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Introduction: This study evaluates the integration of Virtual Reality (VR), utilising Virtual Medical Coaching software, with traditional Siemens radiographic equipment in radiography education, comparing traditional and hybrid training models., Methods: The study included 165 first-year radiography programme students from two groups. One group used traditional radiographic simulation equipment, while the other employed a hybrid approach combining VR simulations with physical simulations. Assessments focused on room setup, patient comfort, and radiographic positioning across various anatomical regions. Methods included practical exams, cost analysis, and data analysis using descriptive and inferential statistics, including ANCOVA., Results: The hybrid group showed significantly superior performance in room setup, achieving more efficient and accurate configurations. For radiographic positioning, the hybrid group exhibited greater precision and adaptability in handling different anatomical regions, such as the lumbar spine, knee, chest, shoulder, and cervical spine. These students also demonstrated a quicker learning curve and higher retention rates in practical skills. In terms of patient comfort, both groups performed equally well. Financial analysis indicated that the hybrid approach reduced training costs by decreasing the need for repeated use of physical resources and shortening educational hours., Conclusion: Incorporating VR into radiography training significantly enhances educational outcomes, student engagement, and clinical skills. The hybrid model, which utilises both Virtual Medical Coaching's VR tools and traditional Siemens equipment, proves to be an effective, scalable, and engaging educational method., Implications for Practice: Given the enhanced performance and cost-efficiency of the hybrid model, radiography programmes are encouraged to adopt VR-enhanced simulation training. This approach prepares students more effectively for the technical and interpersonal demands of radiographic technology careers., Competing Interests: Conflict of interest statement None., (Copyright © 2024 The College of Radiographers. Published by Elsevier Ltd. All rights reserved.)

Virtual reality (VR)-guided motor imagery (MI) is a widely used approach for motor rehabilitation, especially for patients with severe motor impairments. Most approaches provide visual guidance from the first-person perspective (1PP). MI training with visual guidance from the third-person perspective (3PP) remains largely unexplored. We argue that 3PP MI training has its own advantages and can supplement 1PP MI. For some movements beyond the view of 1PP, such as shoulder shrugging and other axial movements, MI are suitable performed under 3PP. However, the efficiency of existing paradigms for 3PP MI is unsatisfactory. We speculate that the absence of sense of body ownership (SOO) from 3PP could be one possible factor and hypothesize that 3PP MI could be enhanced by eliciting SOO over a 3PP avatar. Based on our hypothesis, a novel paradigm was proposed to enhance 3PP MI by inducing full-body illusion (FBI) from 3PP, which is similar to the so-called out-of-body experience (OBE), using synchronous visuo-tactile stimulus with VR. The event-related Electroencephalograph (EEG) desynchronization (ERD) at motor-related regions from 31 healthy participants were calculated and compared with a control paradigm without "OBE" FBI induction. This study attempts to enhance 3PP MI with FBI induction. It offers an opportunity to perform MI guided by action observation from 3PP with elicited SOO to the observed avatar. We believe that 3PP MI could provide more possibilities for effective rehabilitation training, when SOO could be elicited to a virtual avatar and the present work demonstrates its viability and effectiveness., (© 2024 Federation of European Neuroscience Societies and John Wiley & Sons Ltd.)

Introduction: This study investigates the impact of Immersive Virtual Reality (VR) on learning outcomes in radiography training using Virtual Medical Coaching's X-Ray Pro VR software. VR offers immersive experiential learning that may enhance academic performance and professional preparedness., Methods: The study involved 130 students from two consecutive cohorts: one using traditional training methods and the other using VR software. We employed a mixed-methods approach, integrating quantitative measures of academic performance and clinical competency with qualitative insights into student engagement, enjoyment, and stress levels. The VR group used Virtual Medical Coaching simulation software, while the traditional group used physical simulation machines (Siemens Healthineers) to practice positioning anthropomorphic manikins, adjusting exposure settings, and handling X-ray equipment. Data were collected at four points: immediately post-training and at 1 month, 3 months, and 8 months follow-up., Results: The VR cohort showed significantly higher knowledge retention, work readiness, and lower stress levels compared to the traditional cohort. Among the participants trained in VR, a vast majority (59 out of 65) reported a high level of satisfaction with the immersive nature of the training, emphasizing its realism and direct applicability to clinical scenarios. Quantitative analysis revealed superior performance metrics for the VR group across all measured time points (p < 0.001). Qualitative feedback highlighted enhanced engagement and enjoyment among VR-trained students., Conclusion: The results of this study clearly indicate that VR training significantly enhances learning outcomes in radiography education. The VR cohort exhibited higher knowledge retention, work readiness, student engagement, and enjoyment, along with lower stress levels and higher confidence compared to the traditional cohort. These findings support the integration of VR into professional training curricula to improve student performance and engagement., (Copyright © 2024. Published by Elsevier Inc.)

The introduction of Apple Vision Pro (AVP) marks a significant milestone in the intersection of technology and healthcare, offering unique capabilities in mixed reality, which Apple terms "spatial computing." This narrative review aims to explore the various applications of AVP in medical technology, emphasizing its impact on patient care, clinical practices, medical education, and future directions. The review synthesizes findings from multiple studies and articles published between January 2023 and May 2024, highlighting AVP's potential to enhance visualization in diagnostic imaging and surgical planning, assist visually impaired patients, and revolutionize medical education through immersive learning environments. Despite its promise, challenges remain in integrating AVP into existing healthcare systems and understanding its long-term impact on patient outcomes. As research continues, AVP is poised to play a pivotal role in the future of medicine, offering a transformative tool for healthcare professionals., Competing Interests: Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Shanbhag et al.)

Background and Objectives: This study was conducted to identify the characteristics of attentional bias of individuals with Sluggish Cognitive Tempo (SCT) and how Attention Bias to Threat (ABT) changes when feedback was provided in attention training., Methods: First, a dot probe task was conducted to confirm the ABT of the SCT feedback group (N = 27) and SCT no feedback group (N = 25), and healthy control group (N = 30) before intervention. Thereafter, a VR-based attention training was conducted three times with feedback or no feedback. Finally, a dot probe task was executed again., Results: The SCT groups showed a higher ABT than the healthy control group. A result of the attention training, the reaction time of disengage was significantly reduced when provided feedback. In addition, it was confirmed that the ABT of the SCT group that received feedback, was significantly reduced., Limitations: First, the only stimulus used to examine the ABT was the angry face, and the reaction time to other threatening facial expressions was not confirmed. Second, attention training was conducted three times, but further studies are needed on the effect of the duration of training on the magnitude of effect., Conclusions: This study identified ABT associated with internalizing symptoms of SCT and suggests that attention training with immediate and continuous feedback is needed to reduce ABT., Competing Interests: Declaration of competing interest This work was supported by the National Research Foundation of Korea (NRF) grant funded by the Korea government (MSIT) (NRF-2021R1F1A1062371). The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Young healthcare professionals and medical graduates often fall short in the practical experience necessary for handling medical emergencies. This can not only lead to strained feelings of inadequacy and insecurity among future physicians and less experienced healthcare providers in general, but also to detrimental outcomes for patients as emergency medicine demands rapid decision-making with low tolerance for errors. New didactic modalities and approaches may be needed to effectively address this shortcoming. Immersive technologies are powerful novel educational tools with untapped potential in medical training, and may be particularly suitable for simulation trainings in the high-stakes field of emergency medicine.Herein, we systematically explored the educational potential of extended reality (XR) technology, particularly virtual reality (VR), in the management of patients presenting as medical emergencies, combining the use of the STEP-VR application with an untethered hardware setup.Importantly, we aimed at studying multiple, large cohorts of senior medical students involving a total of 529 participants and collecting data over a period of two years. We assessed students' acceptance of the training through a modified questionnaire measuring device handling, content complexity, degree of immersion, learning success, and seminar design.Our results show high, sustained acceptance and ease of use across different student cohorts and subgroups, with most students finding XR/VR engaging and beneficial for acquiring emergency medicine skills. Importantly, the prevalence of simulation sickness was minimal. Moreover, no major effect of the head-mounted displays (HMDs) price range was noted with regard to the learning experience. The results underscore the potential of XR/VR capabilities in effectively enhancing medical education, particularly in areas of high-stakes clinical scenarios and emergency care, by providing realistic and reproducible immersive training environments.In summary, our findings suggest that XR/VR-based training approaches could significantly contribute to preparing future physicians for the complexities of emergency medical care, encouraging the integration of such technologies into medical curricula. However, careful consideration must be given to its suitability for all students and the practical challenges of its implementation, highlighting the need for further research to harness its full potential for medical education., (© 2024. The Author(s).)

