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Purpose – This study investigates the barriers to the adoption of Virtual Reality (VR) in the tourism industry. Although VR has great potential to enhance the tourist experience, the adoption of this technology is still limited in the tourism sector. Building on the fundamental principles of the Technology-Organization-Environment (TOE) theory and its contribution to perceptions of technology adoption, this study aims to fill the knowledge gap regarding the specific barriers to VR adoption by tourism enterprises. Methodology – To achieve this objective, interviews were conducted with managers of tourism companies, and the data was analysed using qualitative methodology through MAXQDA 20 software. Conclusions – The results reveal that the main barriers identified by managers mainly include lack of knowledge about VR, particularly in the tourism sector. The perceived lack of usefulness, limited experience with the technology, and reluctance to invest in technological equipment also emerge as barriers to VR adoption. Originality of research – This study can help companies in the tourism sector to develop more effective strategies to overcome these barriers, thereby improving the tourist experience and increasing their competitiveness in the market using VR equipment.

A Psychtech & Health orgulha-se de ser uma publicação livre e independente. Nasceu no seio de um grupo de investigação cujo objetivo era a partilha e disseminação de conhecimento nas áreas da psicologia e da tecnologia e de como estas podes ser alavancadas tendo em vista o desenvolvimento humano a vários níveis. De forma a ter impato, a PsychTech & Health Journal decidiu seguir um modelo de ciência aberta de forma a promover a partilha de conhecimento entre a comunidade científica, a sociedade e as empresas.

This article presents the development of an augmented reality (AR) application aimed at promoting events in urban environments. The main goal of the project was to create an immersive experience that enhances user interaction with their surroundings, leveraging AR technology. The application was built using Django Rest Framework (DRF) for backend services and Unity for the AR functionalities and frontend. Key features include user registration and authentication, event viewing, interaction with virtual characters, and feedback on attended events, providing an engaging platform to promote urban events. The development process involved several stages, from requirements analysis and system architecture design to implementation and testing. A series of tests were performed, confirming that the application meets its objectives. These tests highlighted the system’s ability to enhance user interaction with urban environments and demonstrated its potential for commercialization. The results suggest that the AR application contributes to innovation in smart cities, offering a new avenue for promoting events and engaging local communities. Future work will focus on refining the user experience and expanding the app’s functionality to support more complex event scenarios.

Over the years, various immersive virtual training environments (iVTEs) have been developed, allowing companies to start transitioning to Virtual Reality (VR) technologies to train their personnel. This transition forces companies to start using game engines as a foundation to develop such iVTEs, which also requires a multidisciplinary team. When developing such training environments, challenges on how to present tasks to users arise. The way these tasks are presented can dictate the efficacy of the VR training application. This paper presents three different task presentation methodologies (avatar animation, videos, and instruction manual) and assesses them using 36 participants, divided into those three groups. Usability, sense of presence, satisfaction, cybersickness, and technology acceptance variables were studied and results indicated that only the total number of actions performed had differences between groups where the instruction manual reported the higher number of actions (usability) when compared to the other conditions. Therefore it was concluded that the instruction manual proved to be where users kept losing focus and making more actions. It was also concluded that all conditions had a similar sense of presence, satisfaction, cybersickness, and acceptance scores.

In this study we explore the impact of multisensory stimuli in virtual reality on users’ emotional responses, addressing a knowledge gap in this rapidly evolving field. Utilizing a range of sensory inputs, including taste, haptics, and smell, in addition to audiovisual cues, this study aims to understand how different combinations of these stimuli affect the users’ emotional experience. Two immersive virtual experiences have been developed for this purpose. One included a scenario to evoke positive emotions through selectively chosen pleasant multisensory stimuli, validated in a focus group. The other sought the contrary: to trigger negative emotions by integrating selected combinations of unpleasant multisensory stimuli, also validated in the same focus group. Through a comparative analysis, our findings revealed significant differences in emotional responses between the groups exposed to positive and negative stimuli combinations. Results indicated that combinations involving haptics and taste were particularly effective in eliciting intense emotions using positive stimuli, but their impact was less significant with negative stimuli. This investigation suggests that a fully multisensory virtual environment integrating positive stimuli might lead to cognitive overload, reducing overall emotional responses. In contrast, environments with negative stimuli could enhance emotional engagement and be more likely to avoid cognitive overload. These findings have important implications for designing emotionally resonant and compelling virtual reality experiences. This research enhances the understanding of sensory integration in virtual reality and its effects on emotional engagement, offering valuable insights for developing more impactful virtual experiences.

Virtual reality (VR) for training helps minimize risks and costs by allowing more frequent and varied use of experiential training experiences, leading to active and improved learning. However, creating VR training experiences is costly and time-consuming, requiring software development experts. Additionally, current authoring tools are desktop-oriented, which detaches the process of creating the immersive experience from experiencing it in a situated context. This paper presents the development of an immersive authoring tool designed to create immersive virtual environments that can be used to train operatives. The authoring tool can record and replay animations of each action the user performed that can later be used to instruct other users how the task should be performed. Participants were divided into two groups, and the proposed authoring tool was evaluated using usability, satisfaction, presence and cybersickness. Between groups, Independent T-tests revealed that there were no significant differences between expert and non-expert groups in any of the studied variables. Also, the results showed that the authoring tool had high usability and satisfaction, average presence, and low probability of cybersickness symptoms.

Cybersickness refers to the negative symptoms caused by exposure to a Virtual Reality (VR) experience. The literature is consensual that cybersickness is a key factor in an experience, as the non-existence of cybersickness provides an optimal virtual experience. Thus, it is of utmost importance to evaluate cybersickness when assessing VR applications to understand the impact of this factor on the user experience and, ultimately, on the VR application viability. However, there is a lack of Portuguese instruments to evaluate this variable. To tackle this, this aimed to translate and validate the Simulator Sickness Questionnaire (SSQ) to Portuguese so it can be used with the Portuguese population and maintain its psychometric properties. The new instrument was validated using a sample of 603 Portuguese subjects aged between 16 and 79. Based on the observed results, the obtained theoretical model shows that the Portuguese version of the SSQ is valid for properly evaluating cybersickness in VR experiences with Portuguese samples.

In this issue of the PsychTech & Health Journal, a set of articles is presented that mainly address problems that currently represent challenges for public health. Overall, the need for early identification of syndromes associated with significant loss of functionality and quality of life stands out. It is also relevant to know the determinants that guide actions to promote quality of life and highlight the advantages of active ageing. The works we publish add to the scientific evidence that can guide support and face the problems that now represent a challenge in Public Health.

