The Effects of Virtual Reality, Augmented Reality, and Mixed Reality as Training Enhancement Methods: A Meta-Analysis

Co-Designing Dynamic Mixed Reality Drill Positioning Widgets: A Collaborative Approach with Dentists in a Realistic Setup

Mixed Reality (MR) is proven in the literature to support precise spatial dental drill positioning by superimposing 3D widgets. Despite this, the related knowledge about widget's visual design and interactive user feedback is still limited. Therefore, this study is contributed to by co-designed MR drill tool positioning widgets with two expert dentists and three MR experts. The results of co-design are two static widgets (SWs): a simple entry point, a target axis, and two dynamic widgets (DWs), variants of dynamic error visualization with and without a target axis (DWTA and DWEP). We evaluated the co-designed widgets in a virtual reality simulation supported by a realistic setup with a tracked phantom patient, a virtual magnifying loupe, and a dentist's foot pedal. The user study involved 35 dentists with various backgrounds and years of experience. The findings demonstrated significant results; DWs outperform SWs in positional and rotational precision, especially with younger generations and subjects with gaming experiences. The user preference remains for DWs (19) instead of SWs (16). However, findings indicated that the precision positively correlates with the time trade-off. The post-experience questionnaire (NASA-TLX) showed that DWs increase mental and physical demand, effort, and frustration more than SWs. Comparisons between DWEP and DWTA show that the DW's complexity level influences time, physical and mental demands. The DWs are extensible to diverse medical and industrial scenarios that demand precision.

Stress Assessment for Augmented Reality Applications Based on Head Movement Features

Augmented reality is one of the enabling technologies of the upcoming future. Its usage in working and learning scenarios may lead to a better quality of work and training by helping the operators during the most crucial stages of processes. Therefore, the automatic detection of stress during augmented reality experiences can be a valuable support to prevent consequences on people's health and foster the spreading of this technology. In this work, we present the design of a non-invasive stress assessment approach. The proposed system is based on the analysis of the head movements of people wearing a Head Mounted Display while performing stress-inducing tasks. First, we designed a subjective experiment consisting of two stress-related tests for data acquisition. Then, a statistical analysis of head movements has been performed to determine which features are representative of the presence of stress. Finally, a stress classifier based on a combination of Support Vector Machines has been designed and trained. The proposed approach achieved promising performances thus paving the way for further studies in this research direction.

Immersive medical training: a comprehensive longitudinal study of extended reality in emergency scenarios for large student groups

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.

Mixed Reality in Clinical Settings for Pediatric Patients and Their Families: A Literature Review

In the post-pandemic context, there has been an increasing demand for technology-based interventions in education and healthcare systems, such as augmented and mixed reality technologies. Despite the promising outcomes of applying mixed reality (MR), there is limited aggregated evidence focusing on child-patient interventions in hospital-based or clinical settings. This literature review aimed to identify and synthesize existing knowledge on MR technologies applied to pediatric patients in healthcare settings. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a comprehensive search of the Scopus and Web of Science databases was conducted to identify articles published in the last 10 years that address the application of augmented and/or MR technologies in pediatric hospital settings or clinical environments to improve patient and family outcomes. A total of 45 articles were identified, and following a rigorous screening and eligibility process, 4 review articles were selected for qualitative synthesis. From these reviews, 10 studies with relevant interventions and measured effects were extracted. The extracted studies were analyzed based on eight key attributes: country of origin, study design, characteristics of the study population, primary clinical setting, type of MR device used, nature of the intervention, variables measured, and significant effects observed in the outcome variables. The analysis revealed diverse approaches across different clinical settings, with a common focus on improving both emotional well-being and learning outcomes in pediatric patients and their families. These findings suggest that MR-based pediatric interventions generally provide children and their parents with positive emotional experiences, enhancing both learning and treatment outcomes. However, the studies reviewed were heterogeneous and varied significantly in terms of clinical settings and MR applications. Future research should focus on developing more controlled study designs that specifically target the pediatric population to strengthen the evidence base for MR interventions in healthcare.

