Metrics details Standardised courses for laypeople in Paediatric Basic Life Support (PBLS) and Foreign Body Airway Obstruction Management (FBAOM) teach essential skills for the initiation of resuscitation by bystanders Performance assessments are necessary to ensure that skills are acquired We aimed to examine the validity of developed performance assessments and to determine credible pass/fail standards Validity evidence was gathered in a standardised simulated setting by testing participants with three different levels of PBLS/FBAOM experience: untrained laypersons Two blinded raters assessed participants’ performance The reliability of test scores was analysed using generalizability theory scores were compared across the three groups More than two raters and two cases were necessary for PBLS to achieve a reliability coefficient above 0.80 which is considered the minimally acceptable level for high-stakes certification Assessment scores differed across the three groups for PBLS skills as well as for FBAOM skills (p < 0.001) Pass levels of 74% and 55% of the maximum score for PBLS and FBAOM were identified as the levels that best discriminated between competent and non-competent laypersons Laypersons’ PBLS and FBAOM skills can be assessed in a reliable and valid way in a standardised simulated setting multiple raters and scenario tests are needed to ensure sufficient reliability which raises questions regarding the feasibility of performing certification tests for laypersons who participate in short paediatric resuscitation courses assessments are needed to ensure that course participants have acquired the skills necessary to deliver effective PBLS and FBAOM in the future The objectives of this study were to collect validity evidence for the assessment of laypersons’ PBLS and FBAOM skills and to establish credible pass/fail standards The study was conducted in a simulated setting in Copenhagen Denmark and enrolled 33 laypersons between March and June 2017 The study was deemed exempt from ethics approval by the Ethical Committee of the Capital Region The Danish Data Protection Agency approved the study (j.nr: 2012–58-0004) All participants provided informed consent prior to enrolment in the study Purposive and convenience sampling was strategically performed to include three different groups: untrained laypersons The three participant groups included in this study represented different levels of PBLS/FBAOM experience and were expected to have increasing levels of PBLS/FBAOM skills The untrained laypersons were daycare employees with no resuscitation training in the past year Instructors were basic life support certified instructors with additional paediatric training Lifeguards participated in a three-day intensive course just prior to the scenario tests The course involved general first aid and basic life support provider resuscitation training with additional resuscitation training for children and infants The participants conducted two standardised simulated scenario tests for PBLS and FBAOM, respectively (Fig. 1). Flowchart for tests by participants. Legend to Fig. 1: The flowchart illustrates the participants in the scenario tests by group and exclusions due to missing rater scorings participants were introduced to the simulated environment and informed about the purpose of the tests A test facilitator led the scenarios using a standardised instruction protocol The PBLS scenario test included a child who was found lifeless on the floor in a daycare The participant was alone at the scene and a helper was present elsewhere in the daycare centre The PBLS test was conducted using Little Junior™ manikins (Laerdal Medical The FBAOM test scenario involved an infant with sudden foreign body airway obstruction with rapid deterioration into unconsciousness The scenario context was explained to the participants: E.g “You are alone in a daycare centre with a ten month old child who suddenly gets something stuck in the throat The scenario tests were repeated once with slight alterations in the child’s age and circumstances (Fig. 1) The clinical problem was identical for the two repeated tests and the expected actions according to current guidelines were the same Each test had a duration of approximately two to five minutes The tests were video-recorded and viewed using iPads™ (Apple The instruments included nine items for PBLS and eight for FBAOM One item for PBLS “Use of AED” was not applicable for the training of the layperson group and hence excluded Each assessment item was evaluated based on five-point scales The research group developed descriptive anchors for values one which targeted expectations for laypersons The authors discussed the descriptive anchors until consensus was achieved The resulting assessment instruments for PBLS and FBAOM are shown in the appendix (Additional file 1 – Appendix tables 1 and 2) A pilot test revealed that four out of eight FBAOM items could be assessed based on video-recorded scenario tests and that for one FBAOM item (“Identify loss of consciousness and change to CPR”) only part of the original item could be assessed The ability to identify unconsciousness was not possible to assess due to the limitations imposed by the manikin only the participant’s actions in response to unconsciousness were assessed