Abstract E-commerce is a field that changed how consumers purchase and interact with products. Although, inherent limitations such as the difficulty of testing the products “first-hand” before a purchase can compromise consumers’ trust in online purchases. Virtual Reality (VR) has been investigated as a tool to solve limitations in several fields and how we can harness its potential to improve the overall user experience. This study analysed how immersive VR (IVR) could solve these limitations by allowing consumers to test products beforehand. We have studied how the Novelty Factor (evaluated by the users’ past VR experience) and Immersive Tendencies correlate with the users’ Purchase Intention and Memory (how well they remember the product’s characteristics). We have analysed a sample of 38 participants (21 males) from 18 to 28 years old. Participants experienced a refrigerator with an interactive touchscreen in an IVR setup and were guided through its functionalities. Results indicated that memory of the product’s characteristics was positively correlated with how recently they experienced VR. No correlations were found in the female sample. A negative correlation between Purchase Intention and Memory of the product’s characteristics was found in the male sample. We concluded that IVR applications could become helpful for both consumers and online shops in an e-commerce context regardless of the Novelty Factor and Immersive Tendencies of consumers. However, differences between genders should be further investigated.

Abstract Background The management of antidiabetic therapy in people with type 2 diabetes (T2D) has evolved beyond glycemic control. In this context, Brazil and Portugal defined a joint panel of four leading diabetes societies to update the guideline published in 2020. Methods The panelists searched MEDLINE (via PubMed) for the best evidence from clinical studies on treating T2D and its cardiorenal complications. The panel searched for evidence on antidiabetic therapy in people with T2D without cardiorenal disease and in patients with T2D and atherosclerotic cardiovascular disease (ASCVD), heart failure (HF), or diabetic kidney disease (DKD). The degree of recommendation and the level of evidence were determined using predefined criteria. Results and conclusions All people with T2D need to have their cardiovascular (CV) risk status stratified and HbA1c, BMI, and eGFR assessed before defining therapy. An HbA1c target of less than 7% is adequate for most adults, and a more flexible target (up to 8%) should be considered in frail older people. Non-pharmacological approaches are recommended during all phases of treatment. In treatment naïve T2D individuals without cardiorenal complications, metformin is the agent of choice when HbA1c is 7.5% or below. When HbA1c is above 7.5% to 9%, starting with dual therapy is recommended, and triple therapy may be considered. When HbA1c is above 9%, starting with dual therapyt is recommended, and triple therapy should be considered. Antidiabetic drugs with proven CV benefit (AD1) are recommended to reduce CV events if the patient is at high or very high CV risk, and antidiabetic agents with proven efficacy in weight reduction should be considered when obesity is present. If HbA1c remains above target, intensification is recommended with triple, quadruple therapy, or even insulin-based therapy. In people with T2D and established ASCVD, AD1 agents (SGLT2 inhibitors or GLP-1 RA with proven CV benefit) are initially recommended to reduce CV outcomes, and metformin or a second AD1 may be necessary to improve glycemic control if HbA1c is above the target. In T2D with HF, SGLT2 inhibitors are recommended to reduce HF hospitalizations and mortality and to improve HbA1c. In patients with DKD, SGLT2 inhibitors in combination with metformin are recommended when eGFR is above 30 mL/min/1.73 m2. SGLT2 inhibitors can be continued until end-stage kidney disease.

This paper investigates the impact of different immersive Virtual Reality (iVR) technological approaches in teaching and learning English as a Foreign Language (EFL). Specifically, this paper explores the passive iVR and interactive iVR in a real authentic learning context as didactic possibilities compared to the conventional method of listening, consisting of audio-only listening exercises. The study was conducted using university students of B1 level EFL classes. The dependent variables considered in the study were Knowledge Retention, Presence, User Satisfaction, Cybersickness, and Preferred Technology. Results indicated that users showed significant satisfaction and preference for using this technology for learning, revealing enjoyment and motivation which are vital factors when learning a foreign language. However, no significant differences were found between learning via traditional listening exercises or the virtual system. Correlation tests were conducted between the questionnaire subscales to understand better which elements can influence learning. The study concludes that using iVR-based learning tools to learn a foreign language as an alternative to audio listening can only produce a broader positive impact and greater motivation. The results also suggest that iVR can be a valuable tool in the education field for knowledge transfer and motivation when learning foreign languages.

Presence is often used to evaluate Virtual Reality (VR) applications. However, the raw scores are hard to interpret and need to be compared to other data to be meaningful. This paper leverages a database of 1909 responses to the Igroup Presence Questionnaire (IPQ) in different contexts to put forward a scale that qualitatively interprets raw Presence scores for VR experiences. The qualitative grading encompasses the acceptability dimension and analogous academic grading scales ranging from A to F and the adjective of such scores in a scale from Excellent to Unacceptable. Furthermore, the qualitative grading system encompasses Presence and its subscales Spatial Presence, Involvement, and Experienced Realism as defined by the IPQ. Adopting this grading system, supported by a robust dataset of Presence scores, enables practitioners to evaluate and interpret individual IPQ scores, allowing them to gain insights regarding the evaluated applications’ effectiveness.

Currently, it is standard to use tracked handheld controllers for interaction in immersive virtual reality (VR). However, since VR interactions are becoming more natural with hand tracking, it is important to provide hands-free alternatives for selection and system control tasks. As such, this study aims to provide an exploratory evaluation of the effectiveness and efficiency of commonly used hands-free interfaces in selection and system control tasks. Nine interaction methods were evaluated while performing a Fitts’ law task with nine advanced users of VR in a within-subject experiment. We evaluated handheld controllers as a baseline, against head gaze, eye gaze, and voice commands for pointing at the targets, and dwell time and voice commands to confirm selections. We found that using eye gaze with a $\mathrm {500 ms}$ dwell time proved to be the hand-free method with the highest performance, matching the handheld controllers and being preferred by users. The evaluation also showed that using a multimodal approach to selection, especially using the voice, decreases performance, but increases effectiveness. Moreover, we verified that Fitts’ law can be applied to hands-free methods, but its usage is limited when the methods have very short travel times. We then suggest selections per minute as a more robust comparative performance metric. Further studies should expand the audience and interaction tasks and focus on the confirmatory method of selection.

IntroductionThyroid specialists influence how hypothyroid patients are treated, including patients managed in primary care. Given that physician characteristics influence patient care, this study aimed to explore thyroid specialist profiles and associations with geo-economic factors.MethodsThyroid specialists from 28 countries were invited to respond to a questionnaire, Treatment of Hypothyroidism in Europe by Specialists: an International Survey (THESIS). Geographic regions were defined according to the United Nations Statistics Division. The national economic status was estimated using World Bank data on the gross national income per capita (GNI per capita).Results5,695 valid responses were received (response rate 33·0%). The mean age was 49 years, and 65·0% were female. The proportion of female respondents was lowest in Northern (45·6%) and highest in Eastern Europe (77·2%) (p 100 patients annually (p

Training with virtual reality (VR) technologies is an expanding application field. Healthcare can largely benefit from it as VR offers many advantages over conventional training methodologies, especially when the goal is to train specialized technicians (Narciso et al., 2019).

