Yersinia pestis are one of the most ancient scourges to haunt the globe, and have been responsible for the deaths of countless other worlds in the deep past, starting even before the Apothecary Healers began offering protection to Soma and other lands. In fact, these Pestilence agents were only discovered centuries after some of their most horrific killing sprees, and over the last several decades, the breath of their wrath was slowly revealed. When Soman scouts visited a string of barrier islands that had fallen victim to a mysterious villain some 600 years ago, for example, they found the remains of some Y. pestis beasts preserved in the rocks surrounding the islands’ entry bays, leaving little doubt as to the cause of the unthinkable natural tragedy. Y. pestis can be so devastating that some lands have gone so far as to purposefully release the Pestilence agents on enemy territories as a form of biological weaponry.

The beasts still lurk around Soma’s perimeter, feasting on giant marine rodents and breaking through the boundary wall whenever the vermin come ashore to nest on the beaches. The Pestilence agents synthesize a sticky excretion that allows them to scale the wall and enter Soma’s border towns. They also produce a potion that eliminates blockages from Soma’s water ways to speed the rate at which they infiltrate the rest of the land, where they are skilled at evading raids by Soma’s Noble Sentry and can cause widespread damage. Thankfully, however, now that Y. pestis have been identified, the appropriate Apothecary counterattack can usually protect Soma from extensive damage from the Lords’ attacks.

Haemophilus influenzae are some of Soma’s most ancient demons, first described over 100 years ago. But despite a century of experience fighting these foes and research on their destructive habits—including the detailing of their entire genome—their attacks are still poorly understood, and they still pose a significant threat to the life on Soma, wreaking havoc on the land’s rivers, Respiro Forest, the Skeleton Mountains, and even Sententia. While there are preventive measures that can brace the land for an attack by one particular strain of H. influenzae, there are many varieties of the Lord that are not deterred by such additional armaments.

There are two different classes of H. influenzae armies—those that possess the slimy capsules, and those that don’t. The capsules protect those predators from the attacks of the Apothecaries, and are thus almost always more invasive than H. influenzae that lack such capsules. But even these so-called unencapsulated Pestilence agents are capable of causing significant damage to Soma, firing into action Soma’s Noble Sentry, whose defensive stands themselves can damage the land and harm its inhabitants.

Many H. influenzae armies are known to live quietly in Soma before springing their attacks. They lie in wait for the attack of another Lord of Pestilence or other invader to weaken Soma’s defenses, then quickly disperse to numerous towns and cities. There, they can inflict widespread damage, choking Soma’s oxygen supply by attacking the Respiro Forest, causing significant pain and suffering in the Skeleton Mountains, or destroying the Oculos, inhibiting Soma’s ability to detect incoming vessels.

Don’t let the name fool you. Streptococcus pneumoniae attack more than just the Respiro Forest. These villains can wreak havoc on a wide range of systems in Soma, including the land surrounding Buccal Bay, the Aural Canals, and even Sententia. They are similar to those of other cocco-demons by their sensitive to bile and the chemical optochin. These sensitivities are one of the few things the more than 90 different armies of S. pneuomonia have in common, however. Each army differs in the intensities and frequency of its attacks, and its vulnerability to various Apothecary defenses, and each attack on Soma must be carefully considered in preparation of an Apothecary counterattack.

S. pneumoniae are an ancient menace to Soma, having plagued the country for more than 100 years. They are relatively well studied, having been the subject of experiments that determined DNA, and not proteins, is the vector of virulence-sharing among Pestilence agents. But that doesn’t make them any less threatening. Like many Lords of Pestilence, they can live peacefully in the canopy of the Respiro forest, but will strike as soon as the opportunity presents itself.

An interesting antagonistic relationship exists between S. pneumoniae and fellow Pestilence agent Haemophilus influenzae. While either group of Lords can list in the Respiro Forest on its own, the two cannot seem to peacefully coexist, and Soma’s Noble Sentry seems to recognize some interesting interactions between the two. Though the details remain murky, it is clear that these two Pestilence agents do not get along, and Soma’s natural defenses are often able to take advantage of their quarrels to extinguish the invaders before they can inflict widespread damage to Soma.

Metronidazole may be most well known for her swift action against the increasingly common attacks of C. difficile, but she is also widely effective against other Pestilence agents, particularly those that live without oxygen. She can be called into action for attacks on the boundary wall, the Skeleton Mountains, Respiro Forest, the aqueduct, and other areas of Soma. She kills her opponents from the inside out, generating a potent substance, which susceptible Pestilence agents absorb into their bodies. There, the potion is converted into toxins that deactivate more than 100 different enzymes that are necessary for the organisms’ survival. The toxins also affect the Lords’ DNA, disrupting the genomic stability of Soma’s worst enemies.

