Expecting parents' perceptions of the digital parental support "childbirth journey" constructed as a serious game-an intervention study.

Objective: The aim of this study was to explore expecting parents' perceptions of the Childbirth Journey as an intervention that includes medical information for parental support, constructed as a serious game. Methods: In this qualitative study, semi-structured interviews were held with expecting parents in Sweden who were able to talk about specific parts of the Childbirth Journey they appreciated or found difficult to understand. A phenomenographic methodology was employed for data analysis. Results: Participants perceived the Childbirth Journey to be easily accessible and customized with reliable information. The design and features of the intervention were perceived by the expecting parents to enhance the intervention's usability, appeal, and trustworthiness. When parental couples used the Childbirth Journey together, it gave them an opportunity to discuss and better understand each other's situation. The participants proposed several changes to the existing version of the game, mostly related to extending practical information and illustrated scenarios but also to the further development of the game's design and animations. The participants found the Knowledge portal to be the most appealing part of the Childbirth Journey. Conclusions: The Childbirth Journey intervention was concluded to be a valuable digital complement to in-person professional support, especially given the current COVID-19 pandemic restrictions in place in Sweden, which do not allow antenatal visits by partners. However, in its current form, the Childbirth Journey has some deficiencies and would therefore benefit from further development and exploration.

Digital Tools as Parental Support-A Study Protocol Describing Prospective Development and Exploration of Two Digital Tools for Parents.

Background: The access to digital tools for parents is increasing, and further exploration is needed to gain knowledge about parents' experiences in using such tools, for example, when preparing for childbirth and parenthood. This study protocol describes a prospective study that will explore serious games as digital tools for parental support, and both parents' and healthcare professionals' views will be included. The objectives of the prospective study are to explore two different serious games: (1) Childbirth Journey (Swedish: Förlossningsresan), relating to pregnancy, childbirth and parenthood; and (2) Interplay (Swedish: Samspel), relating to parental couple relationships and parenthood. Methods: An intervention study will be conducted. The study will include four different sub-studies (A-D) with both qualitative and quantitative methods and a longitudinal design. Both parents (A, B and D) and healthcare professionals (C) will be included, and data will be collected through interviews (A-C) and repeated web-based questionnaires (D). Data will be analysed using phenomenography and qualitative content analysis (A-C), and descriptive and analytical analyses will be performed for comparisons and associations (D). Discussion: The value of monitoring and reporting on developments and trends in digital innovation for public health has been stipulated by the World Health Organization. The prospective study will contribute further knowledge about multidisciplinary development of digital tools as professional support for parents, as well as knowledge about parents' and healthcare professionals' experiences using digital tools concerning pregnancy, labour, parenthood and parental couple relationships. Trial Registration: This study was retrospectively registered (02/10/2020) within the ISRCTN with ID: ISRCTN18017741. http://www.isrctn.com/ISRCTN18017741.

Game-Calibrated and User-Tailored Remote Detection of Stress and Boredom in Games.

Emotion detection based on computer vision and remote extraction of user signals commonly rely on stimuli where users have a passive role with limited possibilities for interaction or emotional involvement, e.g., images and videos. Predictive models are also trained on a group level, which potentially excludes or dilutes key individualities of users. We present a non-obtrusive, multifactorial, user-tailored emotion detection method based on remotely estimated psychophysiological signals. A neural network learns the emotional profile of a user during the interaction with calibration games, a novel game-based emotion elicitation material designed to induce emotions while accounting for particularities of individuals. We evaluate our method in two experiments ( n = 20 and n = 62 ) with mean classification accuracy of 61.6%, which is statistically significantly better than chance-level classification. Our approach and its evaluation present unique circumstances: our model is trained on one dataset (calibration games) and tested on another (evaluation game), while preserving the natural behavior of subjects and using remote acquisition of signals. Results of this study suggest our method is feasible and an initiative to move away from questionnaires and physical sensors into a non-obtrusive, remote-based solution for detecting emotions in a context involving more naturalistic user behavior and games.

The impact of contextualization on immersion in healthcare simulation.

BACKGROUND: The aim of this paper is to explore how contextualization of a healthcare simulation scenarios impacts immersion, by using a novel objective instrument, the Immersion Score Rating Instrument. This instrument consists of 10 triggers that indicate reduced or enhanced immersion among participants in a simulation scenario. Triggers refer to events such as jumps in time or space (sign of reduced immersion) and natural interaction with the manikin (sign of enhanced immersion) and can be used to calculate an immersion score. METHODS: An experiment using a randomized controlled crossover design was conducted to compare immersion between two simulation training conditions for prehospital care: one basic and one contextualized. The Immersion Score Rating Instrument was used to compare the total immersion score for the whole scenario, the immersion score for individual mission phases, and to analyze differences in trigger occurrences. A paired t test was used to test for significance. RESULTS: The comparison shows that the overall immersion score for the simulation was higher in the contextualized condition. The average immersion score was 2.17 (sd = 1.67) in the contextualized condition and -0.77 (sd = 2.01) in the basic condition (p < .001). The immersion score was significantly higher in the contextualized condition in five out of six mission phases. Events that might be disruptive for the simulation participants' immersion, such as interventions of the instructor and illogical jumps in time or space, are present to a higher degree in the basic scenario condition; while events that signal enhanced immersion, such as natural interaction with the manikin, are more frequently observed in the contextualized condition. CONCLUSIONS: The results suggest that contextualization of simulation training with respect to increased equipment and environmental fidelity as well as functional task alignment might affect immersion positively and thus contribute to an improved training experience.