Virtual reality (VR) technology has evolved from entertainment to significant applications in healthcare and education. Despite its potential, there is limited research on the role of VR in cancer care. This study investigates VR's ability to simulate the chemotherapy process, aiming to enhance patients' knowledge and mitigate anxiety associated with chemotherapy. Utilizing a two-arm, mixed-methods pre/post-survey design, the study measured changes in patients' anxiety and knowledge before and after exposure to a VR simulation. Participants ( n = 267) engaged with VR simulations or interactive 360-degree videos depicting the chemotherapy process. Data analyses revealed a significant median increase in chemotherapy knowledge post-exposure to the VR content (z = 12.511, p < 0.001). Demographic factSors significantly influenced perceptions of VR realism and usefulness ( p < 0.05). Additionally, VR exposure was correlated with reduced anxiety levels and improved treatment expectations ( p < 0.05). Participants with higher post-understanding chemotherapy scores considered VR a useful tool for managing anxiety about chemotherapy and recommended VR for other medical procedures ( p < 0.001). These findings underscore VR technology's potential as a valuable tool in cancer treatment, suggesting it can enhance patient education and reduce anxiety, thereby improving patient outcomes during cancer therapy.

Open heart surgery requires a proper understanding of the endocardial surface of the heart and vascular structures. While modern four-dimensional (4D) imaging enables excellent dynamic visualization of the blood pool, endocardial surface anatomy has not routinely been assessed. 4D image data were post-processed using commercially available virtual reality (VR) software. Using thresholding, the blood pool was segmented dynamically across the imaging volume. The segmented blood pool was further edited for correction of errors due to artifacts or inhomogeneous signal intensity. Then, a surface shell of an even thickness was added to the edited blood pool. When the cardiac valve leaflets and chordae were visualized, they were segmented separately using a different range of signal intensity for thresholding. Using an interactive cutting plane, the endocardial surface anatomy was reviewed from multiple perspectives by interactively applying a cutting plane, rotating and moving the model. In conclusions, dynamic three-dimensional (3D) endocardial surface imaging is feasible and provides realistic simulated views of the intraoperative scenes at open heart surgery. As VR is based on the use of all fingers of both hands, the efficiency and speed of postprocessing are markedly enhanced. Although it is limited, visualization of the cardiac valve leaflets and chordae is also possible., Competing Interests: Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://tp.amegroups.com/article/view/10.21037/tp-24-140/coif). The column “Pediatric Heart” was commissioned by the editorial office without any funding or sponsorship. J.P.F. received support from NIH for development of the 4D Cardiac MRI technique used to generate the input image data for this work (No. R01 HL127153-06). He is also a consultant for Covid Pharma from May 2023 on an ad hoc basis, for which he has not yet performed any service or received any fees. The authors have no other conflicts of interest to declare., (2024 Translational Pediatrics. All rights reserved.)

Background: Virtual reality is increasingly being used for health communication. This study aimed to propose and test an integrated model of the determinants of perceived learning effectiveness in virtual reality (VR) within health communication. It proposes that psychological distance negatively affects immersion, flow, and presence, positively affecting perceived learning effectiveness., Methods: The Fuzzy Decision Making Trial and Evaluation Laboratory Method (F-DEMATEL) and structural equation modeling (SEM) were used to test the proposed model. Data for the F-DEMATEL study were collected from 20 participants, whereas data for the SEM study were collected from 1104 participants, with 775 included in the final analysis., Results: The results of the F-DEMATEL study revealed that the three dimensions of psychological distance, emotional distance, spatial distance, and social distance are causal factors. In contrast, temporal, technical, and hypothetical distance are effect factors. The SEM results confirmed the negative effects of psychological distance on flow and presence and the positive effects of immersion and presence on perceived learning effectiveness. In addition, the mediating role of presence was confirmed., Conclusions: The results suggest that interrelationships among the factors can enhance the perceived learning effectiveness of health communication from VR. The crucial role of ensuring low psychological distance and high engagement in VR communication is also confirmed, providing crucial implications for VR communication practitioners., (© 2024. The Author(s).)

Background: Traditional surgical training and further education has historically involved long working hours and hands-on experience within the framework of a teacher-apprentice relationship; however, changes in regulatory policy in the USA and subsequently in Switzerland and the European Union from 2003, led to restrictions in the working hours of medical residents. As a result the traditional method of surgical training "see one, do one, teach one" has come under scrutiny, prompting a search for alternative training methods beyond the confines of the operating theater., Objective: This publication highlights the possibilities and limitations associated with the use of virtual reality (VR) and gamification in surgical training and further education. It examines the ability of these technological resources to enhance the effectiveness and engagement of medical residents and the feasibility of incorporating them into the surgical training curriculum., Material and Methods: The study was based on a literature search for current developments in surgical training, VR and gamification. Furthermore, various studies and projects that investigated the use of VR and gamification in medical training and further education were analyzed., Results and Discussion: In this investigation it could be shown that the use of VR reduces the perioperative risks and improves the training environment and learning. The use of gamification also increases the motivation and engagement of the medical residents. As a result the quality of medical education can be improved by the fusion of VR and gamification., (© 2024. The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)

Inclusive design does not stop at removing physical obstacles such as staircases. It also involves identifying architectural features that impose sensory burdens, such as repetitive visual patterns that are known to potentially cause dizziness or visual discomfort. In order to assess their influence on human gait and its stability, three repetitive patterns-random dots, repetitive stripes, and repetitive waves (Lisbon pattern)-were displayed in a coloured and greyscale variant in a virtual reality (VR) environment. The movements of eight participants were recorded using a motion capture system and electromyography (EMG). During all test conditions, a significant increase in the muscular activity of leg flexor muscles was identified just before touchdown. Further, an increase in the activity of laterally stabilising muscles during the swing phase was observed for all of the test conditions. The lateral and vertical centre of mass (CoM) deviation was statistically evaluated using a linear mixed model (LMM). The patterns did cause a significant increase in the CoM excursion in the vertical direction but not in the lateral direction. These findings are indicative of an inhibited and more cautious gait style and a change in control strategy. Furthermore, we quantified the induced discomfort by using both algorithmic estimates and self-reports. The Fourier-based methods favoured the greyscaled random dots over repetitive stripes. The colour metric favoured the striped pattern over the random dots. The participants reported that the wavey Lisbon pattern was the most disruptive. For architectural and structural design, this study indicates (1) that highly repetitive patterns should be used with care in consideration of their impact on the human visuomotor system and its behavioural effects and (2) that coloured patterns should be used with greater caution than greyscale patterns.

Acromioclavicular joint (AC) sprains are common, usually resulting from a fall on the corner of the shoulder or, less often, an outstretched arm. In this report, we discussed the assessment and physiotherapy protocol along with virtual reality (VR) training of a 21-year-old male state-level kabaddi player who complained of pain in his left shoulder following a history of fall on his left shoulder while playing. This study highlights clinical assessment, diagnostic assessment, therapeutic intervention, and outcomes for patients with a grade II AC sprain. Pain, range of motion (ROM), and muscle strength were clinically assessed. The patient was managed with cryotherapy, movement with mobilization (MWM), rigid taping, ROM exercises, VR training, and muscle strengthening. The results of the study concluded that our conventional physical therapy along with MWM adjunct to VR facilitates the patient's functional recovery., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Satone et al.)