The individual item scores were added to generate an assessment score The maximum score for the two instruments were 40 and 20 points for PBLS and FBAOM the scenario tests were assessed using a 7-point global rating scale for the participant’s performance (1 = poor – 7 = excellent) The response process included assessment of the scenario test videos in a random order by two blinded raters who were European Resuscitation Council (ERC) certified BLS instructors The raters participated in a 5-h rater-training course prior to rating the scenario tests pilot rating videos were assessed and discussed with raters until consensus was reached The internal structure was examined by Generalizability (G) theory to examine the variances that influenced the reliability of the PBLS and FBAOM assessment scores with raters and tests as facets to estimate variances from these sources Internal consistency was examined using Cronbach’s alpha for the PBLS and FBAOM assessment instrument items Correlations of assessment instrument scores and global rating scores were analysed using Pearson’s correlation coefficients SPSS version 24 was used for all other statistical analyses A significance level of 0.05 was used for all analyses Characteristics of the participants are shown in Table 1. There were six missing assessment scores out of a total of 112 possible assessment scores (Fig. 1) Table 2 demonstrates results from the validation process structured according to Messick’s five sources of validity evidence Paediatric Basic Life Support and Foreign Body Airway Obstruction Management d-study results. Legend Fig. 2: The graphs illustrate the generalizability coefficients for different numbers of raters and tests per participant for Paediatric Basic Life Support and Foreign Body Airway Obstruction Management The lines at 0.6 and 0.8 represent the level needed for formative feedback and certification PBLS and FBAOM assessment scores differed significantly across the three groups for both PBLS (F(2,29) = 64.01, p < 0.001) and FBAOM (F(2,27) = 13.04, p < 0.001). Mean scores and post-hoc analysis are shown in Table 3 The individual item scores and analysis are presented in the appendix (Additional file 1 – Individual item scores) The pass/fail level was established as 74% and 55% of the maximum score for PBLS and FBAOM, respectively (Fig. 3). All the untrained laypersons, 20% of the trained laypersons and 8% of the lifeguards failed the PBLS scenario test. For FBAOM, 80% of the untrained laypersons, none of the trained laypersons and 30% of the lifeguards failed. The theoretical distributions of false positives and false negatives are displayed The Y-axis illustrates the relative number of participants receiving each score The validity evidence supports the assumption that increasing scores reflect increasing levels of PBLS and FBAOM skills. The PBLS and FBAOM assessment scores significantly discriminated untrained from trained laypersons and lifeguards (Table 3) The validity argument apparent in our findings is further supported by the strong correlations between PBLS/FBAOM assessment scores and the global rating scores a G coefficient of 0.6 requires one test and one rater and a G coefficient of 0.8 requires at least two tests or three raters The results of our d-study reflect the need for fewer tests to reach sufficient reliability. This may be because our scenario tests were less specialised, and test the same skills in each scenario test, as illustrated by the very low variance contribution from tests in the g study (Additional file 1 – Appendix table 4) the high correlation with the overall performance score of 0.96 suggests that this was not the case For PBLS, the pass/fail level of 74% clearly discriminated competent from non-competent performers and the theoretical distributions revealed only 1.0% false positives (passing incompetent performers) and 0.5% false negatives (failing competent performers) (Fig. 3) For FBAOM, the pass/fail level was 55% and the theoretical distribution of scores resulted in 22% false positives (passing incompetent performers) and 29% false negatives (failing competent performers) (Fig. 3) passing a course implies that participants have attained certain skills which can be used to provide effective resuscitation attempts and significant differences were identified between groups We used convenience sampling which may have resulted in selection of participants who were more motivated about training than the general population this may have resulted in better performance among untrained and trained laypersons we believe that most daycare workers are motivated about gaining paediatric resuscitation skills as we suspect that the poor fit in our study reflects failure to assess participants’ ability to call for help in the simulated setting rather than that the item is non-essential The primary implication of the study is that the PBLS and FBAOM assessment instruments can be used to assess laypersons’ PBLS and FBAOM skill levels The assessment scores make it possible to compare outcomes from different training methods and to assess the quality of various courses the use of standardised performance standards enables competency-based training as an alternative to current time-based models The reliability analyses suggest that the