Virtual Reality (VR) and its capability to replace real stimuli for synthesized ones as if they were real opened several research lines over the years. Many of those consist of trying to validate whether or not VR replicates the same user behaviours seen in reality. In this study, we investigated whether or not product contextualization and gender could influence users’ intention to purchase as well as their satisfaction with the application and how presence levels correlate with purchase intention and user satisfaction. The product tested was a double door refrigerator with a touchscreen. We considered two independent variables: Contextualization (Context - The refrigerator was displayed in a kitchen and filled with food products and Neutral - The refrigerator was empty and displayed in an empty room) and gender (male and female). The results indicated that contextualization and gender had no effective impact on purchase intention, user satisfaction with the VR experience nor the sense of presence. A positive correlation was found between presence and user satisfaction. Evidence indicates that it is not necessary to represent products in their context, saving computational power and human resources.

Virtual reality (VR) potential to isolate users from the real world while producing a rich virtual environment where users act similarly to how they would, in reality, is still being investigated in several fields. In this work, we investigated the effects of product contextualisation and gender under an immersive VR application where users can explore in-depth a commercial product with a “hands-on” experience. An experimental between-subjects study was performed with 38 participants between 18 and 28 years. The product tested consisted of a double-door refrigerator equipped with a touchscreen. Two independent variables were studied: Context (the refrigerator was filled with food products and placed in a kitchen), Neutral Context (empty refrigerator displayed in an empty white room), and Gender (Female and Male). As for the dependent variables, we considered how clarified users felt about the product functionalities, its size, the extent users remember details and characteristics of the refrigerator, and the user’s subjective workload. The evidence shows that contextualisation and gender have no impact on any dependent variables. Therefore, we concluded that presenting a product in its context does not benefit significantly benefit it. Thus, opting for a neutral context would be preferable to save computational costs and human resources necessary to build and run the higher complexity environments required to contextualise the product.

Abstract Atherosclerotic cardiovascular diseases are the leading cause of adverse outcomes in patients with type 2 diabetes, and all new anti-diabetic agents are mandated to undergo cardiovascular outcome trials (CVOTs). Glucagon-like peptide-1 receptor agonists (GLP-1 RA) are incretin mimetics that reduce blood glucose levels with a low associated risk of hypoglycaemia. CVOTs with different GLP-1 RAs yielded different results in terms of major cardiovascular composite outcome (MACE), with some trials showing superiority in the treatment arm, whereas other simply displayed non-inferiority. More importantly, the significance of each component of MACE varied between drugs. This begs the question of whether these differences are due to dissimilarities between drugs or other factors, namely trial design, are at the root of these differences. We analyse the trial designs for all CVOTs with GLP-1 RAs and highlight important differences between them, namely in terms of definition of established cardiovascular disease, and discuss how these differences might explain the disparate results of the trials and preclude direct comparisons between them. We conclude that a fair comparison between GLP-1 RA CVOTs would involve post-hoc analysis re-grouping the patients into different cardiovascular risk categories based upon their baseline clinical parameters, in order to even out the criteria used to classify patients.

Virtual Reality (VR) technologies have been proven valuable in various application fields, ranging from entertainment to more serious purposes such as education and training.

Enhancing tourist visits to cultural heritage sites by making use of mobile augmented reality has been a tendency in the last few years, presenting mainly audiovisual experiences. However, these explorations using only visuals and sounds, or narratives, do not allow users to be presented with, for example, a particular smell that can be important to feel engaged or to better understand the history of the site. This article pursues the goal of creating an experience that puts the user in a scene planned to evoke several stimuli with SensiMAR prototype - a Multisensory Augmented Reality system that aims to be used in cultural heritage outdoors. When using SensiMAR, the user will be involved with visual reconstructions, surrounded by the soundscape of ancient times, and is exposed to a particular smell very common that time. Given the novelty of this proposal, ascertaining the usability of such a system was raised as a foremost demand. Thus, in addition to its development and implementation specifications, an experimental study was conducted to evaluate the usability of the system in end-users' perspective. The results obtained from random visitors of an archaeological site were analysed according to their sex, age, previous experience with augmented reality technology, and provided condition - audiovisual condition, and multisensory condition, with visual, audio, and smell stimuli. Results were collected from a total of 67 participants and show that this multisensory prototype achieved good usability results across all groups. No statistically differences were found, demonstrating good usability of the SensiMAR system regardless of their sex, age, previous experience with the technology or provided condition.

This paper aims to explore the impact of sense of presence and cybersickness on the users’ expectancy and perceived similarity between virtual and the corresponding real environments. Two virtual reality setups were tested (non-immersive and immersive) to achieve further conclusions. This research encompassed a quantitative analysis using data collection based on questionnaires, applied to a sample of 45 participants. A virtual experience was conducted (to explore users’ cybersickness and sense of presence), followed by a visit to the actual real sites (to determine the degree of perceived similarity between the virtual and the corresponding real environment and if their expectations were fulfilled). Our results show a positive correlation between the global sense of presence and perceived similarity and users’ expectancy for the non-immersive VR setup. A positive correlation was also found between the global cybersickness on both perceived similarity and users’ expectancy for the immersive VR setup. Implications of such results for virtual tourism are discussed.

Proper evaluation of realism in immersive virtual experiences is crucial to ensure optimisation of resources. This way, we can take better decisions while designing realistic immersive experiences, prioritising factors that have a higher impact on the perceived realism of the virtual experience. This systematic review aims to provide readers with an overview of methodologies used throughout the literature to evaluate realism in immersive virtual, augmented and mixed reality. A total of 79 from 1300 gathered articles met the eligibility criteria and were analysed. Results have shown that virtual reality is by far the platform where realism studies were performed. Head-mounted displays are by far the preferred equipment for such studies. Visual realism is the most researched, followed by audiovisual. The majority of methodologies consisted of subjective, as well as a combination of objective and subjective measures. The most used evaluation instrument is questionnaires where many of which are custom and non-validated. Presence questionnaires are the most used ones and are often used to evaluate the presence, perceived realism and involvement. Cybersickness evaluation is consistently assessed by one self-report questionnaire.

Immersion is a proven method of learning a foreign language and using Virtual Reality to achieve that immersion has high potential educational benefits. However, there are no recent systematic reviews that combine both foreign language education and immersive Virtual Reality. This systematic review aims to identify features, educational methods, technologies, and gaps of immersive virtual reality for foreign and second language education. PRISMA method was followed to carry out the systematic review. From the analysis of the results, two main conclusions were drawn. Firstly, the relation between immersive Virtual Reality and foreign language learning is quite positive, particularly when compared with conventional pedagogical practices. Not only that, the connection between immersive Virtual Reality and the user’s motivation and satisfaction is also quite positive. Lastly, limitations such as the low sample of studies and gaps in the literature are addressed, and directions for future work and the area’s progress are pointed out.

