable text format, and used here as a first step towards later ambient scenarios. A fully automated pipeline called SINE (Serious Interactive Narrative Engine) is evaluated with four prompting strategies, grammar-guided decoding, deterministic validation, and a repair agent. Across a staged evaluation with 240 seeds and increasing complexity, finalist configurations reach success rates between roughly 68% and 86% on the joint criterion of compilation, playability, and learning-goal fidelity. Repair iterations proved central to robustness, whereas grammar masking on top of reasoning prompts did not consistently improve outcomes. The study provides a reproducible benchmark setup, open artifacts, and a constrained generation pipeline as a basis for later extensions toward broader serious game scenarios. Full article

Stunting remains a major public health challenge in Indonesia, with a national prevalence of 21.6% in 2022. Rural regions such as Madura face heightened vulnerability due to cultural dietary taboos, gendered caregiving structures, intergenerational authority, and digital disparities that shape household nutrition decision-making. This formative qualitative study explores stakeholders’ perceptions to inform the conceptual development of gender-sensitive serious games for nutrition communication in rural Indonesia. Using an exploratory design, 42 informants, including mothers of children under five, brides-to-be, health cadres, midwives, religious and community leaders, and local digital actors, were recruited across rural Madura. Thematic analysis examined trust-based communication patterns, gender dynamics, perceptions of artificial intelligence (AI), and contextual conditions influencing digital health acceptance. Findings indicate that acceptance of gender-sensitive serious games depends on cultural alignment, institutional endorsement, perceived credibility, and usability in low-resource settings. Participants consistently positioned serious games and AI-supported features as complementary communication layers rather than replacements for health workers. Game-based tools were considered potentially relevant when designed to support intergenerational co-play, integrate local narratives and religious values, and function in low-connectivity environments. Rather than evaluating an implemented intervention, this study proposes a conceptual design framework grounded in feminist communication perspectives, serious games scholarship, and technology acceptance theory. The findings provide context-sensitive insights to guide future prototype development and pilot testing within hybrid, community-based nutrition communication systems. Full article