assessment instruments can be used for formative feedback to increase learning for laypersons but not for summative certification purposes if only one or two tests administered if certification of laypersons skills is needed courses should be designed with additional time to allow for an appropriate number of tests and raters for defensible certification of skill levels The study found evidence to support the use of standardised assessment instruments to measure increasing skill levels in PBLS and FBAOM Reliable assessments of performance for formative feedback purposes are attainable multiple raters and scenario tests are needed to ensure reliability which is sufficient to justify PBLS and FBAOM certification and this may not be feasible during brief training courses for laypersons Foreign Body Airway Obstruction Management Conventional and chest-compression-only cardiopulmonary resuscitation by bystanders for children who have out-of-hospital cardiac arrests: a prospective Association of Bystander Cardiopulmonary Resuscitation with Overall and Neurologically Favorable Survival after Pediatric out-of-Hospital Cardiac Arrest in the United States: a report from the cardiac arrest registry to enhance survival surveillance registry Impact of dispatcher-assisted bystander cardiopulmonary resuscitation on neurological outcomes in children with out-of-hospital cardiac arrests: a prospective European resuscitation council guidelines for resuscitation 2015: section 6 Reliability and validity of a scoring instrument for clinical performance during pediatric advanced life support simulation scenarios External validation of scoring instruments for evaluating pediatric resuscitation European resuscitation council guidelines for resuscitation 2015: section 10 Education and implementation of resuscitation Comparison of outcomes of two skills-teaching methods on lay-rescuers' acquisition of infant basic life support skills E-learning in pediatric basic life support: a randomized controlled non-inferiority study Randomised controlled trial of a mobile phone infant resuscitation guide Dispatcher-assisted telephone cardiopulmonary resuscitation using a French-language compression-ventilation pediatric protocol Current concepts in validity and reliability for psychometric instruments: theory and application What should be included in the assessment of laypersons' paediatric basic life support skills Examples and prevalence in a systematic review of simulation-based assessment Competence Assessment as Learner Support in Education Competence-based Vocational and Professional Education Cham: Springer International Publishing; 2016 Part 14: education: 2015 American Heart Association guidelines update for cardiopulmonary resuscitation and emergency cardiovascular care National Council on measurement in education. Standards for educational and psychological testing DC: American Educational Research Association; 2014 A systematic review of validity evidence for checklists versus global rating scales in simulation-based assessment Generalizability theory for the perplexed: a practical introduction and guide: AMEE guide no Observational tools for assessment of procedural skills: a systematic review SPSS and SAS programs for generalizability theory analyses Much ado about differences: why expert-novice comparisons add little to the validity argument Contrasting groups’ standard setting for consequences analysis in validity studies: reporting considerations OSCE checklists do not capture increasing levels of expertise A scoring system for basic cardiac life support skills in training situations Basic cardiac life support education for non-medical hospital employees In: Health measurement scales a practical guide to their development and use A systematic review of sample size adequacy in health professions education research European resuscitation council guidelines for resuscitation 2015: section 1 Download references The data that support the findings of this study are available on request from the corresponding author AH The data are not publicly available due to them containing information that could compromise participant privacy/consent Asbjørn Hasselager received unrestricted grants from TrygFonden (ID: 116660) and Laerdal Foundation (no 3253) Copenhagen Academy for Medical Education and Simulation (CAMES) Department of Children and Adolescence Medicine AH gathered data and prepared the first draft All authors have made substantial contributions to the following: (1) the conception and design of the study (2) drafting the article or revising it critically for important intellectual content (3) final approval of the version to be submitted All authors read and approved the final manuscript The authors declare that they have no competing interests Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations The appendix includes an overview of the scoring instruments flowchart for collecting validity evidence analysis of individual item scores and results of the generalizability analysis Download citation DOI: https://doi.org/10.1186/s13049-018-0544-8 Anyone you share the following link with will be able to read this content: a shareable link is not currently available for this article "The most natural human emotions are so complicated to imagine getting