Abstract Introduction Adult-onset autoimmune diabetes (AID) has two different phenotypes: classic type 1 diabetes mellitus (T1DM), with insulin requirement just after diagnosis, and latent autoimmune diabetes in adults (LADA). The purpose of this study is to characterize patients with AID followed on a tertiary centre, comparing classic T1DM and LADA. Methods We collected data from patients with diabetes and positive islet autoantibodies, aged 30 years old and over at diagnosis. Patients who started insulin in the first 6 months were classified as T1DM and patients with no insulin requirements in the first 6 months were classified as LADA. Data regarding clinical presentation, autoantibodies, A1C and C-peptide at diagnosis, pharmacologic treatment and complications were analysed. Results We included 92 patients, 46 with classic T1DM and 46 with LADA. The percentage of females was 50% in T1DM group and 52.1% in LADA group. The median age at diagnosis was 38 years (IQR–15) for T1DM and 42 years (IQR–15) for LADA (p = 0.057). The median time between diagnosis of diabetes and diagnosis of autoimmune aetiology was 0 months in T1DM group and 60 months in LADA group (p

Abstract Background In current management of type 2 diabetes (T2DM), cardiovascular and renal prevention have become important targets to be achieved. In this context, a joint panel of four endocrinology societies from Brazil and Portugal was established to develop an evidence-based guideline for treatment of hyperglycemia in T2DM. Methods MEDLINE (via PubMed) was searched for randomized clinical trials, meta-analyses, and observational studies related to diabetes treatment. When there was insufficient high-quality evidence, expert opinion was sought. Updated positions on treatment of T2DM patients with heart failure (HF), atherosclerotic CV disease (ASCVD), chronic kidney disease (CKD), and patients with no vascular complications were developed. The degree of recommendation and the level of evidence were determined using predefined criteria. Results and conclusions In non-pregnant adults, the recommended HbA1c target is below 7%. Higher levels are recommended in frail older adults and patients at higher risk of hypoglycemia. Lifestyle modification is recommended at all phases of treatment. Metformin is the first choice when HbA1c is 6.5–7.5%. When HbA1c is 7.5–9.0%, dual therapy with metformin plus an SGLT2i and/or GLP-1RA (first-line antidiabetic agents, AD1) is recommended due to cardiovascular and renal benefits. If an AD1 is unaffordable, other antidiabetic drugs (AD) may be used. Triple or quadruple therapy should be considered when HbA1c remains above target. In patients with clinical or subclinical atherosclerosis, the combination of one AD1 plus metformin is the recommended first-line therapy to reduce cardiovascular events and improve blood glucose control. In stable heart failure with low ejection fraction ( 30 mL/min/1.73 m2, metformin plus an SGLT-2i is recommended to reduce cardiovascular mortality and heart failure hospitalizations and improve blood glucose control. In patients with diabetes-associated chronic kidney disease (CKD) (eGFR 30–60 mL/min/1.73 m2 or eGFR 30–90 mL/min/1.73 m2 with albuminuria > 30 mg/g), the combination of metformin and an SGLT2i is recommended to attenuate loss of renal function, reduce albuminuria and improve blood glucose control. In patients with severe renal failure, insulin-based therapy is recommended to improve blood glucose control. Alternatively, GLP-1RA, DPP4i, gliclazide MR and pioglitazone may be considered to reduce albuminuria. In conclusion, the current evidence supports individualizing anti-hyperglycemic treatment for T2DM.

Fifty ~20–amino acid (aa)–long peptides were selected from functionally relevant SARS-CoV-2 S, M, and E proteins for trial B-21 and another 53 common ones, plus some new ones derived from the virus’ main genetic variants for complementary trial C-21. Peptide selection was based on tremendous SARS-CoV-2 genetic variability for analysing them concerning vast human immunogenetic polymorphism for developing the first supramutational, Colombian SARS-protection (SM-COLSARSPROT), peptide mixture. Specific physicochemical rules were followed, i.e., aa predilection for polyproline type II left-handed (PPIIL) formation, replacing β-branched, aromatic aa, short-chain backbone H-bond-forming residues, π-π interactions (n→π* and π-CH), aa interaction with π systems, and molecular fragments able to interact with them, disrupting PPIIL propensity formation. All these modified structures had PPIIL formation propensity to enable target peptide interaction with human leukocyte antigen-DRβ1* (HLA-DRβ1*) molecules to mediate antigen presentation and induce an appropriate immune response. Such modified peptides were designed for human use; however, they induced high antibody titres against S, M, and E parental mutant peptides and neutralising antibodies when suitably modified and chemically synthesised for immunising 61 major histocompatibility complex class II (MHCII) DNA genotyped Aotus monkeys (matched with their corresponding HLA-DRβ1* molecules), predicted to cover 77.5% to 83.1% of the world’s population. Such chemically synthesised peptide mixture represents an extremely pure, stable, reliable, and cheap vaccine for COVID-19 pandemic control, providing a new approach for a logical, rational, and soundly established methodology for other vaccine development.

Virtual Reality (VR) technologies aim at transporting their users to a virtual space. From the different fields of application, cultural heritage is a field with much to explore. A fact is that everyday pieces of cultural heritage are lost, whether due to natural phenomena that can destroy the natural landscapes or cultural traditions that are slowly and naturally disappears. What if we could leverage Virtual Reality to mitigate this issue?

The expansion of augmented reality across society, its availability in mobile platforms and the novelty character it embodies by appearing in a growing number of areas, have raised new questions related to people’s predisposition to use this technology in their daily life. Acceptance models, which have been updated following technological breakthroughs and society changes, are known to be great tools for predicting the intention to use a new technological system. This paper proposes a new acceptance model aiming to ascertain the intention to use augmented reality technology in heritage sites—the Augmented Reality Acceptance Model (ARAM). ARAM relies on the use of the Unified Theory of Acceptance and Use of Technology model (UTAUT) model’s constructs, namely performance expectancy, effort expectancy, social influence, and facilitating conditions, to which the new and adapted constructs of trust expectancy, technological innovation, computer anxiety and hedonic motivation are added. This model was validated with data gathered from 528 participants. Results confirm ARAM as a reliable tool to determine the acceptance of augmented reality technology for usage in cultural heritage sites. The direct impact of performance expectancy, facilitating conditions and hedonic motivation is validated as having a positive influence on behavioural intention. Trust expectancy and technological innovation are demonstrated to have a positive influence on performance expectancy whereas hedonic motivation is negatively influenced by effort expectancy and by computer anxiety. The research, thus, supports ARAM as a suitable model to ascertain the behavioural intention to use augmented reality in new areas of activity.

Virtual Reality technologies are evolving at a fast pace. It is important to establish if these novel solutions met the goals they were developed for (i. e., to evaluate if they are effective). These technological-based products, whether based on a conventional PC setup or an immersive virtual reality setup, predominantly rely on the stimulation of the sight. With this, the eye movement analysis appears as an important metric to evaluate technological environments. Through eye movement analysis can establish how persons collect information and what influences their actions and decisions and determine certain preferences or behaviours.