Metronidazole’s counterattacks do take their toll on the land and its inhabitants, however. She can disrupt the flow of the aqueduct, irritate the Oculos, generally disrupt Soma’s sense of balance and structure, and cause a sense of unrest among Soma’s loyal inhabitants. Her visits to Soma are also suspected to cause more serious ailments even after she has left the land, including tumorous outgrowths. Finally, she has been known to affect the essential functioning of Sententia, destroying key control centers in the city. These effects can filter down to nearly all of Soma’s systems, disrupting function of the land as a whole. These more serious offenses are most commonly seen when Metronidazole stays in Soma too long, and are often exacerbated during nationwide celebrations that often see widespread consumption of alcoholic tinctures brewed from fermented wildflowers.

So let us pretend for a minute, a situation where you are in front of an imaginary television screen that is hooked up to your Xbox 360 with Fruit Ninja Kinect being the game of choice. Your first fruit pops up in a stylistic fashion from the bottom of the screen, and you execute a slicing motion with your arm to cut the fruit (add juicy sound effect as fruit is being cut). However, what actually goes into that single swinging motion is actually an integration of many different ones that happen subconsciously and almost instantly.

Vision is an amazing and powerful sense. The retina in your eyes alone has about ten distinct layers of a combination of neurons, photoreceptors, membranes, and other cells that allow for you to sense the outside world through your eyes. And the way that you perceive that deliciously looking fruit being popped up into the air is not just because you see a fruit; but because you also recognize spatial dimensions, the amount of luminance that is conveyed, the contrast between colors, the sense of motion found in the fruit twirling in space, and more. This package of information is transferred to what we know as the occipital lobe, or the part of the brain in the back of your head, in a pathway that involves many crossing over events and dissection of the visual field into top, bottom, left, and right compartments. In essence, the way that an image is projected on the retina is actually inverted and reversed, and when transferred to the brain, is meticulously divided further into distinct pathways of information. It is incredible that we can make sense of what we see in the first place! Furthermore, after visual recognition of an object, there are different lobes in your brain that help with the process of voluntary action through individual steps of attention to that object, the identification of what it is, and ultimately what to do or the idea of planning. Once you and your brain agree to the plan of cutting the digital fruit, your musculoskeletal system is accessed through the interface of your nervous system. Using your shoulder, chest, and arm muscle groups which are innervated by many different nerves, you are finally able to cut the fruit with your arms and achieve success!

What we perceive as a simple motion of cutting a digital fruit in a video game is actually a complicated set of mechanisms and integration of various physiological systems. I have mentioned the visual and nervous system in combination with your musculoskeletal system; however, there are more “behind the scenes” organ systems which also help you in accomplishing this task – systems such as your cardiovascular system that help to perfuse blood and energy to your muscles and brain in conjunction with your pulmonary system. If we wanted to take a step further, an added layer to the complexity is the idea of metabolism on a molecular level. Metabolism can be thought as the underlying energy industry in your body that serves to power your organ systems, and to allow the interaction and exchange between them. I’m sure that I have missed the mentioning of a plethora of other mechanisms that help me to cut my deliciously looking digital fruit, but one thing is for sure – we are amazing. Imagine what goes into a task that is a hundred times more complicated than just looking at something and swinging your arms!

-J.W.

Francisella tularensis are nasty Lords that have terrorized Soma for nearly a century. Known as rabbit demons, they can tear apart the boundary wall as well wreak havoc on the interior towns and cities. The damage they cause depends on which of the four F. tularensis armies are attacking, and where they strike first, and without the help of the Apothecaries, even threaten to kill the land and its inhabitants.

They most commonly enter Soma by scaling the boundary wall, but have also been known to descend on the Respiro Forest or occasionally through Buccal Bay and the Oculos. Unlike some Lords, F. tularensis does not need Soma or another land to survive, and can lurk in the waters surrounding the island country, striking without warning. They are also quick to move from one land to another, often stirred up when its burrows are disturbed during land maintenance work, making their threat widespread and unpredictable.

Not only are F. tularensis capable of avoiding the defensive maneuvers of Soma’s Noble Sentry, they actually use the Defenders’ camps to multiply their armies. Once sequestered by the Sentry, the rabbit demons break out of their holding cells, thriving on the camps’ resources while creating countless new, young demons that burst from the site and spread around the land. The details of F. tularensis’s tricks are not well understood, but they are suspected to contain potions that help them break free of the Sentry jails and infiltrate the camps. Soma’s best bet is to deploy one of the few Apothecaries that can defeat the evil Lords before their numbers become too great to overcome.