Analysis of Gait Kinematics in Smart Walker-Assisted Locomotion in Immersive Virtual Reality Scenario

The decline in neuromusculoskeletal capabilities of older adults can affect motor control, independence, and locomotion. Because the elderly population is increasing worldwide, assisting independent mobility and improving rehabilitation therapies has become a priority. The combination of rehabilitation robotic devices and virtual reality (VR) tools can be used in gait training to improve clinical outcomes, motivation, and treatment adherence. Nevertheless, VR tools may be associated with cybersickness and changes in gait kinematics. This paper analyzes the gait parameters of fourteen elderly participants across three experimental tasks: free walking (FW), smart walker-assisted gait (AW), and smart walker-assisted gait combined with VR assistance (VRAW). The kinematic parameters of both lower limbs were captured by a 3D wearable motion capture system. This research aims at assessing the kinematic adaptations when using a smart walker and how the integration between this robotic device and the VR tool can influence such adaptations. Additionally, cybersickness symptoms were investigated using a questionnaire for virtual rehabilitation systems after the VRAW task. The experimental data indicate significant differences between FW and both AW and VRAW. Specifically, there was an overall reduction in sagittal motion of 16%, 25%, and 38% in the hip, knee, and ankle, respectively, for both AW and VRAW compared to FW. However, no significant differences between the AW and VRAW kinematic parameters and no adverse symptoms related to VR were identified. These results indicate that VR technology can be used in walker-assisted gait rehabilitation without compromising kinematic performance and presenting potential benefits related to motivation and treatment adherence.

Adaptive training instructional interventions: A meta-analysis

The United States military services are modernizing their training and education curricula by leveraging advances in technology to deliver instruction that is more engaging and responsive to trainees' needs and better prepares them for the future fight. Adaptive training (AT), or training tailored to the strengths and weaknesses of individual trainees, is a promising technique to meet these modernization goals. The research literature, however, is sporadic and does not clearly prescribe best practices for its employment. Therefore, we conducted a meta-analysis to examine the effectiveness of various AT instructional interventions (i.e. adapting difficulty, feedback, scaffolding, etc.) on learning outcomes. There were 30 peer-reviewed publications included in the analysis. We grouped studies by the adaptive intervention examined and reported the associated effects on learning outcomes. Overall, the results revealed that the effectiveness of AT varied considerably across the instructional interventions. Specifically, studies that implemented adaptive difficulty techniques were the most effective, followed by adaptive scaffolding and remediation/test-out techniques. Based on these findings, we identify design recommendations for future AT systems.

Strategies for case-based training with virtual patients: An experimental study of the impact of integrating mental model articulation and self-reflection

Resilient system performance in high-stakes settings, which includes the ability to monitor, respond, anticipate, and learn, can be enhanced for trainees through simulation of realistic scenarios enhanced by augmented reality. Active learning strategies can enhance simulation-based training, particularly the mental model articulation principle where students are prompted to anticipate what will happen next and the reflection principle where students self-assess their performance compared to a gold standard expert model. In this paper, we compared simulation-based training for trauma care with and without active learning strategies during pauses in the simulated action for progressively deteriorating patients. The training was conducted online and real-time without a facilitator, with 42 medical students viewing training materials and then immediately taking an online quiz for three types of trauma cases: hemorrhage, airway obstruction, and tension pneumothorax. Participants were randomly assigned to either the experimental or control condition in a between-subjects design. We compared performance in the control and experimental conditions based on: A) the proportion of cues correctly recognized, B) the proportion of accurate diagnoses, C) the proportion of appropriate treatment interventions, and D) verbal briefing quality on a 1-5 scale. We found that the training intervention increased recognition of subtle cues critical for accurate diagnosis and appropriate treatment interventions; the training did not improve the accuracy of diagnoses or the quality of the verbal briefing. We conclude that incorporating active learning strategies in simulation-based training improved foundational capabilities in detecting subtle cues and intervening to rescue deteriorating patients that can increase the readiness for trainees to contribute to resilient system performance in the high-stakes setting of emergency care in hospitals.

The effectiveness of extended reality on relieving pain after total knee arthroplasty: a systematic review and meta-analysis of randomized controlled trials

PURPOSE

Patients with total knee arthroplasty (TKA) often suffer from severe postoperative pain, which seriously hinders postoperative rehabilitation. Extended reality (XR), including virtual reality, augmented reality, and mixed reality, has been increasingly used to relieve pain after TKA. The purpose of this study was to evaluate the effectiveness of XR on relieving pain after TKA.

METHODS

The electronic databases including PubMed, Embase, Web of Science, Cochrane Central Register of Controlled Trials (CENTRAL), and clinicaltrials.gov were searched for studies from inception to July 20, 2023. The outcomes were pain score, anxiety score, and physiological parameters related to pain. Meta-analysis was performed using the Review Manager 5.4 software.