Background and Objective: The increasing popularity of three-dimensional (3D) virtual reconstructions of two-dimensional (2D) imaging in urology has led to significant technological advancements, resulting in the creation of highly accurate 3D virtual models (3DVMs) that faithfully replicate individual anatomical details. This technology enhances surgical reality, providing surgeons with hyper-accurate insights into instantaneous subjective surgical anatomy and improving preoperative surgical planning. In the uro-oncologic field, the utility of 3D virtual reconstruction has been demonstrated in nephron-sparing surgery, impacting surgical strategy and postoperative outcomes in prostate cancer (PCa). The aim of this study is to offer a thorough narrative review of the current state and application of 3D reconstructions and augmented reality (AR) in radical prostatectomy (RP)., Methods: A non-systematic literature review was conducted using Medline, PubMed, the Cochrane Database, and Embase to gather information on clinical trials, randomized controlled trials, review articles, and prospective and retrospective studies related to 3DVMs and AR in RP. The search strategy followed the PICOS (Patients, Intervention, Comparison, Outcome, Study design) criteria and was performed in January 2024., Key Content and Findings: The adoption of 3D visualization has become widespread, with applications ranging from preoperative planning to intraoperative consultations. The urological community's interest in intraoperative surgical navigation using cognitive, virtual, mixed, and AR during RP is evident in a substantial body of literature, including 16 noteworthy investigations. These studies highlight the varied experiences and benefits of incorporating 3D reconstructions and AR into RP, showcasing improvements in preoperative planning, intraoperative navigation, and real-time decision-making., Conclusions: The integration of 3DVMs and AR technologies in urological oncology, particularly in the context of RP, has shown promising advancements. These technologies provide crucial support in preoperative planning, intraoperative navigation, and real-time decision-making, significantly improving the visualization of complex anatomical structures helping in the nerve sparing (NS) approach modulation and reducing positive surgical margin (PSM) rate. Despite positive outcomes, challenges such as small patient cohorts, lack of standardized methodologies, and concerns about costs and technology adoption persist.

Virtual reality (VR) and augmented reality (AR) technology hold potential across many disciplines in medicine to expand the delivery of education and healthcare. VR-AR applications in radiology, in particular, have gained prominence and have demonstrated advantages in many areas within the field. Recently, VR software has emerged to redesign the physical radiology workstation (ie, reading room) to expand the possibilities of diagnostic interpretation. Given the novelty of this technology, there is limited research investigating the potential applications of a simulated radiology workstation. In this review article, we explore VR-simulated reading room technology in its current form and illustrate the practical applications this technology will bring to future radiologists and learners. We also discuss the limitations and barriers to adopting this technology that must be overcome to truly understand its potential benefits. VR reading room technology offers great potential in radiology, but further research is needed to appreciate its benefits and identify areas for improvement. The findings and insights presented in this review contribute to the ongoing discourse on future technological advancements in radiology and healthcare, offering valuable recommendations for further research and practical implementation., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Providing patients with accurate and organized information about colonoscopy, while reducing anxiety, is critical to the procedure's success. This study evaluated the impact of an immersive 360° virtual reality (VR)-based educational intervention for first-time adult colonoscopy patients regarding anxiety, attitudes, knowledge, compliance with bowel preparation, and bowel cleanliness. A quasi-experimental design with a non-equivalent control group and non-synchronized pretest-post-test clinical trial was conducted with 40 patients in the experimental group and 40 in the control group. The 360° VR intervention included two sessions: precautions before colonoscopy and the colonoscopy process. The control group received education through individual verbal explanations with written materials. The findings indicated that the VR intervention significantly improved patients' colonoscopy-related anxiety, attitudes, adherence to bowel preparation instructions, and bowel cleanliness. Utilizing 360° VR as an educational tool has the potential to enhance the effectiveness of educational programs by providing realistic information and engaging patients. These findings suggest that 360° VR has the capacity to enhance screening rates and clinical outcomes by reducing negative perceptions associated with colonoscopy. Furthermore, the application of this method can extend to diverse diagnostic testing-related nursing situations in clinical settings.

Objective This study aimed to assess the reliability and reproducibility of the AO Spine Thoracolumbar Injury Classification System by using virtual reality (VR). We hypothesized that VR is a highly reliable and reproducible method to classify traumatic spine injuries. Methods VR 3D models were created from CT scans of 26 pediatric patients with thoracolumbar spine injuries. Seven orthopedic trainees were educated on the VR platform and AO Spine Thoracolumbar Injury Classification System. Classifications were summarized by primary class and subclass for both rater readings performed two weeks apart with image order randomized. Intra-observer reproducibility was quantified by Fleiss's kappa (kF) for primary classifications and Krippendorff's alpha (aK) for subclassifications along with 95% confidence intervals (CIs) for each rater and across all raters. Inter-observer reliability was quantified by kF for primary classifications and aK for subclassifications along with 95% CIs across all raters for the first read, the second read, and all reads combined. The interpretations were as follows: 0-0.2: slight; 0.2-0.4: fair; 0.4-0.6: moderate; 0.6-0.8: substantial; and >0.8: almost perfect agreement. Results A total of 364 classifications were submitted by seven raters. Intra-observer reproducibility ranged from moderate (kF=0.55) to almost perfect (kF=0.94) for primary classifications and from substantial (aK=0.68) to almost perfect (aK=0.91) for subclassifications. Reproducibility was substantial across all raters for the primary class (kF=0.71; 95% CI=0.61-9.82) and subclass (aK=0.79; 95% CI=0.69-0.86). Inter-observer reliability was substantial (kF=0.63; 95% CI=0.57-0.69) for the first read, moderate (kF=0.58; 95% CI=0.52-0.64) for the second read, and substantial (kF=0.61; 95% CI=0.56-0.65) for all reads for primary classifications. For subclassifications, inter-observer reliability was substantial (aK=0.74; 95% CI=0.58-0.83) for the first read, second read (aK=0.70; 95% CI=0.53-0.80), and all reads (aK=0.72; 95% CI=0.60-0.79). Conclusions Based on our findings, VR is a reliable and reproducible method for the classification of pediatric spine trauma, besides its ability to function as an educational tool for trainees. Further research is needed to evaluate its application for other spine conditions., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Boston Children's Hospital Institutional Review Board issued approval IRB-P00040511. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Welch et al.)

The integration of virtual, mixed, and augmented reality technologies in cognitive neuroscience and neuropsychology represents a transformative frontier. In this Commentary, we conducted a meta-analysis of studies that explored the impact of Virtual Reality (VR), Mixed Reality (MR), and Augmented Reality (AR) on cognitive neuroscience and neuropsychology. Our review highlights the versatile applications of VR, ranging from spatial cognition assessments to rehabilitation for Traumatic Brain Injury. We found that MR and AR offer innovative avenues for cognitive training, particularly in memory-related disorders. The applications extend to addressing social cognition disorders and serving as therapeutic interventions for mental health issues. Collaborative efforts between neuroscientists and technology developers are crucial, with reinforcement learning and neuroimaging studies enhancing the potential for improved outcomes. Ethical considerations, including informed consent, privacy, and accessibility, demand careful attention. Our review identified common aspects of the meta-analysis, including the potential of VR technologies in cognitive neuroscience and neuropsychology, the use of MR and AR in memory research, and the role of VR in neurorehabilitation and therapy.

Introduction: Optimal radiographic image quality is critical because it affects the accuracy of the reporter's interpretation. Radiographers have an ethical obligation to obtain quality diagnostic images while protecting patients from unnecessary radiation, including minimizing rejected and repeated images. Repeated imaging due to positioning errors have increased in recent years., Methods: This study evaluated the effectiveness of non-immersive virtual reality (VR) simulation on first-year students' evaluation of positioning errors on resultant knee and lumbar spine images. Crossover intervention design was used to deliver radiographic image evaluation instruction through traditional lecture and guided simulation using non-immersive VR to 33 first-year radiography students at a single academic institution located across four geographic program locations. Pre- and post-test knowledge assessments examined participants' ability to recognize positioning errors on multiple-choice and essay questions., Results: Raw mean scores increased on multiple choice questions across the entire cohort for the knee (M = 0.82, SD = 3.38) and lumbar spine (M = 2.91, SD = 3.69) but there was no significant difference in performance by instructional method (p = 0.60). Essay questions reported very minimal to no raw mean score increases for the knee (M = 0.27, SD = 2.78) and lumbar spine (M = 0.00, SD = 2.55), with no significant difference in performance by instructional method (p = 0.72)., Conclusion: Guided simulation instruction was shown to be as effective as traditional lecture. Results also suggest that novice learners better recognize image evaluation errors and corrections from a list of options but have not yet achieved the level of competence needed to independently evaluate radiographic images for diagnostic criteria., Implications for Practice: Non-immersive VR simulation is an effective tool for image evaluation instruction. VR increases access to authentic image evaluation practice by providing a simulated resultant image based off the students' applied positioning skills., (Copyright © 2024 The College of Radiographers. Published by Elsevier Ltd. All rights reserved.)