I first fell out of the gaming loop six years ago when I made the absurd decision to buy a Mac… I had begun taking a course in Graphic Design and my teacher had managed to convince me to use the college eMacs. Being a born and bred PC user, I was initially adverse to the pretty-boy machine – to me the whole concept of having a white computer was ridiculous. It’s like buying a white car, you just don’t. And then there was the lack of a right click on the mouse – “a statement of simplicity in design and ergonomics” I was told by my design tutor at the time. Despite my reservations I found myself becoming defensive over OSX (Apple’s operating system) like a mother of a child who doesn’t seem to make any friends. The great thing was Macs were just like PCs except that no one else could use them and they seemed to exist for the sole purpose of running Photoshop – a program I had become somewhat addicted to.

As time passed I realised that Apple’s restrictive outlook on gaming was doing my productivity a world of good. Who knows, maybe not being able to waste all of those hours fragging are what meant I was successful in my application to Medicine. However, this honeymoon period was short lived since as Apple became more popular (and addressed some of its stranger software and hardware design choices) the number of games on the platform increased. Whilst I patiently waited for Steam to be ported over to Mac I had a brief (but still embarrassing) stint on World of Warcraft. My brother started playing the game at the same time as me – almost 5 years ago, I haven’t seen him emerge from his room since.

Unlike my brother, I managed to break away from World of Warcraft but this seemed to distance me even further from the gaming world. It was like Warcraft had taxed a little bit of my gaming soul for wanting to leave its immersive (yet socially crippling) universe. I detached myself from games so much that even when Portal made it over to Mac I did not play it. I know, I should be shot. In fact, in the last two years the only gaming I’ve done is the Vech’s Super hostile Series on Minecraft. I’m not sure if that even counts as gaming – to me its more of a regression to my Lego-playing days, except now I don’t have to put all the pieces back in the box after I’m finished making spaceships smash into castles.

At med school there is no denying the fact that people think I’m the geeky guy. I don’t have a problem with that; in fact it must be self-confessed geekery since I’m writing for ‘Nerdcore’. My question is how can I still be the geeky gamer when a) I’m using a Mac and b) the closest thing to a ‘game’ I play is the occasional session on Minecraft. I can only conclude that the sheer amount of FPS hours I crammed in as a kid has left a considerable imprint on my personality. An imprint I am proud of, and an imprint that will help me relate to the people I encounter later on in life.

L.A.R.F

A dear friend of mine

Newton’s third law is a scientific favorite: “To every action there is always an equal and opposite reaction.”  This law is also the core of competitive gameplay. If I make a move, my opponent must respond in order to neutralize the value of my move. The victor is then the player that takes a step beyond the law and causes a force greater than the potential reaction of the opponent. This is a step towards excellence, a concept that is beyond Bill and Ted and their excellent adventures. Excellence, here, is a term I will use to explain the movement beyond the expected, to excel in a field and create a noticeable division between yourself and the baseline. Overcoming an opponent’s equal and opposite reaction by performing more efficient reactions of your own generates excellence.

In a perfect competitive videogame, all playable options are entirely balanced with their own unique flavors. This is technically impossible, but let’s stick with the notion of ideal balance for now. Let’s say this game is something akin to Starcraft or Total War, where you have a selection of armies to take into battle. In this balanced game, if both players met continually with total equality, nothing would happen. What determines the outcome is the individual excellence of the player, and in games such as Starcraft and Total War, that excellence is most often generated through reaction timing. In these games, my job as a player is to evaluate my opponent, their strategy, and the best possible maneuver to shut down the enemy’s strategy. The goal is then to analyze my opponent’s action, formulate a reaction, then formulate possible reactions that they might make to my reaction, and then formulate a reaction to the new action. The deciding factor is the speed at which one player can evaluate and respond to all potential actions, plus battlefield decisions (which I have not yet spoken of).In Starcraft, the value of scouting is high. Read the enemy strategy, respond, then begin responding to the expected opponent response to your response. This process repeats itself dozens of times to varying degrees, but the saying “stay one step ahead of the game” is very true here. Just like in Chess and Risk, you must analyze your opponent and all possible moves to increase your chances of victory.

Beyond the analytical is the kinetic. In a skirmish, players can generally control their units to try and maximize their efficiency. The player with better micromanagement skills will hands-down defeat an opponent with poorer micromanagement skills in an even-army match-up. This is the kinetic form of reaction timing: taking your units and making real-time decisions within a fraction of a second. In the middle of a game of Starcraft, a player typically is faced with, within 10 seconds, producing a back-up or a response army, develop a new strategy towards facing the enemy force, analyze the current map and enemy-controlled regions, and successfully winning a skirmish. Again, these things all happen within seconds, all of which can determine whether or not the game ends up in a W or an L on your record.

This is the nature of excellence in competitive gaming: the rate and efficiency at which a player responds through individual reaction timing. This is directly proportional to what we consider to be “player skill”; the more “skilled” we consider a player, the faster and more efficient their reaction timing is.