Virtual Reality (VR) through head-mounted displays (HMDs) can be delivered via multiple setups such as smartphones, standalone VR or VR Workstations. The VR Workstation setup delivers the best performance of them all; however, as a drawback up until recently, it required cables to power up the VR equipment. The introduction of wireless solutions for VR Workstations came to solve one of the disadvantages of this setup. However, the impact of the wireless solution versus the HMD cables was not yet properly investigated. In this paper, we study the impact of using a wired vs wireless HMD on Presence, Cybersickness, and Game Experience. We conducted a quasi-experimental between-subjects study with 68 participants assigned to the following three groups that were balanced regarding gender and sample size: Cable (participants used a wired HMD), Cable + Help (a researcher assisted the participants with the HMD cable during the experience to reduce the participants' awareness of it), and Wireless (untethered HMD). Results showed no significant differences in presence and cybersickness. The game experience was significantly different, with Cable + Help performing better than Cable and Wireless. We conclude that sense of presence using wireless solutions is equated to wired HMD solutions.

Convolution Neural Network (CNN)-based object detection models have achieved unprecedented accuracy in challenging detection tasks. However, existing detection models (detection heads) trained on 8-bits/pixel/channel low dynamic range (LDR) images are unable to detect relevant objects under lighting conditions where a portion of the image is either under-exposed or over-exposed. Although this issue can be addressed by introducing High Dynamic Range (HDR) content and training existing detection heads on HDR content, there are several major challenges, such as the lack of real-life annotated HDR dataset(s) and extensive computational resources required for training and the hyper-parameter search. In this paper, we introduce an alternative backwards-compatible methodology to detect objects in challenging lighting conditions using existing CNN-based detection heads. This approach facilitates the use of HDR imaging without the immediate need for creating annotated HDR datasets and the associated expensive retraining procedure. The proposed approach uses HDR imaging to capture relevant details in high contrast scenarios. Subsequently, the scene dynamic range and wider colour gamut are compressed using HDR to LDR mapping techniques such that the salient highlight, shadow, and chroma details are preserved. The mapped LDR image can then be used by existing pre-trained models to extract relevant features required to detect objects in both the under-exposed and over-exposed regions of a scene. In addition, we also conduct an evaluation to study the feasibility of using existing HDR to LDR mapping techniques with existing detection heads trained on standard detection datasets such as PASCAL VOC and MSCOCO. Results show that the images obtained from the mapping techniques are suitable for object detection, and some of them can significantly outperform traditional LDR images.

Little is known about the impact of the addition of each stimulus in multisensory augmented reality experiences in cultural heritage contexts. This paper investigates the impact of different sensory conditions on a user’s sense of presence, enjoyment, knowledge about the cultural site, and value of the experience. Five different multisensory conditions, namely, Visual, Visual + Audio, Visual + Smell, and Visual + Audio + Smell conditions, and regular visit referred to as None condition, were evaluated by a total of 60 random visitors distributed across the specified conditions. According to the results, the addition of particular types of stimuli created a different impact on the sense of presence subscale scores, namely, on spatial presence, involvement, and experienced realism, but did not influence the overall presence score. Overall, the results revealed that the addition of stimuli improved enjoyment and knowledge scores and did not affect the value of the experience scores. We concluded that each stimulus has a differential impact on the studied variables, demonstrating that its usage should depend on the goal of the experience: smell should be used to privilege realism and spatial presence, while audio should be adopted when the goal is to elicit involvement.

Resumo: A prevalência da diabetes mellitus tipo 2 (DMT2) continua a aumentar e a sua associação com a doença cardiovascular (CV) tem levado à incorporação e valorização de endpoints CV nos ensaios clínicos sobre o tratamento da DMT2.Este artigo faz uma revisão dos vários ensaios já realizados e em desenvolvimento, neste âmbito, com especial enfoque no estudo EMPA‐REG OUTCOME. Neste estudo, a empagliflozina, um inibidor do cotransportador tipo 2 de sódio/glicose (iSGLT2), demonstrou efeitos benéficos na redução do risco CV em doentes com DMT2 e doença CV estabelecida, para além de segurança CV e diminuição dos valores de HbA1c, representando uma mudança de paradigma com impacto ao nível das recomendações internacionais para o tratamento da DMT2. Estes resultados mantiveram‐se em análises de subgrupos posteriores, nomeadamente na insuficiência cardíaca, doença renal crónica e doença arterial periférica, ainda que muitas questões se coloquem sobre os mecanismos envolvidos nestes efeitos – se efeitos hemodinâmicos, efeitos metabólicos ou se a diminuição das concentrações de sódio citoplasmático no miocárdio.Com a diminuição do risco de eventos CV major em doentes com DMT2, os resultados do estudo EMPA‐REG OUTCOME demonstraram, pela primeira vez, proteção CV associada ao efeito de um fármaco anti‐hiperglicémico e iniciaram uma nova era no tratamento e gestão da DMT2. Este estudo levou ao desenvolvimento de outros ensaios, ainda a decorrer, que permitirão estabelecer quais os doentes que mais beneficiarão desta terapêutica, nomeadamente na relação à existência de comorbilidades. Abstract: The prevalence of type 2 diabetes (T2D) continues to increase, and its association with cardiovascular (CV) disease has led to the inclusion of CV endpoints in clinical trials on the treatment of T2D.This article explores the various trials already performed and under development in this field, with particular focus on the EMPA‐REG OUTCOME trial. In this trial, empagliflozin, a sodium‐glucose co‐transporter 2 inhibitor, demonstrated a reduction in CV risk in patients with T2D and established CV disease, in addition to CV safety and a decrease in glycated hemoglobin. This represents a paradigm shift that has led to changes in the international guidelines for the treatment of T2D. These results were maintained in subsequent subgroup analysis for heart failure, chronic kidney disease and peripheral arterial disease, although there are many questions concerning the mechanisms involved in these effects, including whether they are hemodynamic, metabolic or due to decreased myocardial cytoplasmic sodium concentrations.With this reduction in risk for major CV events in patients with T2D, the EMPA‐REG OUTCOME trial demonstrated CV protection from a hypoglycemic drug for the first time, and opened a new era in the treatment and management of T2D. This study has led to the development of ongoing trials that will establish which patients will benefit most from this therapy, particularly with regard to comorbidities. Palavras‐chave: Empagliflozina, Diabetes, Doença cardiovascular, Insuficiência cardíaca, Keywords: Empagliflozin, Diabetes, Cardiovascular disease, Heart failure