Purpose: The study critically reassesses existing Metaverse concepts and proposes a novel framework for inclusiveness of physically disabled artists. The purpose is to enable and inspire physically disabled users and content creators to participate in the evolving concept of the Metaverse. The article also highlights the need for standards and regulations governing the inclusion of people with disabilities in Metaverse projects., Materials and Methods: The study examines current information technologies and their relevance to the inclusion of physically disabled individuals in the Metaverse. We analyse existing Metaverse concepts, exploring emerging information technologies such as Virtual and Augmented Reality, and the Internet of Things. The emerging framework in the article is based on the active involvement of disabled creatives in the development of solutions for inclusivity., Results: The review reveals that despite the proliferation of Blockchain Metaverse projects, the inclusion of physically disabled individuals in the Metaverse remains distant, with limited standards and regulations in place. The article proposes a concept of the Metaverse that leverages emerging technologies, to enable greater engagement of disabled creatives. This approach is designed to enhance inclusiveness in the Metaverse landscape., Conclusions: Active involvement of physically disabled individuals in the design and development of Metaverse platforms is crucial for promoting inclusivity. The framework for accessibility and inclusiveness in decentralised Metaverses provides a basis for the meaningful participation of disabled creatives. The article emphasises the importance of addressing the mechanisms for art production by individuals with disabilities in the emerging Metaverse landscape.

To understand how the human brain distinguishes itself from external stimulation, it was examined if motor predictions enable healthy adult volunteers to infer self-location and to distinguish their body from the environment (and other agents). By uniquely combining a VR-setup with full-body motion capture, a full-body illusion paradigm (FBI) was developed with different levels of motion control: (A) a standard, passive FBI in which they had no motion control; (B) an active FBI in which they made simple, voluntary movements; and (C) an immersive game in which they real-time controlled a human-sized avatar in third person. Systematic comparisons between measures revealed a causal relationship between (i) motion control (prospective agency), (ii) self-other identification, and (iii) the ability to locate oneself. Healthy adults could recognise their movements in a third-person avatar and psychologically align with it (action observation); but did not lose a sense of place (self-location), time (temporal binding), nor who they are (self/other). Instead, motor predictions enabled them to localise their body and to distinguish self from other. In the future, embodied games could target and strengthen the brain's control networks in psychosis and neurodegeneration; real-time motion simulations could help advance neurorehabilitation techniques by fine-tuning and personalising therapeutic settings., (© 2024. The Author(s).)

Virtualization plays a critical role in enriching the user experience in Virtual Reality (VR) by offering heightened realism, increased immersion, safer navigation, and newly achievable levels of interaction and personalization, specifically in indoor environments. Traditionally, the creation of virtual content has fallen under one of two broad categories: manual methods crafted by graphic designers, which are labor-intensive and sometimes lack precision; traditional Computer Vision (CV) and Deep Learning (DL) frameworks that frequently result in semi-automatic and complex solutions, lacking a unified framework for both 3D reconstruction and scene understanding, often missing a fully interactive representation of the objects and neglecting their appearance. To address these diverse challenges and limitations, we introduce the Virtual Experience Toolkit (VET), an automated and user-friendly framework that utilizes DL and advanced CV techniques to efficiently and accurately virtualize real-world indoor scenarios. The key features of VET are the use of ScanNotate, a retrieval and alignment tool that enhances the precision and efficiency of its precursor, supported by upgrades such as a preprocessing step to make it fully automatic and a preselection of a reduced list of CAD to speed up the process, and the implementation in a user-friendly and fully automatic Unity3D application that guides the users through the whole pipeline and concludes in a fully interactive and customizable 3D scene. The efficacy of VET is demonstrated using a diversified dataset of virtualized 3D indoor scenarios, supplementing the ScanNet dataset.

The proliferation of digital technologies is substantially transforming inspection methodologies for construction activities. Although the implementation of a three-dimensional (3D) model has emerged as an advantageous, feasible inspection application, the selection of the most suitable 3D models is challenging due to multiple technology options. The primary objectives of this study were to investigate current trends and identify future technologies for 3D models in the construction industry. This study utilized systematic reviews by identifying and selecting quality journals, analyzing selected articles, and conducting content analysis and meta-analysis to identify dominant themes in 3D models. Results showed that the top technologies used to model construction projects are building information models, remote sensing, stereo vision system/photo processing programs, and augmented reality/virtual reality. The main benefits and challenges of these technologies for modeling were also determined. This study identified three areas with significant knowledge gaps for future research: (1) the amalgamation of two or more technologies to overcome project obstacles; (2) solution optimization for inspections in remote areas; and (3) the development of algorithm-based technologies. This research contributes to the body of knowledge by exploring current trends and future directions of 3D model technologies in the construction industry.

Introduction: Diagnosis of Attention Deficit/Hyperactivity Disorder (ADHD) is based on clinical evaluation of symptoms by a psychiatrist, referencing results of psychological tests. When diagnosing ADHD, the child's behavior and functionality in real-life situations are critical components. However, direct observation by a clinician is often not feasible in practice. Therefore, such information is typically gathered from primary caregivers or teachers, which can introduce subjective elements. To overcome these limitations, we developed AttnKare-D, an innovative digital diagnostic tool that could analyze children's behavioral data in Virtual Reality using Artificial Intelligence. The purpose of this study was to explore the utility and safety of AttnKare-D for clinical application., Method: A total of 21 children aged between 6 and 12 years were recruited for this study. Among them, 15 were children diagnosed with ADHD, 5 were part of a normal control group, and 1 child was excluded due to withdrawal of consent. Psychological assessments, including K-WISC, Conners CPT, K-ARS, and K-CBCL, were conducted for participants and their primary caregivers. Diagnoses of ADHD were confirmed by child and adolescent psychiatrists based on comprehensive face-to-face evaluations and results of psychological assessments. Participants underwent VR diagnostic assessment by performing various cognitive and behavioral tasks in a VR environment. Collected data were analyzed using an AI model to assess ADHD diagnosis and the severity of symptoms., Results: AttnKare-D demonstrated diagnostic performance with an AUC of 0.893 when compared to diagnoses made by child and adolescent psychiatrist, showing a sensitivity of 0.8 and a specificity of 1.0 at a cut-off score of 18.44. AttnKare-D scores showed a high correlation with K-ARS scores rated by parents and experts, although the correlation was relatively low for inattention scores., Conclusion: Results of this study suggest that AttnKare-D can be a useful tool for diagnosing ADHD in children. This approach has potential to overcome limitations of current diagnostic methods, enhancing the accuracy and objectivity of ADHD diagnoses. This study lays the groundwork for further improvement and research on diagnostic tools integrating VR and AI technologies. For future clinical applications, it is necessary to conduct clinical trials involving a sufficient number of participants to ensure reliable use., Competing Interests: T-MC is the CEO of Hippo T&C, the developer of AttnKare-D. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Oh, Joung, Chung, Lee, Seok, Kim and Son.)

Pain is a significant health issue, and pain assessment is essential for proper diagnosis, follow-up, and effective management of pain. The conventional methods of pain assessment often suffer from subjectivity and variability. The main issue is to understand better how people experience pain. In recent years, artificial intelligence (AI) has been playing a growing role in improving clinical diagnosis and decision-making. The application of AI offers promising opportunities to improve the accuracy and efficiency of pain assessment. This review article provides an overview of the current state of AI in pain assessment and explores its potential for improving accuracy, efficiency, and personalized care. By examining the existing literature, research gaps, and future directions, this article aims to guide further advancements in the field of pain management. An online database search was conducted via multiple websites to identify the relevant articles. The inclusion criteria were English articles published between January 2014 and January 2024). Articles that were available as full text clinical trials, observational studies, review articles, systemic reviews, and meta-analyses were included in this review. The exclusion criteria were articles that were not in the English language, not available as free full text, those involving pediatric patients, case reports, and editorials. A total of (47) articles were included in this review. In conclusion, the application of AI in pain management could present promising solutions for pain assessment. AI can potentially increase the accuracy, precision, and efficiency of objective pain assessment., (© 2024. The Author(s).)