RESULTS

Overall, 11 randomized control trials (RCTs) with 887 patients were included. The pooled results showed XR had lower pain scores (SMD = - 0.31, 95% CI [- 0.46 to - 0.16], P < 0.0001) and anxiety scores (MD = - 3.95, 95% CI [- 7.76 to - 0.13], P = 0.04) than conventional methods. The subgroup analysis revealed XR had lower pain scores within 2 weeks postoperatively (SMD = - 0.49, 95% CI [- 0.76 to - 0.22], P = 0.0004) and XR had lower pain scores when applying XR combined with conventional methods (SMD = - 0.43, 95% CI [- 0.65 to - 0.20], P = 0.0002).

CONCLUSION

This systematic review and meta-analysis found applying XR could significantly reduce postoperative pain and anxiety after TKA. When XR was combined with conventional methods, postoperative pain can be effectively relieved, especially within 2 weeks after the operation. XR is an effective non-pharmacological analgesia scheme.

Effect of virtual reality-based seizure management education program for parents (VR-ESMEPP) on seizure management: A randomized controlled trial

OBJECTIVE

This study evaluated the efficacy of Virtual Reality-Based Seizure Management Education Program for Parents (VR-ESMEPP) that was designed to improve parents' knowledge-skill percentage about epileptic seizure, and motivation levels about educational material.

METHODS

The study was conducted at a university hospital's pediatric neurology clinic in Turkey and involved both a VR-trained group and a control group. The parents' knowledge-skill percentage about epileptic seizure, and motivation levels about educational material were assessed before, after, and at 15 days after participating in VR-ESMEPP.

RESULTS

The parents' knowledge-skill percentage about epileptic seizure increased in the group that participated in the VR-ESMEPP. There was no such increase in the control group. Examination of the scores of the Instructional Materials Motivation Survey (IMMS) for the parents showed that while there was a significant increase between the pre-test and post-test within the group that participated in the VR-ESMEPP, there was no significant difference in the scores of the control group. However, the high IMMS scores obtained by all parents indicate the motivating nature of the education material.

SIGNIFICANCE

The study established the efficacy of VR-ESMEPP and demonstrated its ability to enhance parents' knowledge-skill percentage about epileptic seizure. Despite the absence of a difference in motivation levels between the groups, the high scores obtained by all participants indicate that the program was indeed motivating.

The role of extended reality in optometry education: a narrative review

The evolution of digitally based pedagogies, such as extended reality (XR) - a group of simulated learning environments that include virtual simulation, virtual reality, and augmented reality - has prompted optometry educators to seek evidence to guide the implementation of these teaching and learning activities within their curricula. Looking more broadly across the medical and allied health fields, there is a wealth of evidence to guide the incorporation of XR, as it is increasingly being integrated into the curricula of other select health professions disciplines. Educators from these disciplines continue to explore and embed XR in practice. This narrative review summarises the findings and appraises the literature on the use of XR in optometry education. It identifies the learning domains in which XR has been implemented in optometry education and proposes areas for further investigation. The review questions the technology-focused approach that has driven the literature within the review and calls for richer pedagogical foundations with suggestions for future research agendas. As such, this narrative review provides optometry educators with new ways of understanding XR and its relationship with the curriculum.

Quintessential Solutions to Existential Problems: How Human Factors and Ergonomics Can and Should Address the Imminent Challenges of Our Times

OBJECTIVE

To examine and evaluate ways in which an understanding of the quintessential element of Human Factors/Ergonomics can address the spectrum of existential threats that confront contemporary civilization.

BACKGROUND

HF/E is dedicated to improving quality of life. Paradoxically, many processes which sustain contemporary civilization act to reduce that overall quality. Some technological developments themselves now even present existential threats to the fragile skein of civilization itself. Many disciplines address these diverse threats, and each may be advised and facilitated by HF/E knowledge and methods. It is a moral imperative of our science to contribute what we can to proposed resolutions.

METHOD

A primary conduit, by the established strengths of HF/E can contribute to potential solutions is identified. The present work advocates for specific, practical interventions using a direct-perception mediated, panopticon principle, that derives from the corpus of our science.

