Unlabelled: This letter presents the conceptualization, design, and technical evaluation of the RedMan-GreenMan game co-designed with carers, aimed to help children with autism spectrum disorder (hereafter autism) acquire pedestrian safety skills. While the system has been implemented and is in active use, no empirical evaluation of learning outcomes or behavioral impact has been conducted to date, and the focus of this work is on system development, functionality, and technical evaluation.
Background: Augmented reality head-mounted displays could overcome the spatial dissociation between medical imaging and the surgical field, which may be particularly important in anatomically dense regions, such as the head and neck. Although many head-mounted displays offer markerless inside-out tracking at a fraction of the cost of navigation systems, their overlay accuracy with superimposition (SI) modality onto the surgical field remains limited. The virtual twin (VT), displaying holography adjacent to the surgical field, may offer a viable alternative. However, its performance is still unclear.
Objective: This study aimed to compare the accuracy and efficiency of the two visualization modalities, SI and VT, for anatomical localization in the head and neck region.
Methods: In a randomized crossover trial to compare two augmented reality visualization modalities (SI and VT), 38 participants used a HoloLens 2 to localize point, line-based, and volume-based anatomical structures on head phantoms. Their performance was evaluated with respect to accuracy, workload, time, and user experience.
Results: SI achieved significantly better point localization accuracy than VT both in absolute (mean 14.4, SD 4.2 mm vs mean 15.8, SD 5.5 mm; P=.003) and relative accuracy (mean 3.4, SD 2.2 mm vs mean 6.0, SD 5.0 mm; P<.001). In line-based structures, accuracy was comparable between SI (average surface distance [ASD], mean 23.4, SD 4.1 mm; Hausdorff distance [HD], mean 31.5, SD 7.8 mm) and VT (ASD=mean 23.0, SD 4.5 mm; P=.51; HD=mean 31.0, SD 7.5 mm; P=.57). However, SI showed significantly higher deviation than VT in volume-based structure (ASD=mean 37.1, SD 13.8 mm vs mean 34.1, SD 14.2 mm; P=.01; HD=mean 52.0, SD 16.8 mm vs mean 49.1, SD 15.8 mm; P=.03). Participants were faster with SI (P=.02), while workload NASA-TLX (National Aeronautics and Space Administration Task Load Index) scores did not demonstrate a significant difference (P=.79).
Conclusions: Given that SI did not clearly outperform VT under overlaid soft tissue and viewing challenges, VT remains a viable alternative in certain surgical scenarios where high accuracy is not required. Future research should focus on optimizing viewing angle guidance and the linkage between the anatomical target and the skin surface.
Background: Unrelenting pressure and an "always-on" culture can leave no time for genuine rest among young adults. While playing video games has been noted to afford cognitive escapism and relaxation, critical questions remain about the influence of popular video games, such as Super Mario Bros., and their potential effects on young adults' burnout risk.
Objective: This study examined the extent to which, if at all, popular video games such as Super Mario Bros. and Yoshi could foster childlike wonder. It also investigated the potential of these games to reduce burnout risk among young adults.
Methods: We used a mixed methods approach. First, qualitative data were collected through 41 exploratory, in-depth interviews (women: n=19, 46.3%; men: n=21, 51.2%; prefer not to disclose sex: n=1, 2.4%; mean age 22.51, SD 1.52 years) with university students who had experience playing Super Mario Bros. or Yoshi. Second, quantitative data were collected in a cross-sectional survey (N=336) of players of Super Mario Bros. and Yoshi to examine the games' affordance of childlike wonder, overall happiness in life, and burnout risk.
Results: Insights from in-depth interviews showed that players appreciated the ability of Super Mario Bros. and Yoshi games to instill childlike wonder, enhance happiness in life, and reduce burnout risk. Quantitative analyses showed that the games' affordance of childlike wonder positively affected young adults' happiness (b=0.30, SE=0.04, t=6.80, 95% CI 0.21-0.38; P<.001). In turn, overall happiness significantly reduced the risk of burnout (b=-0.48, SE=0.05, t=-9.55, 95% CI -0.572 to -0.377). Results showed that happiness fully mediated the impact of childlike wonder on burnout, as the direct effect of childlike wonder on burnout risk became insignificant (b=-0.08, SE=0.04, t=-1.88, 95% CI -0.16 to 0.01; P=.06), while the indirect effect of childlike wonder on burnout risk was significant (b=-0.14, bootstrapped SE=0.03, 95% CI -0.20 to -0.09).
Conclusions: The findings showed the significant positive effect of popular video games such as Super Mario Bros. and Yoshi on fostering players' childlike wonder, increasing happiness, and reducing burnout risk. This study was among the first to identify childlike wonder as an emotional pathway through which mainstream video games could enhance well-being and reduce burnout. By moving beyond escapism and nostalgia, it offers a new perspective on how well-designed, globally familiar games can function as accessible, resilience-building digital microenvironments. These findings contributed to research bridging gaming and mental health and have practical implications for game designers, educators, and health professionals interested in promoting mental wellness through everyday play.
Background: Amblyopia, a leading cause of preventable childhood blindness, often remains inadequately addressed by traditional treatment methods such as refractive correction and occlusion therapy, which can be noninteractive and lead to poor adherence.
Objective: This study aimed to design and evaluate the feasibility and preliminary efficacy of a serious game intervention that integrates perceptual learning and stereoscopic vision training for pediatric amblyopia and to explore its potential as a complementary or alternative approach to conventional treatments such as occlusion or atropine therapy.
Methods: We evaluated visual acuity, accommodative sensitivity, binocular accommodation, stereopsis, and compliance-related data in a cohort of children with amblyopia aged 7 to 12 years before and after a 3-month intervention. Participants engaged in visual training via a serious game, attending sessions 4 times weekly for 30 minutes each.
Results: Best-corrected visual acuity improved significantly from 0.42 (SD 0.16) to 0.37 (SD 0.18) logMAR, yielding a mean difference of 0.05 (95% CI 0.03-0.08; t24=4.82; Cohen d=0.96; P<.001). Accommodative sensitivity showed marked enhancement following the intervention. In the amblyopic eye, mean values increased from 1.44 (SD 2.18) to 4.96 (SD 2.91) cycles per minute, corresponding to a mean change of -3.52 (95% CI -4.59 to -2.45; t24=-6.81; Cohen d=-1.36; P<.001). Under binocular viewing, accommodative sensitivity improved from 1.52 (SD 2.49) to 5.08 (SD 2.71) cycles per minute (Δ=-3.56, representing the mean paired difference (baseline minus post), 95% CI -4.88 to -2.24; t24=-5.56; Cohen d=-1.11; P<.001). Stereoacuity also improved significantly, decreasing from 780.0 (SD 613.6) to 448.8 (SD 472.2) arc sec (Δ=331.20, 95% CI 134.20-528.20; t24=3.47; Cohen d=0.69; P=.002). The proportion of participants with normal Worth 4 dot responses increased from 76% (19/25) at baseline to 96% (24/25) after the intervention, and treatment adherence was high under supervised clinical conditions.
Conclusions: The integration of gamified elements into amblyopia treatment was associated with high adherence under supervised clinical conditions and with significant short-term improvements in visual function, suggesting a promising complementary approach to conventional therapies. This interactive approach effectively combines perceptual learning with stereopsis training, presenting a potential alternative to conventional therapies.
[This corrects the article DOI: 10.2196/52644.].
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