Virtual reality (VR) is a potent educational tool with untapped potential in medical training. However, its integration into medical schools faces challenges such as cybersickness and hesitancy among medical students and professionals. Notably, there has been no systematic assessment of the acceptance of medical educational VR applications by both students and educators. In our single-center study, we enrolled 133 medical students and 14 medical educators. Following a practical demonstration of the established VR anatomy application, Sharecare YOU VR, participants completed a self-reporting survey based on the Technology Acceptance Model (TAM), exploring user acceptance of information technologies and focusing on perceived usefulness (PU), perceived ease of use (PEU), and attitude toward using (ATU). We also sought insights into potential future applications of VR in medical education. Our findings indicate a high level of acceptance among medical students and educators upon structured exposure to VR with significantly positive responses for all three TAM variables (PU, PEU, and ATU). Intriguingly, hands-on experience influenced acceptance. Students envisioned VR's benefits in anatomy, surgery, emergency medicine, and communication skill training with patients. Both students and educators believed that VR could enhance traditional approaches and complement the existing curriculum, anticipating improved preparedness for medical students through VR training applications. In conclusion, our results demonstrate the receptivity of both students and educators to immersive technologies, including VR, in medical education. Importantly, the data suggest that the adoption of VR in this field would be welcomed rather than resisted, potentially enhancing students' self-efficacy and enriching the medical school curriculum.

Chronic pain is prevalent in the Veteran population at a disproportionate rate. Given the concerns for traditional pharmacologic management of pain, many are turning to nonpharmacologic alternatives for the treatment of pain. Virtual reality (VR) is an evidence-based tool, which has been demonstrated to reduce pain in hospitalized patients, and has been used for this purpose within the VA Sierra Nevada Healthcare System (VASNHCS) since 2019. Given the ongoing demonstrated benefit in this setting, these authors set to assess benefit for pain when used in an outpatient setting (demonstrations in the clinic, treatments in the patient's home) and demonstrate safety when used outside of a supervised setting. In this analysis, pain intensity decreased by an average of 22% when comparing pre- and postimmersion pain scores, and by 12.7% when comparing baseline pain scores with the end of the analysis. Patients also reported that the use of VR reduced their stress, decreased pain, and improved their mood, and some participants were able to reduce use of their as-needed pain medications with the use of VR. These findings are limited by a small sample size; however, this study provides encouraging evidence of benefit and a framework for future, larger scale analyses., (© Megan Rumzie and Carla Figura 2024; Published by Mary Ann Liebert, Inc.)

Introduction: This study introduces a new method to create virtual reality (VR) environments for studying synchrony in human body movements and their prosocial effects. Previous studies have shown the positive effects of synchrony, but more controlled and ecologically valid paradigms are needed to explore these effects deeper and translate them to the therapeutic domain., Methods: A total of 82 healthy subjects participated in this study. They performed simple periodic hand movements in a virtual environment with a virtual character (VC) mimicking them. We used inverse kinematics (IKs) to create character movements. The VCs mimic the participants after a short delay in the synchronous group and after a great delay in the nonsynchronous group. The subjective feeling of synchrony and social closeness was measured using a set of rating questionnaires., Results: The participants in the synchronous group reported more synchrony than the nonsynchronous group. The degree of social closeness between the two groups was not significantly different; however, there was a significant positive correlation between the reported degree of synchrony and social closeness within each group., Conclusion: Using a simple VR environment in which body movements are simulated by IKs can engender the feeling of synchrony and exert its prosocial effects., (Copyright© 2024 Iranian Neuroscience Society.)

Background: Low self-confidence in patients with psychosis is common. This can lead to higher symptom severity, withdrawal from activities, and low psychological well-being. There are effective psychological techniques to improve positive self-beliefs but these are seldom provided in psychosis services. With young people with lived experience of psychosis we developed a scalable automated VR therapy to enhance positive-self beliefs., Aims: The aim was to conduct a proof of concept clinical test of whether the new VR self-confidence therapy (Phoenix) may increase positive self-beliefs and psychological well-being., Method: Twelve young patients with non-affective psychosis and with low levels of positive self-beliefs participated. Over 6 weeks, patients were provided with a stand-alone VR headset so that they could use Phoenix at home and were offered weekly psychologist meetings. The outcome measures were the Oxford Positive Self Scale (OxPos), Brief Core Schema Scale, and Warwick-Edinburgh Well-being Scale (WEMWBS). Satisfaction, adverse events and side-effects were assessed., Results: Eleven patients provided outcome data. There were very large end-of-treatment improvements in positive self-beliefs (OxPos mean difference = 32.3; 95% CI: 17.3, 47.3; Cohen's d =3.0) and psychological well-being (WEMWBS mean difference = 11.2; 95% CI: 8.0, 14.3; Cohen's d =1.5). Patients rated the quality of the VR therapy as: excellent ( n =9), good ( n =2), fair ( n =0), poor ( n =0). An average of 5.3 ( SD =1.4) appointments were attended., Conclusions: Uptake of the VR intervention was high, satisfaction was high, and side-effects extremely few. There were promising indications of large improvements in positive self-beliefs and psychological well-being. A randomized controlled clinical evaluation is warranted.

This work expands the existing understanding of quality assessments of VR experiences. Historically, VR quality has focused on presence and immersion, but current discourse emphasizes plausibility and believability as critical for lifelike, credible VR. However, the two concepts are often conflated, leading to confusion. This paper proposes viewing them as subsets of authenticity and presents a structured hierarchy delineating their differences and connections. Additionally, coherence and congruence are presented as complementary quality functions that integrate internal and external logic. The paper considers quality formation in the experience of authenticity inside VR emphasizing that distinguishing authenticity in terms of precise quality features are essential for accurate assessments. Evaluating quality requires a holistic approach across perceptual, cognitive, and emotional factors. This model provides theoretical grounding for assessing the quality of VR experiences., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Hameed and Perkis.)

Previous research has already provided evidence regarding the favorable impact of green walls and outdoor views on stress reduction and anxiety alleviation. However, there has been limited exploration into the combined effects of green walls and outdoor views on older adults. In this study, a between-subjects experiment was conducted using virtual reality (VR) technology with 23 participants. Following exposure to stressors, each participant underwent four randomized sessions, each lasting 5 min, in various virtual reality (VR) environments, encompassing non-biophilic and biophilic environments (including green walls, outdoor views, and their combination). Throughout the process, we measured physiological indicators of stress responses, including heart rate, heart rate variability, skin conductance levels, and blood pressure, using biometric sensors. Psychological changes in participants, including anxiety levels, were evaluated through the State-Trait Anxiety Inventory, recovery scales, and self-reported emotional assessments. In conclusion, in comparison to non-biophilic environments, older adults consistently exhibited lower stress levels, experienced superior anxiety relief, and demonstrated improved recovery in nature connectedness environments, with a notably faster recovery rate. These findings suggest that the incorporation of nature connectedness principles into the indoor environments of public activity spaces within older adults care facilities can significantly contribute to stress reduction and anxiety alleviation among older adults. Furthermore, these effects appear to be contingent on the specific types of nature connectedness environments. These results can provide substantial evidence to support the design of indoor common activity spaces within older adults care facilities., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Xiaoxue and Huang.)

Steady-state visual evoked potential brain-computer interfaces (SSVEP-BCI) have attracted significant attention due to their ease of deployment and high performance in terms of information transfer rate (ITR) and accuracy, making them a promising candidate for integration with consumer electronics devices. However, as SSVEP characteristics are directly associated with visual stimulus attributes, the influence of stereoscopic vision on SSVEP as a critical visual attribute has yet to be fully explored. Meanwhile, the promising combination of virtual reality (VR) devices and BCI applications is hampered by the significant disparity between VR environments and traditional 2D displays. This is not only due to the fact that screen-based SSVEP generally operates under static, stable conditions with simple and unvaried visual stimuli but also because conventional luminance-modulated stimuli can quickly induce visual fatigue. This study attempts to address these research gaps by designing SSVEP paradigms with stereo-related attributes and conducting a comparative analysis with the traditional 2D planar paradigm under the same VR environment. This study proposed two new paradigms: the 3D paradigm and the 3D-Blink paradigm. The 3D paradigm induces SSVEP by modulating the luminance of spherical targets, while the 3D-Blink paradigm employs modulation of the spheres' opacity instead. The results of offline 4-object selection experiments showed that the accuracy of 3D and 2D paradigm was 85.67 and 86.17% with canonical correlation analysis (CCA) and 86.17 and 91.73% with filter bank canonical correlation analysis (FBCCA), which is consistent with the reduction in the signal-to-noise ratio (SNR) of SSVEP harmonics for the 3D paradigm observed in the frequency-domain analysis. The 3D-Blink paradigm achieved 75.00% of detection accuracy and 27.02 bits / min of ITR with 0.8 seconds of stimulus time and task-related component analysis (TRCA) algorithm, demonstrating its effectiveness. These findings demonstrate that the 3D and 3D-Blink paradigms supported by VR can achieve improved user comfort and satisfactory performance, while further algorithmic optimization and feature analysis are required for the stereo-related paradigms. In conclusion, this study contributes to a deeper understanding of the impact of binocular stereoscopic vision mechanisms on SSVEP paradigms and promotes the application of SSVEP-BCI in diverse VR environments., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Liu, Wang, Li, Zhao, Xu, Zhou and Hu.)

Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Background: Chronic pain is a disabling condition which is prevalent in about 20% of the adult population. Physiotherapy is the most common non-pharmacological treatment option for chronic pain, but often demonstrates unsatisfactory outcomes. Virtual Reality (VR) may offer the opportunity to complement physiotherapy treatment. As VR has only recently been introduced in physiotherapy care, it is unknown to what extent VR is used and how it is valued by physiotherapists. The aim of this study was to analyse physiotherapists' current usage of, experiences with and physiotherapist characteristics associated with applying therapeutic VR for chronic pain rehabilitation in Dutch primary care physiotherapy., Methods: This online survey applied two rounds of recruitment: a random sampling round (873 physiotherapists invited, of which 245 (28%) were included) and a purposive sampling round (20 physiotherapists using VR included). Survey results were reported descriptively and physiotherapist characteristics associated with VR use were examined using multivariable logistic regression analysis., Results: In total, 265 physiotherapists participated in this survey study. Approximately 7% of physiotherapists reported using therapeutic VR for patients with chronic pain. On average, physiotherapists rated their overall experience with therapeutic VR at 7.0 and "whether they would recommend it" at 7.2, both on a 0-10 scale. Most physiotherapists (71%) who use therapeutic VR started using it less than two years ago and use it for a small proportion of their patients with chronic pain. Physiotherapists use therapeutic VR for a variety of conditions, including generalized (55%), neck (45%) and lumbar (37%) chronic pain. Physiotherapists use therapeutic VR mostly to reduce pain (68%), improve coordination (50%) and increase physical mobility (45%). Use of therapeutic VR was associated with a larger physiotherapy practice (OR = 2.38, 95% CI [1.14-4.98]). Unfamiliarity with VR seemed to be the primary reason for not using VR., Discussion: Therapeutic VR for patients with chronic pain is in its infancy in Dutch primary care physiotherapy practice as only a small minority uses VR. Physiotherapists that use therapeutic VR are modestly positive about the technology, with large heterogeneity between treatment goals, methods of administering VR, proposed working mechanisms and chronic pain conditions to treat., (© 2024. The Author(s).)

Background: The concepts of advance care planning (ACP) and advance decisions/directives (ADs) are widely recognized around the world. The Patient Right to Autonomy Act in Taiwan, the first of its kind in Asia, went into effect in 2019. However, a lack of knowledge and confidence regarding ACP and ADs is a barrier for medical professionals in discussing ACP and ADs with their patients. In addition, in Asian countries, physicians tend to make family-centered decisions, which influence how they can implement ADs., Methods: Virtual reality (VR) is known for its immersive and interactive simulation experience and can upgrade medical education. We developed a VR teaching module to help medical professionals better understand ACP and ADs, with assessment tools integrated into the module. The participants were asked to answer seven knowledge items embedded in the module and fill out the surveys regarding attitudes toward ACP and ADs and confidence in implementing ADs before and after the module. They also reported behaviors related to ADs before and three months after the VR experience., Results: From July 2020 to June 2022, 30 physicians and 59 nurses joined the study, and 78.7% of them had no prior experience in hospice care. After learning from the VR module, all 89 participants were able to answer all seven items correctly. The results showed a slightly more positive attitude toward ACP and ADs (scores: 32.29 ± 3.80 versus 33.06 ± 3.96, p < .05) and more confidence in implementing ADs (scores: 13.96 ± 2.68 versus 16.24 ± 2.67, p < .001) after the VR module. Changes in AD-related behaviors (scores: 11.23 ± 4.01 versus 13.87 ± 4.11, p < .001) were also noted three months after the VR experience., Conclusions: This study found that medical professionals may have better knowledge of ACP and ADs, slightly improved attitudes toward ACP and ADs, and greater confidence in implementing ADs after experiencing the VR module. Most importantly, the findings suggested that using a VR format may help motivate medical professionals to perform essential behaviors related to ADs, including introducing ADs to their patients and discussing ADs with their own family., (© 2023. The Author(s).)

Extended reality (XR) technology refers to any situation where real-world objects are enhanced with computer technology, including virtual reality, augmented reality, and mixed reality. Augmented reality and mixed reality technologies have been widely applied in orthopedic clinical practice, including in teaching, preoperative planning, intraoperative navigation, and surgical outcome evaluation. The primary goal of this narrative review is to summarize the effectiveness and superiority of XR-technology-assisted intraoperative navigation in the fields of trauma, joint, spine, and bone tumor surgery, as well as to discuss the current shortcomings in intraoperative navigation applications. We reviewed titles of more than 200 studies obtained from PubMed with the following search terms: extended reality, mixed reality, augmented reality, virtual reality, intraoperative navigation, and orthopedic surgery; of those 200 studies, 69 related papers were selected for abstract review. Finally, the full text of 55 studies was analyzed and reviewed. They were classified into four groups-trauma, joint, spine, and bone tumor surgery-according to their content. Most of studies that we reviewed showed that XR-technology-assisted intraoperative navigation can effectively improve the accuracy of implant placement, such as that of screws and prostheses, reduce postoperative complications caused by inaccurate implantation, facilitate the achievement of tumor-free surgical margins, shorten the surgical duration, reduce radiation exposure for patients and surgeons, minimize further damage caused by the need for visual exposure during surgery, and provide richer and more efficient intraoperative communication, thereby facilitating academic exchange, medical assistance, and the implementation of remote healthcare., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (© 2024 Bian, Lin, Lu, Zhong, Wang, Tang and Zang.)

Healthcare providers, particularly during the COVID-19 crisis, have been forced to make difficult decisions and have reported acting in ways that are contrary to their moral values, integrity, and professional commitments, given the constraints in their work environments. Those actions and decisions may lead to healthcare providers' moral suffering and distress. This work outlines the development of the Moral Distress Virtual Reality Simulator (Moral Distress VRS) to research stress and moral distress among healthcare workers during the COVID-19 pandemic. The Moral Distress VRS was developed based on the agile methodology framework, with three simultaneous development streams. It followed a two-week sprint cycle, ending with meetings with stakeholders and subject matter experts, whereby the project requirements, scope, and features were revised, and feedback was provided on the prototypes until reaching the final prototype that was deployed for in-person study sessions. The final prototype had two user interfaces (UIs), one for the participant and one for the researcher, with voice narration and customizable character models wearing medical personal protective equipment, and followed a tree-based dialogue scenario, outputting a video recording of the session. The virtual environment replicated an ICU nursing station and a fully equipped patient room. We present the development process that guided this project, how different teams worked together and in parallel, and detail the decisions and outcomes in creating each major component within a limited deadline. Finally, we list the most significant challenges and difficulties faced and recommendations on how to solve them., Competing Interests: VB has received research support from CIHR, BBRF, MOH Innovation Funds, RCPSC, DND, Canada, NFRF, AMS HealthCare, and from Roche Canada, Novartis and Eisai., (Copyright © 2024, Torres et al.)