RESULT

Limitations upon a general, social understanding of imminent global concerns, which are largely ignorable when not actually present, are brought to immediate consciousness via an HF/E principle emphasizing the direct-perception of threat. It is argued that this, and allied HF/E insights can generate practical steps toward problem resolution at both macroscopic and localized levels of implementation.

APPLICATIONS

The primary, practical application of the proposed panopticon principle is to use our science to save global civilization. It is postulated that this represents useful employment of the knowledge we have adduced and accumulated across our discipline's existence.

Virtual reality in experiential pharmacy education: A quasi-experimental study

Introduction

Extended reality (XR) technologies are an umbrella term for simulated-based learning tools that cover 3-dimensional technologies, including virtual reality (VR), augmented reality (AR), and mixed reality (MR). At King Saud University, first-year pharmacy students are required to experience hospital observational training during the Introductory Pharmacy Practice Experience (IPPE). We aimed to measure the effectiveness and satisfaction of the VR learning experience among IPPE students.

Methods

A Quasi-Experimental study was conducted. The experimental arm included first-year PharmD students. VR headset was used to watch three narrated videos capturing 360° views of the outpatient, inpatient pharmacy, and counseling clinic. A test measuring students' general knowledge was required prior to and post the experience, followed by a satisfaction survey. The control arm included second-year PharmD students who had traditional hospital visits and were administered a knowledge test and satisfaction survey.

Results

A total of 336 students were enrolled, 174 in the experimental arm and 162 in the control arm. The results showed improvement in the knowledge scores average among the experimental arm, 1.9 vs 3.5 in the pre-test and post-test. The control arm had a comparable score with an average of 3.7. Regarding self-assessment using four 5-likert scales assessing pharmacist role, skills, and responsibilities, 31.8 % and 42 % in the experimental arm compared to 28.9 % and 28.9 % in the control group answered strongly agree and agree, respectively. Regarding satisfaction, using five 5-Likert scales assessing the experience time, quality, and content, 53 % and 25 % in the experimental group compared to 34 % and 23 % in the control group answered strongly agree and agree, respectively.

Conclusion

VR provides pharmacy students with a standardized and effective learning and training experience. The experimental arm reported higher satisfaction rates and self-reported outcomes. Thus, implementing VR experiences within the pharmacy curriculum will provide students with an advanced educational advantage.

Investigating Whether the Mass of a Tool Replica Influences Virtual Training Learning Outcomes

Virtual Reality (VR) has emerged as a promising solution to address the pressing concern of transferring know-how in the manufacturing industry. Making an immersive training experience often involves designing an instrumented replica of a tool whose use is to be learned through virtual training. The process of making a replica can alter its mass, making it different from that of the original tool. As far as we know, the influence of this difference on learning outcomes has never been evaluated. To investigate this subject, an immersive training experience was designed with pre and post-training phases under real conditions, dedicated to learning the use of a rotary tool. 80 participants took part in this study, split into three groups: a control group performing the virtual training using a replica with the same mass as the original tool ($\mathrm{m}=100\%$), a second group that used a replica with a lighter mass than the original tool ($\mathrm{m}= 50\%$) and a third group using a replica heavier than the original tool ($\mathrm{m}=150\%$). Despite variations in the mass of the replica used for training, this study revealed that the learning outcomes remained comparable across all groups, while also demonstrating significant enhancements in certain performance measures, including task completion time. Overall, these findings provide useful insights regarding the design of tool replicas for immersive training.

How the Effect of Virtual Reality on Cognitive Functioning Is Modulated by Gender Differences

Virtual reality (VR) can be a promising tool to simulate reality in various settings but the real impact of this technology on the human mental system is still unclear as to how VR might (if at all) interfere with cognitive functioning. Using a computer, we can concentrate, enter a state of flow, and still maintain control over our surrounding world. Differently, VR is a very immersive experience which could be a challenge for our ability to allocate divided attention to the environment to perform executive functioning tasks. This may also have a different impact on women and men since gender differences in both executive functioning and the immersivity experience have been referred to by the literature. The present study aims to investigate cognitive multitasking performance as a function of (1) virtual reality and computer administration and (2) gender differences. To explore this issue, subjects were asked to perform simultaneous tasks (span forward and backward, logical-arithmetic reasoning, and visuospatial reasoning) in virtual reality via a head-mounted display system (HDMS) and on a personal computer (PC). Our results showed in virtual reality an overall impairment of executive functioning but a better performance of women, compared to men, in visuospatial reasoning. These findings are consistent with previous studies showing a detrimental effect of virtual reality on cognitive functioning.

