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Background: Physical inactivity has been identified as the fourth leading cause of death globally. It is now well established that a sedentary lifestyle is a unique risk factor for several diseases such as type 2 diabetes and cardiovascular disease, which account for about 30% of global mortality. Diabetes is a major preventable cause of costly and debilitating renal failure, heart disease, lower limb amputation, and avoidable blindness. In recent years, the idea of using interactive computing systems that leverage gamification to promote physical activity has been widely researched. Prior studies have shown that exergames, that is those that encourage physical activity, can increase enjoyment and intrinsic motivation compared with conventional exercises; as such, they can be effective in promoting physical and mental health. There has been some research on immersive virtual reality (VR) exergames; however, to the best of our knowledge, it is limited and preliminary. This work aims at filling the gap and investigates the effect of display type (DT) and viewing perspective (VP) on players' exertion, engagement, and overall game experience in immersive VR exergames. Objective: This article aims at examining whether DT and VP can affect gameplay performance, players' exertion, game experience, cybersickness, and electroencephalography (EEG) engagement index when playing a gesture-based (i.e., body motion) exergame. Materials and Methods: Study 1 employed a one-way between-subjects design with 24 participants equally distributed in two groups (immersive VR and 50-inch TV) to perform 12 pre-defined gestures. The main outcome measures were National Aeronautics and Space Administration-Task Load Index (NASA-TLX) workload for each group as well as 7 Likert scale and EEG engagement index for each gesture. Study 2 included 16 participants in playing a game with the gestures selected from study 1. All participants played 4 versions based on combinations of DT (immersive VR and 50-inch TV) and VP (first-person and third-person) to assess exertion (%HRmax, calories consumption, and Borg RPE 6-20), game experience, cybersickness, and EEG engagement index. Results: Study 1 results showed that DT had no effect on the ratings of the gestures, NASA-TLX workload, and EEG engagement index. Study 2 results showed that immersive VR not only resulted in a significantly higher exertion (%HRmax, calories consumption, and Borg RPE) but also helped achieve better positive game experience in challenge, flow, sensory and imaginative immersion, as well as lower negative affect. We also found that nausea and oculomotor were significantly higher in immersive VR. Conclusion: This pilot study demonstrates that youth who played gesture-based exergame in immersive VR had a higher level of exertion (%HRmax, calories consumption, and Borg RPE), although the number of performed gestures were not significantly different. They also felt that immersive VR was much more challenging, immersive (flow, sensory and imaginative immersion), and had a lower negative affect than a 50-inch TV; however, immersive VR was more likely to make youth have higher cybersickness.
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PMID:Studying the Effect of Display Type and Viewing Perspective on User Experience in Virtual Reality Exergames. 3207 63

The incretin hormones glucagon-like peptide-1 (GLP-1) and glucose-dependent insulinotropic polypeptide (GIP) are released from enteroendocrine cells in response to the presence of nutrients in the small intestines. These homones facilitate glucose regulation by stimulating insulin secretion in a glucose dependent manner while suppressing glucagon secretion. In patients with type 2 diabetes (T2DM), an impaired insulin response to GLP-1 and GIP contributes to hyperglycemia. Dipeptidyl peptidase-4 (DPP-4) inhibitors block the breakdown of GLP-1 and GIP to increase levels of the active hormones. In clinical trials, DPP-4 inhibitors have a modest impact on glycemic control. They are generally well-tolerated, weight neutral and do not increase the risk of hypoglycemia. GLP-1 receptor agonists (GLP-1 RA) are peptide derivatives of either exendin-4 or human GLP-1 designed to resist the activity of DPP-4 and therefore, have a prolonged half-life. In clinical trials, they have demonstrated superior efficacy to many oral antihyperglycemic drugs, improved weight loss and a low risk of hypoglycemia. However, GI adverse events, particularly nausea, vomiting, and diarrhea are seen. Both DPP-4 inhibitors and GLP-1 RAs have demonstrated safety in robust cardiovascular outcome trials, while several GLP-1 RAs have been shown to significantly reduce the risk of major adverse cardiovascular events in persons with T2DM with pre-existing cardiovascular disease (CVD). Several clinical trials have directly compared the efficacy and safety of DPP-4 inhibitors and GLP-1 RAs. These studies have generally demonstrated that the GLP-1 RA provided superior glycemic control and weight loss relative to the DPP-4 inhibitor. Both treatments were associated with a low and comparable incidence of hypoglycemia, but treatment with GLP-1 RAs were invariably associated with a higher incidence of GI adverse events. A few studies have evaluated switching patients from DPP-4 inhibitors to a GLP-1RA and, as expected, improved glycemic control and weight loss are seen following the switch. According to current clinical guidelines, GLP-1RA and DPP-4 inhibitors are both indicated for the glycemic management of patients with T2DM across the spectrum of disease. GLP-1RA may be preferred over DPP- 4 inhibitors for many patients because of the greater reductions in hemoglobin A1c and weight loss observed in the clinical trials. Among patients with preexisting CVD, GLP-1 receptor agonists with a proven cardiovascular benefit are indicated as add-on to metformin therapy.
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PMID:GLP-1 Analogs and DPP-4 Inhibitors in Type 2 Diabetes Therapy: Review of Head-to-Head Clinical Trials. 3230 45

Our analysis from a national registry shows that compared to cancer, cardiovascular disease (CVD) patients referred to palliative care are a decade older, have worse functional status and clinician-estimated prognosis. Both groups have very high symptom burden, with CVD patients experiencing more dyspnea while pain, nausea, and fatigue are more common in cancer.
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PMID:Differences Between Patients with Cardiovascular Disease and Cancer Referred for Palliative Care. 3330 93


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