A emergência de discussões sociais sobre temáticas que englobam pessoas e populações em algum estado e/ou processo de vulnerabilidade social faz-se necessária nos espaços coletivos, tais como a escola. O presente estudo toma como centro de análise a Xenofobia motivada pelo racismo religioso às religiões de matrizes africanas e afrodescendentes. Este estudo tem como objetivo avaliar se as formulações epistemológicas da Educação Intercultural Alemã, poderiam ser transplantadas e aplicadas, como instrumento preventivo-pedagógico de enfrentamento as ações de racismo religioso, as quais estão presentes no cotidiano das políticas em currículo no ensino brasileiro. Os procedimentos metodológicos de base qualitativa, aconteceram em três momentos, a saber: 1) revisão de literatura; 2) levantamento de dados hemerográficos; e, 3) análise do conteúdo e escrita do relatório da investigação. Ao término desses processos, é possível apontar principalmente que: o tratamento da xenofobia (aversão ao estranho), conforme ocorre na realidade europeia, não deve ser equiparado à realidade brasileira, uma vez que os motivos da interculturalidade na Alemanha (dialogo com a diferença advinda da migração), são distintos da razão de ser que levam a sua implementação no Brasil (diálogo com povos e comunidades tradicionais); e que, há uma urgência de se refletir sobre a xenofobia, como exemplo, as ações de racismo religioso direcionadas às comunidades tradicionais (povos de terreiro) dentro e fora do ambiente escolar.

Segundo a Organização Mundial do Turismo, em 2019 registou-se um número total de 1.4 mil milhões de turistas internacionais, que representaram um volume de negócios ligado ao sector de cerca de 1 426 mil milhões de euros. Sendo que a indústria do turismo envolve diversos atores, desde os próprios turistas passando pelos operadores turísticos até as entidades responsáveis pelos pontos turísticos de interesse, este alto volume de turismo torna evidente dois problemas que dele advêm: (1) com o elevado número de destinos turísticos, torna-se mais desafiante criar estratégias de marketing que diferenciem determinadas ofertas turísticas das demais e; (2) o alto volume turístico acarreta uma sobrecarga aos recursos dos próprios destinos turísticos, pondo a sua sustentabilidade em causa.

O ano de 2020 apresentou-nos novosdesafios que nunca pensaríamos atravessar.Nomeadamente, uma epidemia global devidoao novo coronavívurs CoViD-19 que impôso isolamento social a uma grande partedo mundo, senão a todo o mundo mesmo.Sendo que o ser humano é, por natureza, umser social e que a sua interação como o meioe com os outros permite-lhe desenvolver seupróprio “eu”, o isolamento social impostopela pandemia trouxe grandes desafios àsociedade, provocando a consequências nãosó ao nível da saúde física mas sobretudo anível da saúde mental, incluindo depressãoe ansiedade. Existem mesmo estudos queindicam que o isolamento social podeaumentar em cerca 29% o risco de doençascardíacas e em cerca de 32% o risco deacidentes vasculares cerebrais.É com os olhos postos nestes desafiossocietais que existe a motivação de quererfazer mais e melhor tirando partida das ferramentastecnológicas.

A tecnologia está cada vez mais presenteno nosso dia a dia, tornando-se incontornávela sua utilização. Sendo que o conceito decomportamento humano se refere, de formageral, a um conjunto de reações face às interaçõesde um indivíduo com o meio envolvente,percebe-se desde logo a estreita ligação entreos domínios da tecnologia e do comportamentohumano.

Dada a evolução significativa das tecnologiasde Realidade Virtual, estas tornaram-seferramentas robustas para diferentes áreasde aplicação que vão muito para além daárea do entretenimento. Uma das áreas ondeesta tecnologia se tem destacado é no treinoe certificação de competências em contextoprofissional.

Intracranial germinomas are rare tumors affecting mostly patients at young age. Therefore, molecular data on its etiopathogenesis are scarce. We present a clinical case of a male patient of 25 years with an intracranial germinoma and a 16p11.2 microdeletion. His initial complaints were related to obesity, loss of facial hair and polydipsia. He also had a history of social-interaction difficulties during childhood. His blood tests were consistent with hypogonadotropic hypogonadism and secondary adrenal insufficiency, and he had been previously diagnosed with hypothyroidism. He also presented with polyuria and polydipsia and the water deprivation test confirmed the diagnosis of diabetes insipidus. His sellar magnetic resonance imaging (MRI) showed two lesions: one located in the pineal gland and other in the suprasellar region, both with characteristics suggestive of germinoma. Chromosomal microarray analysis was performed due to the association of obesity with social disability, and the result identified a 604 kb 16p11.2 microdeletion. The surgical biopsy confirmed the histological diagnosis of a germinoma. Pharmacological treatment with testosterone, hydrocortisone and desmopressin was started, and the patient underwent radiotherapy (40 Gy divided in 25 fractions). Three months after radiotherapy, a significant decrease in suprasellar and pineal lesions without improvement in pituitary hormonal deficiencies was observed. The patient is currently under follow-up. To the best of our knowledge, we describe the first germinoma in a patient with a 16p11.2 deletion syndrome, raising the question about the impact of this genetic alteration on tumorigenesis and highlighting the need of molecular analysis of germ cell tumors as only little is known about their genetic background.

Although selection menus are widely used for interaction, their use on 3D virtual reality applications needs to be objectively assessed. The focus of this study is to evaluate a traditional panel and a radial menu in two distinct virtual environment placements (i.e. fixed on the wall and following the users' hands). Fifty-one participants used two different menus of the four possible combinations. To evaluate the menus' effectiveness and efficiency, we measured usability (System Usability Scale Questionnaire), user satisfaction (After-Scenario Questionnaire), time to finish the tasks (in seconds) and the number of unnecessary steps (errors) performed by the users. Overall results showed a clear preference for the traditional panel menu type and the fixed wall placement of the menu. We conclude that all menu types perform well, despite different user preferences, and that fixing the menu to the wall gives users a better overview of both the menu and the virtual environment, improving their ability to perceive their actions on the menu.

High dynamic range (HDR) displays are capable of displaying a wider dynamic range of values than conventional displays. As HDR content becomes more ubiquitous, the use of these displays is likely to accelerate. As HDR displays can present a wider range of values, traditional strategies for mapping HDR content to low dynamic range (LDR) displays can be replaced with either directly displaying values, or using a simple shift mapping (exposure adjustment). The latter approach is especially important when considering ambient lighting, as content viewed in a dark environment may appear substantially different to a bright one. This paper seeks to identify an exposure value which is suitable for displaying specific HDR content on an HDR display under a range of ambient lighting levels. Based on data captured with human participants, this paper establishes user preferred exposure values for a variety of maximum display brightnesses, content and ambient lighting levels. These are then used to develop two models to predict preferred exposure. The first is based on linear regression using straightforward image statistics which require minimal computation and memory to be computed, making this method suitable to be directly used in display hardware. The second is a model based on convolutional neural networks (CNN) to learn image features which best predict exposure values. The CNN model generates better results than the first model at the cost of memory and computation time.