The Effectiveness of Virtual Reality, Augmented Reality, and Mixed Reality Rehabilitation in Total Knee Arthroplasty: A Systematic Review and Meta-Analysis

BACKGROUND

Extended reality (XR), including virtual reality, augmented reality, and mixed reality, has been increasingly used in postoperative rehabilitation of total knee arthroplasty (TKA). The purpose of this systematic review and meta-analysis was to evaluate the effectiveness of XR-based rehabilitation in TKA compared to conventional rehabilitation.

METHODS

In this study, we searched PubMed (MEDLINE), Embase (OVID), Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science, and clinicaltrials.gov from inception to February 15, 2023 for eligible studies. A total of 14 randomized controlled trials with 989 patients were included in our study. The primary outcomes were pain and function. The secondary outcomes were anxiety and quality of life. A systematic review and meta-analysis was performed.

RESULTS

The pooled data indicated XR-based rehabilitation significantly improved the visual analog scale (standardized mean difference [SMD] = -0.31, 95% Confidence Interval [CI] [-0.47 to -0.15], P = .0001), the Western Ontario and McMaster Universities Osteoarthritis Index (SMD = -0.46, 95% CI [-0.86 to -0.06], P = .02), range of motion (SMD = 0.40, 95% CI [0.09 to 0.72], P = .01), and anxiety scores (mean difference = -3.95, 95% CI [-7.76 to -0.13], P = .04) than conventional rehabilitation, but Timed Up and Go test and quality of life were similar in the 2 groups.

CONCLUSION

This systematic review and meta-analysis found XR-based rehabilitation improved pain, function, and anxiety, but not quality of life in TKA compared to conventional rehabilitation within 1 month postoperatively. Based on the pooled results, we suggested that XR-based rehabilitation may have benefit in patients' postoperative rehabilitation in TKA.

Embodied mental rotation ability in open- and closed-skill sports: pilot study with a new virtual paradigm

Embodied mental rotation is the influence of the body on mental rotation ability. Sports expertise enhances embodied mental rotation ability. However, sport-skill-dependent effects remain unclear. Previous studies refer to the influence of body positions on mental rotation ability. Yet, in sports, the investigation of the effect of simultaneous body and mental rotation movements is essential. Athletes need to constantly mentally and physically adapt to environmental changes and new motor tasks while being in motion themselves. This study aimed to investigate embodied mental rotation ability with simultaneous body and mental rotation in individuals with different sport skills, i.e., in open- and closed-skill sports. Forty-eight men and women, divided into two groups depending on their sport, performed 32 trials of an extended embodied mental rotation task. Simultaneous body and mental rotation were enabled by a novel test method including Virtual Reality. Results revealed shorter response times to the task stimulus in closed-skill sports participants than in open-skill sports participants. This group difference was significant for trials in which rotation directions of the own body and the mental rotation stimulus were aligned. The results might be related to sport-specific skill development processes. Motor imitation skills, as relevant in many closed-skill sports, may facilitate cognitive processes when the motion direction of the own body and of the mental rotation stimulus are aligned. The novel test method identifies potential applications that should be increasingly explored in the future, both for cognitive science and sports research.

Effects of Augmented Reality-, Virtual Reality-, and Mixed Reality-Based Training on Objective Performance Measures and Subjective Evaluations in Manual Assembly Tasks: A Scoping Review

OBJECTIVE

The present scoping review aims to transform the diverse field of research on the effects of mixed reality-based training on performance in manual assembly tasks into comprehensive statements about industrial needs for and effects of mixed reality-based training.

BACKGROUND

Technologies such as augmented and virtual reality, referred to as mixed reality, are seen as promising media for training manual assembly tasks. Nevertheless, current literature shows partly contradictory results, which is due to the diversity of the hardware used, manual assembly tasks as well as methodological approaches to investigate the effects of mixed reality-based training.

METHOD

Following the methodological approach of a scoping review, we selected 24 articles according to predefined criteria and analyzed them concerning five key aspects: (1) the needs in the industry for mixed reality-based training, (2) the actual use and classification of mixed reality technologies, (3) defined measures for evaluating the outcomes of mixed reality-based training, (4) findings on objectively measured performance and subjective evaluations, as well as (5) identified research gaps.