into a game." Enter Patrick Jarnfelt and Andrea Hasselager of the Copenhagen Game Collective, who've launched the government-funded annual game jam Lyst an exploration of video games about romance The state-funded Lyst network now consists of multiple Scandinavian countries banding together to promote gaming based around these topics The Lyst Summit is a four-year venture into this fluttery realm with its inaugural conference having launched in Copenhagen in 2014 and an epic finale will transpire in Sweden the following year "Such a big part of games out there are very one-sided and don't deal with topics like human emotions in a nuanced way," Hasselager tells me over Skype "It's all about seeing the status quo and then questioning the status quo and we have a discussion about it," Jarnfelt adds "But discussions are not enough in our mind We're an artist collective that's also a bit activist in the sense that we want to do stuff So we felt it was important to do a game jam to show the world that it's possible to tackle these subjects in a constructive way." For the 40 odd years video games have been around developers have struggled with how to apply them to our lives in ways more illuminating than mere entertainment Surely the medium has become an increasingly relevant touchstone in our culture and presenting us with challenging moral and ethical dilemmas But when it comes to matters of the heart - or the loins for that matter - games are still very much in their infancy "When we started a lot of developers were like 'but I wouldn't know what to make,'" Hasselager tells me "It's funny that some of the most natural human emotions are so complicated to imagine getting into a game." "A lot of people are like 'you can't do that You can't make Lyst because what if it's like a bunch of dudes getting together doing a rape game Hasselager and Jarnfelt went to great lengths to prevent this sort of sleaze Participants had to apply to partake in Lyst by writing an essay about what they hoped to achieve through the summit and the participant count was intentionally kept slim at around 40 developers This was to provide a more intimate atmosphere as the participants wrack their brains to come up with something bold The setting for this creative incubator is important and to that end Hasselager and Jarnfelt went all out on what their admittedly somewhat meagre budget could afford The first Lyst was set on what Hasselager called "an old retired ferry" tethered to a Copenhagen dock for three days The following Lyst was held on an remote island One time the organisers even hired a masseuse to offer massages for the participants "It was very important that we spend that public funding on massages," Jarnfelt jokes The games that emerge from Lyst are as varied and strange as they comes The winner of 2014's Lyst Summit was a game called Custody about two divorced parents trying to raise a child together Played by two players across three devices here's how it works: Each player takes the role of a parent playing a Bejeweled-like puzzle game on a computer The players' child is a tamagotchi-like character on a mobile device and the two players need to physically pass the child back and forth physically when prompted If you're not good at the Bejeweled-like game then you'll be low on funds and unable to buy your child things like teddy bears and ice cream you'll fail to cover your alimony payments and lose custody of your child altogether and your child will feel neglected and prefer the other parent Sometimes you'll find momentum in your work and attaining your offspring becomes a burden It's a catch-22 based on a very real scenario (one of the developers behind it was in the midst of a custody battle) when the game is over after a handful of rounds the child's heart gets divided based on which parent it prefers That year the runner-up (by only one vote) was a pattern-matching game called Fever two people use one Xbox Gamepad to match shapes Each button does something different and you need to simultaneously twist move and match these shapes in a process so complicated that both players have to use both hands to correctly manipulate the controller They'll also need to verbally communicate as they coordinate their efforts across the controller's various inputs "It's supposed to be like the first time you're having sex with somebody and you're trying to figure out ways to do it and not do it and there's this communication that gets awkward as it goes on," Hasselager explains "That's actually the conversation you'd have." "It's a perfect digital game representation of how first time sex is," Jarnfelt adds "Even the way you communicate sounds like it." "So if you present it like that to people they're like 'okay cool.' Then they start touching each other's hands and are like 'okay this is actually kind of intimate.' On top of that there are some pretty suggestive ones as well." Chopsticks has people scissoring each other's hands with fingers while Temaki merges penetration and spooning "It's too much for most people," Jarnfelt laughs The Lyst winner from 2015 was a physical game called Surrender A two-player competitive game played by three people Surrender begins with a blindfolded person standing over a line with one leg on each side On each side of them is