O presente artigo tem como foco explorar as questões de gênero dentro dos terreiros de candomblé brasileiros sob a perspectiva da etnofilosofia, ou seja, da filosofia da encruzilhada e do encantamento. O recorte temporal da pesquisa foi construído entre os anos de 2015 e de 2017. A metodologia utilizada foi eminentemente etnográfica, tomando por fundamento os métodos de etnografia virtual de Christine Hine (2008) e a pesquisa qualitativa online com utilização da internet de Uwe Flick (2009). Buscou-se assim, promover a intersecção entre o legado da filosofia religiosa africana com as questões de gênero - sexualidade e identidade de gênero - dentro dos terreiros de candomblé em contextos socioculturais encantados que findam por reproduzir as hostilidades, as abjeções, os estigmas e os mesmos rótulos da cultura judaico-cristã em relação às travestis e às mulheres transexuais.

Addison’s disease (AD) is the most common endocrine manifestation of antiphospholipid syndrome (APS), but it remains a very rare complication of the syndrome. It is caused by adrenal venous thrombosis and consequent hemorrhagic infarction or by spontaneous (without thrombosis) adrenal hemorrhage, usually occurring after surgery or anticoagulant therapy. We present a clinical case of a 36-year-old female patient with a previous diagnosis of APS. She presented with multiple thrombotic events, including spontaneous abortions. During evaluation by the third episode of abortion, a CT imaging revealed an adrenal hematoma, but the patient was discharged without further investigation. A few weeks later, she presented in the emergency department with manifestations suggestive of adrenal insufficiency. Based on that assumption, she started therapy with glucocorticoids, with significant clinical improvement. After stabilization, additional investigation confirmed AD and excluded other etiologies; she also started mineralocorticoid replacement. This case illustrates a rare complication of APS that, if misdiagnosed, may be life threatening. A high index of suspicion is necessary for its diagnosis, and prompt treatment is crucial to reduce the morbidity and mortality potentially associated.

Thyroid cancer therapy is based on surgery followed by radioiodine treatment. The incorporation of radioiodine by cancer cells is mediated by sodium iodide symporter (NIS) (codified by the SLC5A5 gene), that is functional only when targeted to the cell membrane. We aimed to evaluate if NIS expression in thyroid primary tumors would be helpful in predicting tumor behavior, response to therapy and prognosis. NIS expression was addressed by qPCR and immunohistochemistry. In order to validate our data, we also studied SLC5A5 expression on 378 primary papillary thyroid carcinomas from The Cancer Genome Atlas (TCGA) database. In our series, SLC5A5 expression was lower in carcinomas with vascular invasion and with extrathyroidal extension and in those harboring BRAFV600E mutation. Analysis of SLC5A5 expression from TCGA database confirmed our results. Furthermore, it showed that larger tumors, with locoregional recurrences and/ or distant metastases or harboring RAS, BRAF and/or TERT promoter (TERTp) mutations presented significantly less SLC5A5 expression. Regarding immunohistochemistry, 12/211 of the cases demonstrated NIS in the membrane of tumor cells, those cases showed variable outcomes concerning therapy success, prognosis and all but one were wild type for BRAF, NRAS and TERTp mutations. SLC5A5 mRNA lower expression is associated with features of aggressiveness and with key genetic alterations involving BRAF, RAS and TERTp. Mutations in these genes seem to decrease protein expression and its targeting to the cell membrane. SLC5A5 mRNA expression is more informative than NIS immunohistochemical expression regarding tumor aggressiveness and prognostic features.

Introduction: In addition to macro and microvascular complications that are associated with the disease, hyperglycaemia is also a risk factor for several oral complications. The aim of this study is to establish a relationship between dental caries in patients with type 1 diabetes mellitus treated with multiple insulin injections and that of individuals without diabetes. It is also an aim to characterize the oral hygiene habits of this population. Material and Methods: An observational clinical study of analytical and cross-sectional nature was conducted. Thirty patients with type 1 diabetes mellitus and 30 individuals without diabetes were observed and questioned about information regarding their medical history. Oral examination was conducted according to the standards of the World Health Organization and ICDAS was used for caries detection. Statistical analysis was performed and the significance level was set at 5%. Results: Patients with diabetes mellitus showed similar caries levels to that of individuals without diabetes. Patients with diabetes mellitus had a higher dental plaque index. Only 10% of the patients having episodes of nocturnal hypoglycaemia brush their teeth after glucose intake. Discussion: Although there’s some controversy in the literature regarding the prevalence of caries in patients with diabetes mellitus, the results are in agreement with a great number of studies. However, patients with diabetes mellitus have a higher plaque index which can be associated with a higher risk for developing certain oral pathologies. Conclusion: No statistically significant association was found between type 1 diabetes mellitus and dental caries.

Virtual reality has shown to have great potential as an educational tool when it comes to new learning methods. With the growth and dissemination of this technology, there is a massive opportunity for teachers to add this technology to their methods of teaching a second/foreign language, since students keep showing a growing interest in new technologies. This systematic review of empirical research aims at understanding whether the use of gaming strategies in virtual reality is beneficial for the learning of a second/foreign language or not. Results show that more than half of the articles proved that virtual reality technologies with gaming strategies can be used to learn a foreign language. It was also found that “learning” was the most evaluated dependent variable among the chosen records, augmented reality was the leading technology used, primary education and lower secondary was the most researched school stages, and the most used language to evaluate the use of gamified technology was by far the English language. Given the lack of directed investigation, it is recommended to use these technologies to support second language learning and not entirely replace traditional approaches. A research agenda is also proposed by the authors.