Together with the wide range of possible benefits for the rehabilitation/training of people with multiple sclerosis (pwMS) and other neurologic conditions, exposure to immersive virtual reality (VR) has often been associated with unpleasant symptoms, such as transient dizziness, headache, nausea, disorientation and impaired postural control (i.e., cybersickness). Since these symptoms can significantly impact the safety and tolerability of the treatment, it appears important to correctly estimate their presence and magnitude. Given the existing data scarcity, this study aims to assess the existence and severity of possible adverse effects associated with exposure to immersive VR in a cohort of pwMS using both objective measurements of postural control effectiveness and subjective evaluations of perceived symptoms. To this aim, postural sway under upright quiet posture (in the presence and absence of visual input) of 56 pwMS with an Expanded Disability Status Scale score (EDSS) in the range of 0-6.5 (mean EDSS 2.3) and 33 unaffected individuals was measured before and after a 10-min immersive VR session and at 10 min follow-up on the basis of center of pressure (COP) trajectories. The severity of cybersickness symptoms associated with VR exposure was also self-rated by the participants using the Italian version of the Simulator Sickness Questionnaire (SSQ). Temporary impairments of postural control in terms of significantly increased sway area were observed after the VR session only in pwMS with mild-moderate disability (i.e., EDSS in the range of 2.5-6.5) in the presence of visual input. No changes were observed in pwMS with low disability (EDSS 0-2) and unaffected individuals. In contrast, when the visual input was removed, there was a decrease in sway area (pwMS with mild-moderate disability) and COP path length relating to the use of VR (pwMS with mild-moderate disability and unaffected individuals), thus suggesting a sort of "balance training effect". Even in this case, the baseline values were restored at follow-up. All participants, regardless of their status, experienced significant post-VR side effects, especially in terms of blurred vision and nausea. Taken together, the findings of the present study suggest that a short immersive VR session negatively (eyes open) and positively (eyes closed) impacts the postural control of pwMS and causes significant disorientation. However, such effects are of limited duration. While it is reasonable to state that immersive VR is sufficiently safe and tolerable to not be contraindicated in the rehabilitation/training of pwMS, in order to reduce possible negative effects and maximize the efficacy, safety and comfort of the treatment, it appears necessary to develop specific guidelines that consider important factors like individual susceptibility, maximum exposure time according to the specific features of the simulation, posture to adopt and protocols to assess objective and perceived effects on participants.

Background . Robotic-assisted thoracic surgery (RATS) is now standard for lung cancer treatment, offering advantages over traditional methods. However, RATS's minimally invasive approach poses challenges like limited visibility and tactile feedback, affecting surgeons' navigation through com-plex anatomy. To enhance preoperative familiarization with patient-specific anatomy, we devel-oped a virtual reality (VR) surgical navigation system. Using head-mounted displays (HMDs), this system provides a comprehensive, interactive view of the patient's anatomy pre-surgery, aiming to improve preoperative simulation and intraoperative navigation. Methods . We integrated 3D data from preoperative CT scans into Perspectus VR Education software, displayed via HMDs for in-teractive 3D reconstruction of pulmonary structures. This detailed visualization aids in tailored preoperative resection simulations. During RATS, surgeons access these 3D images through Tile-Pro TM multi-display for real-time guidance. Results . The VR system enabled precise visualization of pulmonary structures and lesion relations, enhancing surgical safety and accuracy. The HMDs offered true 3D interaction with patient data, facilitating surgical planning. Conclusions . VR sim-ulation with HMDs, akin to a robotic 3D viewer, offers a novel approach to developing robotic surgical skills. Integrated with routine imaging, it improves preoperative planning, safety, and accuracy of anatomical resections. This technology particularly aids in lesion identification in RATS, optimizing surgical outcomes.

While immersive media services represented by virtual reality (VR) are booming, They are facing fundamental challenges, i.e., soaring multimedia applications, large operation costs and scarce spectrum resources. It is difficult to simultaneously address these service challenges in a conventional radio access network (RAN) system. These problems motivated us to explore a quality-of-service (QoS)-driven resource allocation framework from VR service perspective based on the fog radio access network (F-RAN) architecture. We elaborated details of deployment on the caching allocation, dynamic base station (BS) clustering, statistical beamforming and cost strategy under the QoS constraints in the F-RAN architecture. The key solutions aimed to break through the bottleneck of the network design and to deep integrate the network-computing resources from different perspectives of cloud, network, edge, terminal and use of collaboration and integration. Accordingly, we provided a tailored algorithm to solve the corresponding formulation problem. This is the first design of VR services based on caching and statistical beamforming under the F-RAN. A case study provided to demonstrate the advantage of our proposed framework compared with existing schemes. Finally, we concluded the article and discussed possible open research problems.

Thermal discomfort is a driver of negative user experiences with modern VR headsets since they are similar to head-worn gaming computers. Here, we examined the effect of microclimate temperature (MCT; i.e., the air between headset and user) and the effect of standing and seated use on thermal discomfort for a goggle style headset. Users played VR games across three 48-min sessions with different thermal profiles ranging between 28°-43 °C. Perceived thermal and weight discomfort were rated by participants every 12-min. Thermal, but not weight comfort declined during the study period as MCT increased. Users sweat more and had greater forehead temperatures while standing with the lowest thermal profile, suggesting thermal management is more critical for active experiences. Overall, this study recommends MCT should be kept below 36 °C. Finally design for thermal comfort should be tailored to the individual, experience duration and activity level., Competing Interests: Declaration of competing interest For the manuscript titled “Is It Getting Hot In Here? The Effects Of VR Headset Microclimate Temperature on Perceived Thermal Discomfort, VR Sickness, and Skin Temperature”. We declare no conflicts of interests associated with this publication. There has been no significant financial support for this work that would have influenced the outcomes. The manuscript has been read and approved by all named authors., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Digital well-being records are multimodal and high-dimensional (HD). Better theradiagnostics stem from new computationally thorough and edgy technologies, i.e., hyperspectral (HSI) imaging, super-resolution, and nanoimaging, but advance mess data portrayal and retrieval. A patient's state involves multiple signals, medical imaging (MI) modalities, clinical variables, dialogs between clinicians and patients, metadata, genome sequencing, and signals from wearables. Patients' high volume, personalized data amassed over time have advanced artificial intelligence (AI) models for higher-precision inferences, prognosis, and tracking. AI promises are undeniable, but with slow spreading and adoption, given partly unstable AI model performance after real-world use. The HD data is a rate-limiting factor for AI algorithms generalizing real-world scenarios. This paper studies many health data challenges to robust AI models' growth, aka the dimensionality curse (DC). This paper overviews DC in the MIs' context, tackles the negative out-of-sample influence and stresses important worries for algorithm designers. It is tricky to choose an AI platform and analyze hardships. Automating complex tasks requires more examination. Not all MI problems need automation via DL. AI developers spend most time refining algorithms, and quality data are crucial. Noisy and incomplete data limits AI, requiring time to handle control, integration, and analyses. AI demands data mixing skills absent in regular systems, requiring hardware/software speed and flexible storage. A partner or service can fulfill anomaly detection, predictive analysis, and ensemble modeling.

Introduction: This study investigates the relationship between ceiling height and emotional responses in art galleries, using editable 360-degree VR panoramic scenes. Prior research has explored the influence of spatial dimensions on general emotions, but the specific impact of ceiling height in art gallery settings, particularly on discrete emotions, remains understudied., Methods: The study utilized 360-degree panoramic photo scene modeling to modify ceiling heights within virtual art galleries, assessing emotional responses through self-report measures. Participants were presented with virtual art gallery environments featuring varying ceiling heights. Two studies were conducted: Study 1 involved absolute emotion rating across different ceiling heights, and Study 2 focused on selecting ceiling heights based on assigned emotions., Results: The data revealed that ceiling height significantly impacts specific emotions, notably disgust and joy. Lower ceiling heights generally evoked higher levels of fear and anger, while higher ceiling heights were associated with increased joy. The impact on other emotions like sadness, surprise, and disgust was more nuanced and varied across different ceiling heights., Discussion: The findings highlight a complex relationship between ceiling height and emotional responses in art galleries. The study demonstrates the efficacy of using editable 360-degree VR panoramic scenes in environmental psychology and architecture research, offering insights into how spatial dimensions influence emotional experiences in architectural settings., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Zhang, Fort, Giménez Mateu and Chi.)

This study delved into the realm of facial emotion recognition within virtual reality (VR) environments. Using a novel system with MobileNet V2, a lightweight convolutional neural network, we tested emotion detection on 15 university students. High recognition rates were observed for emotions like "Neutral", "Happiness", "Sadness", and "Surprise". However, the model struggled with 'Anger' and 'Fear', often confusing them with "neutral". These discrepancies might be attributed to overlapping facial indicators, limited training samples, and the precision of the devices used. Nonetheless, our research underscores the viability of using facial emotion recognition technology in VR and recommends model improvements, the adoption of advanced devices, and a more holistic approach to foster the future development of VR emotion recognition., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Zhang, Fort and Giménez Mateu.)