Measuring participants' immersion in healthcare simulation: the development of an instrument.

BACKGROUND: Immersion is important for simulation-based education; however, questionnaire-based instruments to measure immersion have some limitations. The aim of the present work is to develop a new instrument to measure immersion among participants in healthcare simulation scenarios. METHODS: The instrument was developed in four phases: trigger identification, content validity scores, inter-rater reliability analysis and comparison with an existing immersion measure instrument. A modified Delphi process was used to develop the instrument and to establish validity and reliability. The expert panel consisted of 10 researchers. All the researchers in the team had previous experience of simulation in the health and/or fire and rescue services as researchers and/or educators and simulation designers. To identify triggers, the panel members independently screened video recordings from simulation scenarios. Here, a trigger is an event in a simulation that is considered a sign of reduced or enhanced immersion among simulation participants. RESULTS: The result consists of the Immersion Score Rating Instrument (ISRI). It contains 10 triggers, of which seven indicate reduced and three enhanced immersion. When using ISRI, a rater identifies trigger occurrences and assigns them strength between 1 and 3. The content validity analysis shows that all the 10 triggers meet an acceptable content validity index for items (I-CVI) standard. The inter-rater reliability (IRR) among raters was assessed using a two-way mixed, consistency, average-measures intra-class correlation (ICC). The ICC for the difference between weighted positive and negative triggers was 0.92, which indicates that the raters are in agreement. Comparison with results from an immersion questionnaire mirrors the ISRI results. CONCLUSIONS: In conclusion, we present a novel and non-intrusive instrument for identifying and rating the level of immersion among participants in healthcare simulation scenarios.

Computer game-based upper extremity training in the home environment in stroke persons: a single subject design.

BACKGROUND: The objective of the present study was to assess whether computer game-based training in the home setting in the late phase after stroke could improve upper extremity motor function. METHODS: Twelve subjects with prior stroke were recruited; 11 completed the study. DESIGN: The study had a single subject design; there was a baseline test (A1), a during intervention test (B) once a week, a post-test (A2) measured directly after the treatment phase, plus a follow-up (C) 16-18 weeks after the treatment phase. Information on motor function (Fugl-Meyer), grip force (GrippitR) and arm function in activity (ARAT, ABILHAND) was gathered at A1, A2 and C. During B, only Fugl-Meyer and ARAT were measured. The intervention comprised five weeks of game-based computer training in the home environment. All games were designed to be controlled by either the affected arm alone or by both arms. Conventional formulae were used to calculate the mean, median and standard deviations. Wilcoxon's signed rank test was used for tests of dependent samples. Continuous data were analyzed by methods for repeated measures and ordinal data were analyzed by methods for ordered multinomial data using cumulative logistic models. A p-value of < 0.05 was considered statistically significant. RESULTS: Six females and five males, participated in the study with an average age of 58 years (range 26-66). FMA-UE A-D (motor function), ARAT, the maximal grip force and the mean grip force on the affected side show significant improvements at post-test and follow-up compared to baseline. No significant correlation was found between the amount of game time and changes in the outcomes investigated in this study. CONCLUSION: The results indicate that computer game-based training could be a promising approach to improve upper extremity function in the late phase after stroke, since in this study, changes were achieved in motor function and activity capacity.

Towards a FRET-based immunosensor for continuous carbohydrate monitoring.