Also, this isn’t limited to Starcraft or any war-based games by any means. All games are dependent upon reaction timing, even old-school Mario games.

- M.B

Treponema pallidum are crafty Lords who penetrate Soma’s boundary by charming their way onto boats heading for the Southern Harbor adjacent to Fecal Outlet. They uses their feminine wiles to stow away on cargo ships, full of unsuspecting and impressionable young workers, then spread their terror across Soma once inside the Wall. Like mermaids at sea, they spiral their way swiftly upstream from the Harbor to Uterine Bay searching for imperfections along the shore through which they can infiltrate Soma’s natural waterways and travel to the far corners of the world.

No one knows exactly how T. pallidum devastate the lands they infect, but the results are far from subtle. The wily temptresses can wreak havoc on Soma’s filtration systems, the camps of the valiant Sentry, even making their way to the Skeleton Mountains. If T. pallidum are not eliminated quickly by the Apothecaries, damage begins to appear along the length of the Boundary Wall, with notable deterioration around Buccal Bay and the Southern Harbor. Their presence can also cause harmful rises in temperature and decreases in the nutrients that come in through Buccal Bay to supply the land. Eventually, T. pallidum will even permeate the Twin Cities and Sententia, where they can disrupt the overall rhythm of life in Soma and affect drastic alterations in Soma’s typically warm and inviting persona. While a handful of Apothecaries can successfully eradicate T. pallidum from the land, the Lords cannot be captured, and thus much remains unknown about how they inflict such destruction, making it nearly impossible for Soma to prepare for such attacks.

The rise of real-time strategy (RTS) games back in the ‘90s had such a legacy and cultural impact amongst the male population in the virtual world. Especially in South Korea and the United States, competitive and corporate-sponsored leagues (including participation in Major League Gaming) were created for one of the most popular RTS games in video game history, StarCraft – and yes, I was an avid StarCraft player at the prime age of 12. Although StarCraft possessed most of my time during my adolescent years, I did go to school, get a good education; and here I am now, eons later in medical school now playing StarCraft II (and learning medicine). Every time I go to my immunology class, I can’t help but think about the mechanisms of our immune system as a StarCraft game (the concept can be replaced with any RTS game of your preference). This is not because I believe that life is a game (which some may consider it to be), but there appears to be something very “real-time” and “strategic” about our bodies, particularly how our immune system works in fighting and preventing disease.

The concept of StarCraft and other RTS games is to build a military base, expand, and conquer the enemy. The ways in which to accomplish these objectives include building an array of spectacularly-looking units, matched with equally awesome-looking attacks, upgrades, and special abilities. I would propose that our immune system, although not as colorful and flashy as computer graphics, sort of works in the same way. The immune system is a wonderful and intricate defensive network created to protect a great nation of cells called the human body. It certainly has a command base, it can expand throughout the body, and it serves to conquer enemies – which we will define as pathogens. Likewise, the immune system has units, known as immune cells, leukocytes, white blood cells (all of which are one in the same), that have the ability to attack, upgrade, and certainly have special abilities against specific pathogens.

If we integrate our immune system into an RTS format, it might be described in the following ways. You could consider our bone marrow and thymus as the immune command centers of our body, creating different immune units. These units would most likely venture throughout our bodies into secondary lymphoid organs that we can allude to as bunkers, such as lymph nodes and the spleen, where these immune units can reside and defend. We have large macrophage cell units that phagocytize (eat and destroy) bacteria, which I consider to be the tanks in our immune army. There are other battle cells including natural killer cells, mast cells, and eosinophils each with their respective functions such as specializing in destroying viruses, creating allergic reactions, and defeating parasites. Some cells can even be upgraded such as T and B cells. B cells can be upgraded into plasma cells that create antibodies against pathogens, and T cells can be upgraded to have special effector functions such as being a helper or cytotoxic T cell. Before I bore you with scientific lingo and concepts, let me assure you that our immune system has many cool cells (many of which are not described here) that do a lot of cool things – to put it simply.

The proven concepts and mechanisms of our immune system are vast and cannot be contained in a blog entry (which is why we have immunology textbooks with hundreds of pages), but hopefully I have been able to elucidate the nuance that playing RTS games alludes to what actually happens in real life on a microscopic level. The immune system is a network of many fascinating cells that act as our body’s defense system. In addition, these cells are specialized in what they do, and there are other mechanisms besides cells that help in our defense (e.g. chemicals, proteins, barriers). As individuals with personalities, we think of ourselves with a single identity; however, our individuality is also comprised of billions of cells that have different functions, abilities, and power ups that allow us to be the person that we are. The next time that you play an RTS game, hopefully it will remind you of how your immune cells subconsciously work together to help protect your body.

-J.W.