RESULTS

Regarding the improvement of performance and effectiveness through mixed reality-based training, promising results were found particularly for augmented reality-based training, while virtual reality-based training is mostly-but not consistently-as good as traditional training.

APPLICATION

Mixed reality-based training is still not consistently better, but mostly at least as good as traditional training. However, depending on the use case and technology used, the training outcomes in terms of assembly performance and subjective evaluations show promising results of mixed reality-based training.

Online learning in health professions education. Part 2: Tools and practical application: AMEE Guide No. 163

Part 1 of the AMEE Guide Online learning in health professions education focused on foundational concepts such as theory, methods, and instructional design in online learning. Part 2 builds upon Part 1, introducing technology tools and applications of these foundational concepts by exploring the various levels (from beginner to advanced) of utilisation, while describing how their usage can transform Health Professions Education. This Part covers Learning Management Systems, infographics, podcasting, videos, websites, social media, online discussion forums, simulation, virtual patients, extended and virtual reality. Intertwined are other topics, such as online small group teaching, game-based learning, FOAM, online social and collaboration learning, and virtual care teaching. We end by discussing digital scholarship and emerging technologies. Combined with Part 1, the overall aim of Part 2 is to produce a comprehensive overview to help guide effective use online learning in Health Professions Education.

Augmented reality-assisted versus conventional total hip arthroplasty: a systematic review and meta-analysis

BACKGROUND

Extended reality (XR), including virtual reality, augmented reality (AR), and mixed reality, has been used to help achieve accurate acetabular cup placement in total hip arthroplasty (THA). This study aimed to compare the differences between XR-assisted and conventional THA.

METHODS

In this systematic review and meta-analysis, electronic databases including PubMed, Embase, Web of Science, Cochrane Central Register of Controlled Trials (CENTRAL), and clinicaltrials.gov were searched for studies from inception to September 10, 2023. The outcomes were accuracy of inclination and anteversion, duration of surgery, and intraoperative blood loss. Meta-analysis was performed using Review Manager 5.4 software.

RESULTS

A total of five studies with 396 patients were included in our study. The pooled results indicated AR-assisted THA had better accuracy of inclination and anteversion than conventional THA (SMD = - 0.51, 95% CI [- 0.96 to - 0.07], P = 0.02; SMD = - 0.96, 95% CI [- 1.19 to - 0.72], P < 0.00001), but duration of surgery and intraoperative blood loss were similar in the two groups.

CONCLUSION

This systematic review and meta-analysis found that AR-assisted THA had better accuracy of inclination and anteversion than conventional THA, but the duration of surgery and intraoperative blood loss were similar in the two groups. Based on the pooled results, we suggested that AR can provide more precise acetabular cup placement than conventional methods in THA.

Competencies Development Strategy Using Augmented Reality for Self-Management of Learning in Manufacturing Laboratories (AR-ManufacturingLab)

Technological tools in education open new learning possibilities. This proposal describes integrating augmented reality and different educational elements to develop engineering competencies, specifically using specialized machinery in the manufacturing laboratory. It is necessary to encourage self-management of learning, where users interact with the devices employing an application that contains significant information about procedures to perform and essential elements to consider when manipulating the machinery. The machines involved include industrial robots, CNC (Computer Numerical Control) lathes and milling machines, and PLCs (Programmable Logic Controls). In a traditional training model, an instructor guides the users in learning how to manipulate the equipment. This proposal intends that the participants use their mobile devices to receive each machine's instruction and the necessary documentation. The participants' learning pace varies. So, the research aimed to reduce the deficit in the disciplinary competencies since, in the traditional methodology, there is no heterogeneity in understanding the contents. We designed a competency development strategy with six laboratory practices, integrating multimedia elements to address the significant learning content of each manufacturing cell device. Each lesson contained information about each device and a practice activity and self-evaluation to ensure learning the content.

Realizing consumers' existential dreams via product marketing and mixed reality: a perspective based on affective neuroscience theories

In an era of swift societal changes and escalating consumerism, this paper presents an exploration of an innovative approach that integrates product marketing strategies, mixed reality (MR) technology, and affective neuroscience theories to actualize consumers' existential dreams. MR, with its unique capacity to blend the virtual and real worlds, can enhance the consumer experience by creating immersive, personalized environments that resonate with consumers' existential aspirations. Insights from affective neuroscience, specifically the brain's processing of emotions, guide the development of emotionally engaging marketing strategies, which strengthen the connection between consumers, products, and brands. These integrated strategies not only present a novel blueprint for companies to deepen consumer engagement but also promise more fulfilling and meaningful consumer experiences. Moreover, this approach contributes to societal well-being and prosperity, marking a significant stride in the field of marketing.