In this report we have evaluated the potential of using fluorescence/Förster resonance energy transfer (FRET) in a competitive immunosensor for continuous monitoring of the carbohydrate hapten maltose. The cyanine dyes Cy5 and Cy5.5 were used as a donor-acceptor pair by conjugation to maltose-labeled bovine serum albumin (BSA) and the monoclonal antibody IgG 39.5, giving Cy5-BSA-maltotriitol (3.1/1/18) and Cy5.5-mAb39.5 (2.2/1), respectively. This antibody with weak affinity towards maltose showed full reversibility to both the free maltose and the maltose-labeled conjugate. It allowed us to measure continuously the maltose content by monitoring the FRET signal change over time due to displacement of Cy5-BSA-maltotriitol from Cy5.5-mAb39.5 inside a semipermeable capsule. A near 22% total increase was seen in the fluorescence intensity ratio I(670)/I(700) in the presence of maltose, with a calculated EC(50)=1.87+/-0.13 mM (R(2)=0.9984) from the sigmoidal dose-response curve at 25 degrees C. Specificity of the immunosensor was shown with the structural analog to maltose, cellobiose, and it generated no detectable response. A minor drift in the sensor baseline was seen with 0.4% per 24 h, which was in the same magnitude as the signal-to-noise ratio, during the 4 weeks of measurements. The immunosensor was applied to crude samples of oat drinks for direct quantification of the maltose content. Overall, this work demonstrates the potential to use an immunosensor based on weakly binding antibodies and FRET technology for remote and non-invasive carbohydrate monitoring.

Evaluation of a glucose sensing antibody using weak affinity chromatography.

Continuous monitoring of drug levels and endogenous molecules in biological fluids is a developing research area with many applications. One example is the need to improve life for millions of diabetes mellitus patients by continuously monitoring the glucose level. In order to have a dynamic response, the recognition molecule in a continuous sensor should preferentially have a fast dissociation rate and a dissociation constant in the millimolar range. We have evaluated the monoclonal antibody (mAb) 3F1E8-A2 for its potential to be used in a future glucose sensor application. The mAb was generated from hybridomas by immunizing mice with 10 kDa dextran (an alpha1,6-glucose polymer) with the aim of obtaining mAbs that can recognize the glucose monomer. The mAb was immobilized to macroporous silica and the interaction with dextran-derived oligosaccharides was evaluated with weak affinity chromatography (WAC). To measure the low affinities between the mAb 3F1E8-A2 and different monosaccharides, a competitive weak affinity chromatography approach was employed. It was found that the mAb had a higher specificity for glucose compared with other monosaccharides and the dissociation constant (K(d)) towards glucose was determined as 18.8 +/- 2.6 mm.

A label-free continuous total-internal-reflection-fluorescence-based immunosensor.

In this study, we continuously monitored, second-by-second, concentration changes of two different carbohydrates (maltose and panose) by using monoclonal antibodies in an optical immunosensor based on total internal reflection fluorescence. Earlier studies have demonstrated that these antibodies increase their intrinsic tryptophan fluorescence upon binding of carbohydrate antigens. Using the four immobilized monoclonal antibodies with low affinities (K(d)>10(-6)M), fast kinetics (k(off)>1s(-1)), and high reversibility gave opportunities for developing a continuous immunosensor without any need for regeneration. Since intrinsic fluorescence was used, no extrinsic labeling was necessary. Sensitivity was in the range of 1-5 microM for panose, and 10-15 microM for maltose and the loss of intensity was as low as 3.5% per hour during measurements. Calculations of DeltaH degrees and DeltaS degrees from the temperature dependence of K(d) indicated an enthalpic driven antigen-antibody binding event that is diminished upon antibody immobilization. We feel certain that weakly interacting antibodies can be used in future applications for continuous monitoring where there is a need to achieve instantaneous information on the concentration of an analyte.

Analysis of the specificity and thermodynamics of the interaction between low affinity antibodies and carbohydrate antigens using fluorescence spectroscopy.

The purpose of this work has been to examine whether fluorescence spectroscopy can be used to investigate weak or transient binding between monoclonal antibodies and carbohydrate antigens. In earlier studies we have demonstrated that the three monoclonal antibodies 39.4 (IgG2b), 39.5 (IgG2b) and 61.1(IgG3) bind weakly to the glycosidic alpha(1-4) bond present in e.g. maltose and panose. In this study these antibodies showed an enhancement in the fluorescence intensity of tryptophan upon binding in solution to these two carbohydrate antigens. Using a structural analog to maltose, cellobiose, no fluorescence intensity change was induced. Dissociation constants for these antibodies at different temperatures (5-40 degrees C) were obtained in the range of 0.003-0.2 mM and they were in accordance with earlier data from studies on affinity chromatography and surface plasmon resonance. Almost a doubling of the dissociation constants was observed for every 10 degrees C increase in temperature, giving an exothermal reaction with standard enthalpy change of -51 kJ/mol, for the association between antibody and carbohydrate antigen. It was seen that the extra glycosyl ring in panose increased the affinity more than eight times for the monoclonal antibody 39.5. A standard entropy increase of 21%, probably due to hydrophobic effects, is introduced by the extra glycosyl ring, while the enthalpy stays unaffected. This direct fluorescence approach to measure the binding and thermodynamics of an interacting antigen-antibody pair is simple and accurate since measurements are performed in solution and no immobilization or fluorophore labeling of the components is required. Introduction of fluorescence techniques will be a useful complement to current procedures to measure interaction of antibody with antigen and in particular they will offer solutions to detect transiently binding antigens.