Introdução: O uso da terapêutica com perfusão subcutânea contínua de insulina na diabetes mellitus tipo 1 é cada vez mais frequente devido aos seus efeitos benéficos no controlo glicémico e na flexibilidade do estilo de vida. Constituiu objetivo deste estudo avaliar o impacto da terapêutica com perfusão subcutânea contínua de insulina no controlo glicémico, índice de massa corporal, dose diária total de insulina e complicações desta modalidade terapêutica durante vinte anos de experiência no Centro Hospitalar e Universitário de Coimbra. Material e Métodos: Estudo retrospetivo que inclui doentes com diabetes mellitus tipo 1 seguidos no Centro Hospitalar e Universitário de Coimbra, que iniciaram terapêutica com perfusão subcutânea contínua de insulina até 2005 e com pelo menos 10 anos de tratamento com terapêutica com perfusão subcutânea contínua de insulina. Avaliou-se a hemoglobina glicada A1c, o índice de massa corporal e a dose diária total de insulina imediatamente antes e seis meses, um ano, cinco, 10, 15 e 20 anos após terapêutica com perfusão subcutânea contínua de insulina a partir dos registos médicos. Avaliou-se ainda a frequência de complicações agudas associadas a este tipo de terapêutica. Resultados: Obtiveram-se dados de 20 doentes (sete homens; 13 mulheres) com duração média de doença até início da terapêutica com perfusão subcutânea contínua de insulina de 16,1 ± 7,9 anos, idade média de início de terapêutica com perfusão subcutânea contínua de insulina de 31,1 ± 8,4 anos e seguimento durante 13,2 ± 2,3 anos. As indicações para colocação de bomba foram: inadequado controlo metabólico em 15 doentes, história de hipoglicemias assintomáticas ou severas em quatro doentes, e gravidez/planeamento de gravidez em um doente. A mediana de hemoglobina glicada A1c prévia foi 9,3% (6,5 - 16,0) tendo diminuído aos seis meses para o valor mínimo de 7,2% (5,3 - 9,8); p < 0,0125. A redução da hemoglobina glicada A1c manteve-se estatisticamente significativa nos primeiros 10 anos de seguimento. Verificou-se uma diferença estatisticamente significativa na variação do índice de massa corporal após 10 anos de seguimento comparativamente com o valor prévio à terapêutica com perfusão subcutânea contínua de insulina; 24,7kg/m2 (18,9 - 31,8) vs 25,5 kg/m2 (18,9 - 38,9), p < 0,0125. As necessidades diárias de insulina foram reduzidas de 56,5 U (32,0 - 94,0) para 43,8 U (33,0 - 64,0) (p < 0,0125) nos primeiros seis meses e não se encontraram diferenças estatísticas no restante seguimento relativamente às necessidades prévias à terapêutica com perfusão subcutânea contínua de insulina. Verificaram-se duas hipoglicemias severas (incidência 0,0095/doente/ano), cinco cetoacidoses diabéticas (0,0238/doente/ano) e nenhuma infeção no local de inserção do cateter. Discussão: Este estudo demonstrou a eficácia da terapêutica com perfusão subcutânea contínua de insulina, que está associada a uma diminuição significativa da hemoglobina glicada A1c sustentada durante 10 anos e a uma redução da dose diária total de insulina, significativa nos primeiros seis meses. A taxa de complicações agudas foi baixa. Conclusão: A evidência sugere que a terapêutica com perfusão subcutânea contínua de insulina é efetivamente vantajosa no controlo metabólico em doentes com diabetes mellitus tipo 1 selecionados.

Resumo: Introdução e objetivos: Na fibrilhação auricular o controlo da hipocoagulação avaliado pelo tempo em alvo terapêutico correlaciona‐se positivamente com a segurança e eficácia tromboprofiláticas. Pretende‐se realizar essa avaliação na unidade dos autores e pesquisar determinantes de melhor controlo. Métodos: Série de casos – utentes da Unidade de Saúde Familiar de Fânzeres com fibrilhação auricular sob varfarina ou acenocumarol. Colheram‐se dados sociodemográficos e clínicos; calculou‐se o tempo em alvo terapêutico pelo método de Rosendaal, usando os resultados de Razão Normalizada Internacional realizados em laboratórios externos à unidade nos seis meses precedentes. Os dados foram tratados em SPSS 21.0®, recorrendo‐se a estatística descritiva, correlação de Spearman, teste de Mann‐Whitney U e Kruskal‐Wallis. Resultados: Participaram 70% dos 106 pacientes elegíveis. O tempo em alvo terapêutico mediano foi de 65,3% (P25 = 48,3%; P75 = 86,8%). Encontrou‐se relação positiva entre essa variável e duração da doença (ρ = 0,477; p 0,05). Conclusões: O tempo em alvo terapêutico mediano na unidade é semelhante ao dos países sul europeus, ficando próximo do «bom controlo» definido pela Sociedade Europeia de Cardiologia (70%). A duração da fibrilhação auricular e da hipocoagulação explicam uma pequena parte da variabilidade dessa medida. Serão necessários estudos para identificação de outros determinantes do controlo da hipocoagulação e estudos comparativos com unidades que realizem os testes laboratoriais de monitorização da hipocoagulação nas suas instalações. Abstract: Introduction and Aims: Anticoagulation control as assessed by time in therapeutic range (TTR) correlates positively with the safety and efficacy of thromboprophylaxis in atrial fibrillation. We set out to assess TTR in our unit and to investigate determinants of better control. Methods: This was a case series study of atrial fibrillation patients anticoagulated with warfarin or acenocoumarol at the Family Health Unit of Fânzeres. Sociodemographic and clinical data were collected and TTR was calculated by the Rosendaal method, based on international normalized ratio tests performed in external laboratories in the preceding six months. SPSS® 21.0 was used for the statistical analysis, with descriptive statistics, Spearman's correlation, and the Mann‐Whitney U and Kruskal‐Wallis tests. Results: Of the 106 eligible patients, 70% participated in the study. Median TTR was 65.3% (P25 = 48.3%, P75 = 86.8%). We found a positive association between this variable and duration of atrial fibrillation (ρ =0.477, p 0.05). Conclusions: Median TTR in our unit is similar to that in southern European countries and close to the good control threshold (70%) proposed by the European Society of Cardiology. The duration of atrial fibrillation and of anticoagulation explains only a small part of the measure's variability. Other determinants of anticoagulation control must be investigated in future studies and comparative studies should be carried out in family health units monitoring anticoagulation on the premises. Palavras‐chave: Fibrilhação auricular, Anticoagulantes, Tempo em alvo terapêutico, Keywords: Atrial fibrillation, Anticoagulants, Time in therapeutic range

O objetivo principal do deste estudo consiste em perceber de que forma a posição do alvo influencia o movimento ocular nas tarefas navegacional e informativa. O estudo integrou uma amostra de 20 estudantes universitários, 13 do sexo feminino e 7 do sexo masculino, com idades compreendidas entre os 18 e os 44 anos, de uma Universidade. Os participantes responderam a um questionário sociodemográfico e realizaram duas tarefas, uma navegacional e outra informativa. Foram realizadas combinações lineares, através do teste da MANOVA (2x2), de variáveis dependentes que maximizam as diferenças entre várias condições das variáveis independentes. Concluímos que a posição do alvo na tarefa navegacional influencia de forma significativa o movimento ocular dos estudantes universitários e a posição do individuo influencia o movimento ocular em ambas as tarefas, navegacional e informativa.

The sense of presence is an important aspect of virtual reality experiences, being increasingly researched in educational contexts for its potential association with learning outcomes. A panorama of how these investigations have been conducted could help researchers and practitioners to harness this potential and find new directions. A systematic literature review was conducted to contribute to this perspective, with a comprehensive analysis of 140 primary studies recovered from five worldwide databases. The results show an overview of 24 years of research, with a summarization of areas, factors, and methodological approaches that have been the focus of investigation when these three variables of interest (VR, sense of presence, and learning) are together. We conclude with a list of research gaps that need to be addressed and a research agenda, identifying current and emerging challenges.