a person who must touch the Sensor's arm from the elbow down in a way they'll find pleasurable The Sensor will move in the direction of whoever's touch they enjoy more Get them to move their whole body over the line in your direction and you've won If they don't like the way you're touching their arm they'll make a fist encouraging you to stop and try something else There's plenty of room for outside the box thinking in this one too Hasselager says that some players picked grass off the ground and used it to tickle their Sensor while others implemented massaging techniques "It's talking about surrendering yourself to these people," Jarnfelt says so it's very much about consent and whether they like it or not but it also opens up questions and it's an interesting experience when you're in it One person felt complete abandonment in it because they were trying to caress their friend and that friend started walking away strongly." Feeling distraught over someone not liking your forearm-rubbing skills may seem silly (after all but that's the power of games: they make you feel real emotions over seemingly arbitrary challenges as some deal with altogether darker subjects but rather software designed by a child psychologist in Holland to aide in communicating with children who have been abused there are two connected devices showing the same child When one person interacts with the child by selecting a type of touch and applying it to a body part on the avatar At any point a player can say 'Stop!" if they don't like how the other person is touching their shared digital avatar On the surface this could be done with the doll child psychologists usually whip out a doll and say "show me where they touched you." It's always upsetting Vil Du isn't a video game in the general sense of the word but it applies a game-like interface that children find engaging "It's more game-y which makes them feel more detached from it and more able to talk about it because they're used to games," Jarnfelt says "It's very hard to talk to these kids about their experience directly as it's a traumatic experience but the kid distances themselves from their own experience by playing the game." Vil Du can also be used as an educational tool about consent but its primary purpose is to be used by medical professionals treating children Vil Du has since received government funding to be developed as a real therapeutic tool is a card game about two people trying to stay in a relationship by tearing their partner down you can ruin the contraception so she gets pregnant then she has to stay Or looking through their emails and finding some dirt horrible things that you shouldn't do in a relationship It's super satirical in that sense," Jarnfelt explains because maybe you do to some degree some of these things that you know you shouldn't and this is just an extreme version of that." isn't a competitive game the perfect metaphor for an abusive relationship You enjoy your opponent's presence - you need them to play after all - but you're so invested in staying in the game that you don't realise how harmful your behaviour is Outside of Lyst proper, Jarnfelt and Hasselager are working on a risqué mindfulness app called La Petite Mort Upon looking at a screenshot of it (below) La Petite Mort looks like a bunch of reddish pixels with deeper hues towards the centre along a vertical crevice "That is a vagina that you have to pleasure," Jarnfelt plainly states It's actually a mindfulness app when it comes out on Apple," he winks So the sound is weirdly sensual and abstract But then you build up this energy and pleasure this vagina Hasselager notes that there are four different vaginas each with a different musical composers putting their own spin on how they'd articulate an orgasm as a piece of music "You rub it and there's more sensitive areas and less sensitive areas and there's a really complex system behind it," Jarnfelt explains "Each of these cells is intelligent and knows how much it's been rubbed and how sensitive they are And you have to move around and do it in a way this vagina likes." Jarnfelt was adamant that getting the abstract vagina to climax isn't actually the point and that there are no explicit goals in La Petite Mort "We're trying to make a statement that pleasuring is not typically a more male-oriented more goal-oriented thing [like] try to get a woman to have an orgasm There will be one slightly game-y mechanic though in the form of Experiences La Petite Mort's parlance for achievements "In real life you have experiences," Jarnfelt says Like a giant tantric orgasm is an experience So if you play the game multiple times and you play it differently then you can have this Experience or that Experience But that made sense for this kind of game." La Petite Mort was presented last month at Arse Electronika But Hasselager and Jarnfelt didn't just present their experimental app they took it one step further by having a room where vagina-sporting folks could get their genitalia scanned into the game "We wanted to make this as real as possible so we wanted to have real people in the game," Hasselager says of this exhibit "Then I was digitising them and putting them in the game so people could come up and play with themselves at the conference," Jarnfelt adds Hasselager and