BACKGROUND: Virtual patients provide a safe way to simulate authentic clinical practice. Twine is an open-source software that can be used to create intricate virtual patient games, including elements like non-linear free text history taking and time-related changes to the game\'s narrative. We evaluated the incorporation of Twine virtual patient games into a diabetes acute care online learning package for undergraduate medical students at the University of Glassgow, Scotland.
METHODS: Three games were developed using Twine, Wacom Intuous Pro, Autodesk SketchBook, Camtasia Studio, and simulated patients. Online material included three VP games, eight microlectures, and a single best answer multiple choice question quiz. The games were evaluated at Kirkpatrick Level 1 with an acceptability and usability questionnaire. The entire online package was evaluated at Kirkpatrick Level 2 with pre- and post-course multiple choice and confidence questions, with statistical analysis performed using paired t-tests.
RESULTS: 122 of approximately 270 eligible students provided information on resource utilisation, with 96% of these students using at least one online resource. 68% of students who returned surveys used at least one VP game. 73 students provided feedback on the VP games they had played, with the majority of median responses being \"agree\" on positive usability and acceptability statements. The online resources were associated with a mean multiple choice score increase from 4.37 out of 10 to 7.96 out of 10 (p < 0.0001, 95% CI + 2.99 to + 4.20, n = 52) and a mean total confidence score increase from 4.86 out of 10 to 6.70 out of 10 (p < 0.0001, 95% CI + 1.37 to + 2.30, n = 48).
CONCLUSIONS: Our VP games were well-received by students and promoted engagement with online material. The package of online material led to statistically significant increases in confidence and knowledge in diabetes acute care outcomes. A blueprint with supporting instructions has now been created to facilitate rapid creation of further games using Twine software.

With technology becoming an essential component in classrooms, it is becoming more crucial for pharmacy faculty to explore innovative active learning strategies that engage students inside and outside the classroom. This manuscript discusses how two fourth-year students and their preceptor developed interactive patient cases using an open-source software application called Twine (www.twinery.org).
Two different cases were developed in Twine. The first patient case story was created by the fourth-year students and will be implemented in the future. The second patient case, consisting of two Twine stories, was created by the faculty preceptor and was implemented during new student orientation.
Resources for development as well as advantages and disadvantages of developing and implementing Twine stories into the curriculum are discussed. Implementation of the faculty\'s Twine stories into the pharmacy curriculum is also discussed.
Twine is a user-friendly application and has the potential to be utilized in healthcare programs as an effective and engaging teaching strategy that both professor and students enjoy.
While development of a Twine story could be time-consuming, the benefit of increasing student engagement outweighs the cost. Active learning is an essential component in the classroom, and finding new and innovative ways to enhance student learning is imperative.

Applying geographical knowledge in new contexts is a creative and difficult task for school pupils. However, creating text adventures with the open-source tool Twine may be one way to apply geographic knowledge, but there is currently no research that confirms this. We attempted to determine how pupils in small groups constructed text adventures in geography lessons, focused on the topic \"Tourism in Myanmar: threat or opportunity\". We recorded the construction processes of 14 pupils audibly, organized into six teams, and analyzed their games. We found that the different text adventure construction activities between the groups had minimal differences. The groups predominantly asked questions and expressed ideas that used meta-conversation for organization and used agreements. These and other text adventure construction activities can help to specify a model of collaborative creativity. In addition, successful groups wrote geographical narratives with adverbs to emphasize the psychological proximity, rhetorical questions and feelings in their stories, and used more words than the others. The results suggest a focus of future research should be on developing a model for integrating geographical narrative skills into geography lessons and intensifying research about collaborative creativity.

Higher education teaching in the forensic sciences tends to follow a traditional format of lectures followed by practical laboratory sessions. Sometimes this approach is not possible or viewed as not innovative enough. The free, open access software Twine was used with final year undergraduates in forensic and crime scene science in a UK university in order to create an interactive learning experience based around the creation of non-linear stories. Evaluation of this approach demonstrated the positive impact on student understanding when compared to the traditional lecture model. Students found the experience engaging and were keen to use Twine again.

The phaeophyte macroalgae Sargassum muticum is under investigation as a cultivation crop within its native range in SE Asia, alongside other members of the Sargassum genus. During the critical hatchery phase, germlings are grown to ≥ several millimeters ready for outplanting. By optimising the growth medium and twine substrate used for the germling attachment, hatcheries can become more efficient and cost-effective. An 8-week replicated laboratory experiment investigated these factors. It found that adding 0.125 mL L-1 of saturated germanium dioxide during the first week increased mean germling size by 23% (p < 0.005), whereas additional nutrients in the form of F/2 medium made no difference (p > 0.05). Six twine substrates were also tested: jute, cotton, polyamide/cotton, polyester, polyvinyl alcohol and polypropylene. Sargassum muticum grew similarly well on all, although attachment success during the first week was highest on the rougher natural fibres, particularly jute. A negative density-dependent effect of germling density on growth was seen across all materials, with the highest growth seen on the materials with the lowest germling density. Jute is recommended as a highly suitable substrate for hatchery cultivation in this species, although the initial density should be carefully controlled to prevent intraspecific competition.