In the realm of dentistry, a myriad of technological advancements, including teledentistry, virtual reality (VR), artificial intelligence (AI), and three-dimensional printing, have been extensively embraced and rigorously evaluated, consistently demonstrating their remarkable effectiveness. These innovations have ushered in a transformative era in dentistry, impacting every facet of the field. They encompass activities ranging from the diagnosis and exploration of oral health conditions to the formulation of treatment plans, execution of surgical procedures, fabrication of prosthetics, and even assistance in patient distraction, prognosis, and disease prevention. Despite the significant strides already taken, the relentless pursuit of new horizons fueled by human curiosity remains unabated. The future landscape of dentistry holds the promise of sweeping changes, notably characterized by enhanced accessibility to dental care and reduced treatment durations. In this comprehensive review article, we delve into the pivotal roles played by AI, VR, augmented reality, mixed reality, and extended reality within the realm of dentistry, with a particular emphasis on their applications in oral medicine, oral radiology, oral surgery, and oral pathology. These technologies represent just a fraction of the technological arsenal currently harnessed in the field of dentistry. A thorough comprehension of their advantages and limitations is imperative for informed decision-making in their utilization., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Singhal et al.)

Objectives: This research focuses on how built environment experts can contribute to the MXR-enabled digital innovation as part of the multidisciplinary team effort to ensure post-pandemic resilience in healthcare built environment. The goal of this research is to help healthcare providers, built environment experts, and policy makers respectively: (1) Advocate the benefits of MXR for innovating health and social care; (2) Spark debate across networks of expertise to create health-promoting environment; and (3) Understand the overriding priorities in making effective pathways to the implementation of MXR., Methods: To highlight the novelty of this research, the study relies on two qualitative methodologies: exploratory literature review and semi-structured interviews. Based on the evaluation of prior works and cross-national case studies, hypotheses are formulated from three arenas: (1) Cross-sectional Initiatives for Post-pandemic Resilience; (2) Interoperability and Usability of Next-gen Medicines; and (3) Metaverse and New Forms of Value in Future Healthcare Ecosystems. To verify those hypotheses, empirical findings are derived from in-depth interviews with nine key informants., Results: The main findings are summarized under the following three themes: (1) Synergism between Architecture and Technology; (2) Patient Empowerment and Staff Support; and (3) Scalable Health and Wellbeing in Non-hospital and Therapeutic Settings. Firstly, both built environment and healthcare sectors can benefit from the various capabilities of MXR through cross-sectional initiatives, evidence-based practices, and participatory approaches. Secondly, a confluence of knowledge and methods of HCI and HBI can increase the interoperability and usability of MXR for the patient-centered and value-based healthcare models. Thirdly, the MXR-enabled technological regime will largely affect the new forms of value in healthcare premises by fostering more decentralized, preventive, and therapeutic characteristics in the future healthcare ecosystems., Conclusion: Whether it's virtual or physical, our healthcare systems have placed great emphasis on the rigor of evidence-based approach linking health outcome to a clinical environment. Henceforth, built environment experts should seek closer ties with the MXR ecosystems for the co-production of scalable health and wellbeing in non-hospital and therapeutic settings. Ultimately, this is to improve resource efficiency in the healthcare sector while considering the transition of health resources towards in silico status by increasing the implementation of MXR., Competing Interests: The author declares that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (© 2023 Yang.)

Background: Occupational workers at altitudes are more prone to falls, leading to catastrophic outcomes. Acrophobia, height-related anxiety, and affected executive functions lead to postural instabilities, causing falls. This study investigated the effects of repeated virtual height exposure and training on cognitive processing and height-related anxiety., Methods: Twenty-eight healthy volunteers (age 20.48 ± 1.26 years; mass 69.52 ± 13.78 kg) were recruited and tested in seven virtual environments (VE) [ground (G), 2-story altitude (A1), 2-story edge (E1), 4-story altitude (A2), 4-story edge (E2), 6-story altitude (A3), and 6-story edge (E3)] over three days. At each VE, participants identified occupational hazards present in the VE and completed an Attitude Towards Heights Questionnaire (ATHQ) and a modified State-Trait Anxiety Inventory Questionnaire (mSTAIQ). The number of hazards identified and the ATHQ and mSTAIQ scores were analyzed using a 7 (VE; G, A1, A2, A3, E1, E2, E3) x 3 (DAY; DAY 1, DAY 2, DAY 3) factorial repeated measures analysis of variance., Results: The participants identified the lowest number of hazards at A3 and E3 VEs and on DAY 1 compared to other VEs and DAYs. ATHQ scores were lowest at G, A1, and E1 VEs., Conclusion: Cognitive processing is negatively affected by virtual altitudes, while it improves with short-term training. The features of virtual reality, such as higher involvement, engagement, and reliability, make it a better training tool to be considered in ergonomic settings. The findings of this study will provide insights into cognitive dual-tasking at altitude and its challenges, which will aid in minimizing occupational falls., Competing Interests: All authors have no conflicts of interest to declare., (© 2023 The Authors.)

Objective . When multitasking, we must dynamically reorient our attention between different tasks. Attention reorienting is thought to arise through interactions of physiological arousal and brain-wide network dynamics. In this study, we investigated the relationship between pupil-linked arousal and electroencephalography (EEG) brain dynamics in a multitask driving paradigm conducted in virtual reality. We hypothesized that there would be an interaction between arousal and EEG dynamics and that this interaction would correlate with multitasking performance. Approach . We collected EEG and eye tracking data while subjects drove a motorcycle through a simulated city environment, with the instructions to count the number of target images they observed while avoiding crashing into a lead vehicle. The paradigm required the subjects to continuously reorient their attention between the two tasks. Subjects performed the paradigm under two conditions, one more difficult than the other. Main results . We found that task difficulty did not strongly correlate with pupil-linked arousal, and overall task performance increased as arousal level increased. A single-trial analysis revealed several interesting relationships between pupil-linked arousal and task-relevant EEG dynamics. Employing exact low-resolution electromagnetic tomography, we found that higher pupil-linked arousal led to greater EEG oscillatory activity, especially in regions associated with the dorsal attention network and ventral attention network (VAN). Consistent with our hypothesis, we found a relationship between EEG functional connectivity and pupil-linked arousal as a function of multitasking performance. Specifically, we found decreased functional connectivity between regions in the salience network (SN) and the VAN as pupil-linked arousal increased, suggesting that improved multitasking performance at high arousal levels may be due to a down-regulation in coupling between the VAN and the SN. Our results suggest that when multitasking, our brain rebalances arousal-based reorienting so that individual task demands can be met without prematurely reorienting to competing tasks., (Creative Commons Attribution license.)

Objectives: To study the effect of virtual reality (VR) on satisfaction, discomfort, stress, and cooperation in patients undergoing in-office potassium titanyl phosphate (KTP) laser procedure., Study Design: Prospective study., Methods: Thirty-seven patients were enrolled in this prospective study. The State Anxiety Scale of Spielberg's State-Trait Anxiety Inventory was used to measure the level of state anxiety. Satisfaction, discomfort, pain, stress, acceptance of VR, relaxation with VR, and willingness to wear VR were evaluated using a 100-mm visual analog scale (VAS). A 5-point Likert-like scale was used to rate the patient cooperation., Results: All procedures were completed successfully with cooperation of patients. Satisfaction score in VR group was 88.3 ± 9.0, and in control group was 81.6 ± 9.7 (P = 0.040). There were significant differences in both nasal cavity and laryngopharynx discomfort between two groups (P = 0.030 and P = 0.016, respectively). The pain score of control group was higher than that of VR group but it was not statistically significant (P = 0.140). The stress of control group during procedure was more obvious than that of VR group (30.5 ± 24.0 versus 17.0 ± 9.2, P = 0.021). The mean VAS scores of acceptance of VR were all more than 75. The results of regression analysis showed that VR had significant effects on satisfaction with the procedure (P = 0.004), discomfort of nasal cavity (P = 0.030) and laryngopharynx (P = 0.016), and feeling of stress (P = 0.021) during the procedure., Conclusion: Distraction of VR can enhance satisfaction in both procedure and stress management for patients undergoing in-office KTP laser procedure. Acceptance of VR in VR group was relatively good., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 The Authors. Published by Elsevier Inc. All rights reserved.)