Jarnfelt are crossing their fingers that Apple will accept La Petite Mort "Let's see if it gets accepted on the App Store," Jarnfelt mischievously ponders "We're trying to push the boundary of what is accepted in general Speaking with Hasselager and Jarnfelt it's clear that the two have had no problem finding passionate participants in the Lyst Summit, but the question is: will these themes move beyond the experimental exhibition space and indie scene? Could the next Naughty Dog game or Ubisoft blockbuster tackle issues of sex That we'll start seeing more of these diverse sexual stories love stories in more conventional games," Hasselager says It's just a matter of a little patience and a lot of activism." "If things need to change it often comes from the underground And I really feel like we are doing something different here in Scandinavia © 2025 Eurogamer.net a brand of IGN Entertainment No part of this website or its content may be reproduced without the copyright owner's permission Eurogamer is a registered trademark of Gamer Network Limited Buttonmasher is Douglas Heaven's monthly column about video games By Douglas Heaven La Petite Mort: Too “crude” for some Chunky pink and red pixels flush under my touch As I stroke the screen of my phone I’m hyper aware of the people to my left and the woman behind me learning what makes the ambient sounds swell and soar – and avoiding the rushed rough strokes that bring everything to a halt La Petite Mort is a game made by Andrea Hasselager and Patrick Jarnfelt the pair behind two-person Danish studio Lovable Hat Cult Last month Apple banned the game from its app store “We were told the game contained excessively objectionable and crude content,” says Jarnfelt Just the idea of touching a sexual organ was a problem.” we’re getting more and more participants,” says Hasselager romance and sex are some of the most natural human emotions but they are portrayed so badly in games,” she says La Petite Mort is not the pair’s first game about sex. In 2008 the pair were co-creators of Dark Room Sex Game, in which two players swing Wii remotes back and forth in an escalating rhythm to reach a musical climax “You had to look each in the eye and communicate through body language,” says Jarnfelt The idea for La Petite Mort came to Jarnfelt when he was playing around with cellular automata– abstract models that can simulate complex systems Jarnfelt got his automata to respond to touch – and immediately saw the erotic potential To make the game’s graphics Jarnfelt and Hasselager filmed the genitals of actual women then pixelated the footage to such a degree that it is almost unrecognisable “We’ve had people play through the game without realising what they were touching,” says Hasselager When Jarnfelt tested it with a group of male friends they all looked over the player’s shoulder They were checking out each other’s technique Others prefer to go off and sit by themselves “The images are in your head,” says Hasselager “But this is why it can become embarrassing to watch somebody else.” New York-based developer Robert Yang has also explored intimacy – and the awkwardness that often goes with it – in dozens of games Yang makes games about gay men that are often tongue in cheek and funny it is often presented as part of the game’s story as a reward or a goal for the player But Yang presents intimacy as a process in itself “When we think of sex as a process laden with tension it suddenly opens up a lot of emotional language in games,” he says Games can help teach us about consideration and consent Yang explores important themes that few others do says writer and game designer Cara Ellison Yang has had his games banned from certain online distribution services the largest online games store and he is not allowed to use the payment processing service PayPal Such companies have a relatively conservative policy about what they deem pornographic. There is a line that defines what forms of sexual content companies permit developers to include in games, but it’s blurry, he says. “And they can shift the line without warning. Even asking for donations puts me in danger of getting banned from PayPal.” We have a problem with prudishness when it comes to games, says Ellison. Sexual content is more common in films and on TV than ever and books like Fifty Shades of Grey are mainstream bestsellers, yet attitudes about sexual content in games have not caught up. Many people still think games are for kids, says Jarnfelt. “It’s an antiquated view, but it has stuck in people’s minds and the rules have formed around it.” Ellison feels similarly. She also thinks many people are still uneasy about games because of their interactive element. “People are slightly suspicious of that still, they think it’s much more influential to play a sex scene than merely watch one.” But that’s ridiculous, she says. There is more to interactivity than pressing buttons to move hips, she says. In Yang’s game Hurt Me Plenty, for example, a player is locked out if they violate their partner’s trust. “It’s perfect for understanding exactly how important consideration of another body is,” says Ellison. “There are lots of games coming out pushing the boundaries,” says Jarnfelt. “They’re not getting widely released but they’re getting made and that’s the first step.” Games are obsessed with violence because players find it entertaining. But we also like sex, says Yang. “I suspect that sex is the only other cultural force in the universe that is sufficiently weird, scary, funny and sad to dethrone violence as the default interactive experience.” Hasslager has a similar view. “It would not be obvious for me to make a game about war because I’ve never been in a war,” she says. Explore the latest news, articles and features MenuThis New App Wants to Teach You Everything You've Ever Wanted to Know About Female Orgasms ImpactBy Leigh CuenJune 6, 2016A new musical video game by the Danish studio Lovable Hat Cult is spreading the self-pleasure gospel with an app that gameifies the female orgasm. It's called La Petite Mort which means "the little death," French slang for orgasm — and it's intended to teach people to explore the diversity of female orgasms "We want people to honor and be able to talk about female pleasure," designer Patrick Jarnfelt told Mic in a Skype interview "The game is an artistic experience." which is available for download for $2 on the Google Play store features four "levels," or unique pixelated vulvas modeled after those of real women Players can "unlock" the vulvas to produce three different types of orgasm "experiences," which are named after classical music patterns — one while another is more of a fast-paced and exhilarating burst "We hope it's a small contribution to demystifying the vulva," game producer Andrea Hasselager told Mic over Skype "It's very different from the goal-oriented focus of porn It's all about reading the person and responding to that If anything we're trying to tell people to stop and listen more."  As the player draws closer to simulating female climax, the music swells and the digital vulva reddens, mimicking the biological process of female arousal Every vulva in the game has different "preferences" regarding where and how it reacts to touch so observation and experimentation are crucial to the player's success Sexologist Timaree Schmit said this is a crucial aspect of the game "The diversity of bodies is incredibly important,"  Schmit told Mic in a phone interview "There's no one-size-fits-all model."  The collective and summit alike explore the artistic and educational potential of erotic mobile games featuring workshops on LGBTQ representation in video games and playful approaches to sexual relationships in art "We have had a focus on expanding games as an artistic medium in general," La Petite Mort's designer Jarnfelt told The Guardian "We felt like erotic games was a very unexplored area." La Petite Mort isn't the first digital simulation to help users play their way to better sexual stimulation. Last year, OMGYES enlisted thousands of real women to record footage demonstrating exactly how they make themselves come Users are able to replicate the variety of self-pleasure techniques on an interactive touchscreen enabling them to bring the women onscreen to climax OMGYES created a lexicon of new, pleasure-oriented vocabulary to describe different female orgasm techniques, such as "edging," teetering on the brink of orgasm while avoiding climax. The website's real-time feedback provided a crash course in female sexual pleasure But La Petite Mort takes the concept further: For instance while the touch screen can't identify pressure it can measure the speed Failing to adjust to the visual and musical cues for pleasure the pixelated screen projects might trigger a text message saying something like "Slow down" or "I'm sensitive."  Lovable Hat Cult For Hasselager and Jarnfelt it was important their new mobile game celebrated orgasms without coming across as goal-oriented or arguing that orgasms are the be-all and end-all of sex They were careful to add video game staples like levels and features that can be "unlocked," without assigning players points for each level "We don't want it to be associated with achievement and goal-oriented [play]," Jarnfelt said over Skype "We wanted it to be about the experience."  Yet the team will likely face resistance if they want to offer their app on a mainstream platform Jarnfelt said that during their negotiations with the Apple store they were asked to change everything from the concept so it's not the visuals," Jarnfelt said They wanted us to go completely away from the idea."  Hasselager said her frustrating experience trying to distribute the app reflects the way society views female pleasure as a whole "Explicit and crude don't apply at all to what we've done," she said Just the thought of it [female pleasure] is too much."  The stigma surrounding female pleasure manifests itself in a huge gap between rates of male and female orgasm. The National Survey of Sexual Health and Behavior found that 91% of men got off during their last sexual encounter Games like La Petite Mort could go a long way towards starting conversations and allowing users to explore pleasure without the pressure of interacting with a real-life partner "When we think about the orgasm gap and the idea that the female orgasm is 'elusive,' it has to do with this traditional view of sex," Schmit said "Women are shamed away from playing with their bodies and learning what they want It's not that it's hard [to make a woman climax]