Alterations in Physical Demands During Virtual/Augmented Reality-Based Tasks: A Systematic Review

The digital world has recently experienced a swift rise in worldwide popularity due to Virtual (VR) and Augmented Reality (AR) devices. However, concrete evidence about the effects of VR/AR devices on the physical workload imposed on the human body is lacking. We reviewed 27 articles that evaluated the physical impact of VR/AR-based tasks on the users using biomechanical sensing equipment and subjective tools. Findings revealed that movement and muscle demands (neck and shoulder) varied in seven and five studies while using VR, while in four and three studies during AR use, respectively, compared to traditional methods. User discomfort was also found in seven VR and three AR studies. Outcomes indicate that interface and interaction design, precisely target locations (gestures, viewing), design of virtual elements, and device type (location of CG as in Head-Mounted Displays) influence these alterations in neck and shoulder regions. Recommendations based on the review include developing comfortable reach envelopes for gestures, improving wearability, and studying temporal effects of repetitive movements (such as effects on fatigue and stability). Finally, a guideline is provided to assist researchers in conducting effective evaluations. The presented findings from this review could benefit designers/evaluations working towards developing more effective VR/AR products.

The assessment of presence and performance in an AR environment for motor imitation learning: A case-study on violinists

The acquisition of advanced gestures is a challenge in various domains of proficient sensorimotor performance. For example, orchestral violinists must move in sync with the lead violinist's gestures. To help train these gestures, an educational music play-back system was developed using a HoloLens 2 simulated AR environment and an avatar representation of the lead violinist. This study aimed to investigate the impact of using a 2D or 3D representation of the lead violinist's avatar on students' learning experience in the AR environment. To assess the learning outcome, the study employed a longitudinal experiment design, in which eleven participants practiced two pieces of music in four trials, evenly spaced over a month. Participants were asked to mimic the avatar's gestures as closely as possible when it came to using the bow, including bowing, articulations, and dynamics. The study compared the similarities between the avatar's gestures and those of the participants at the biomechanical level, using motion capture measurements, as well as the smoothness of the participants' movements. Additionally, presence and perceived difficulty were assessed using questionnaires. The results suggest that using a 3D representation of the avatar leads to better gesture resemblance and a higher experience of presence compared to a 2D representation. The 2D representation, however, showed a learning effect, but this was not observed in the 3D condition. The findings suggest that the 3D condition benefits from stereoscopic information that enhances spatial cognition, making it more effective in relation to sensorimotor performance. Overall, the 3D condition had a greater impact on performance than on learning. This work concludes with recommendations for future efforts directed towards AR-based advanced gesture training to address the challenges related to measurement methodology and participants' feedback on the AR application.

Metaverse: Evolving role in healthcare delivery and implications

Metaverse, or the immersive internet, is touted as the next considerable technology-led disruption on the horizon, which can potentially disrupt clinician-patient interactions, patient experience, innovation and research and development processes. Metaverse is still in the evolution phase, and its firm definition framework is a work in progress. Surgical training allows the trainees to mimic procedures and simulate cross-collaborations within time and space, shortening the learning cycles. Similarly, patient experiences can be built by creating unique experiences replicating the real world without constraints. At the same time, the care providers can foster greater empathy while serving the patients with regular or special specific needs per disease conditions.

Training effects of set- and repetition-interval rest time on recumbent-boxing exercise: Could virtual reality improve further?

This study examined the influence of set-interval and repetition-interval rest time of virtual reality (VR) boxing game in supine-lying posture. Fifty healthy middle-aged adults were randomly assigned into VR and non-VR groups to perform six different exercise protocols with varying set-interval and repetition-interval rest times (S0R0, S0R1/3, S0R2/3, S40R0, S40R1/3, and S40R2/3). Analysis on the non-VR group showed significant differences between exercise protocols for average heart rate (p < 0.001), maximum ventilation volume (p < 0.001), respiratory quotient (p < 0.001), oxygen pulse (p < 0.001), and excess post-exercise oxygen consumption (EPOC) (p = 0.003). VR appeared to have no further improvement on physical training effects in middle-aged adults, while the participants reported negative experience that might be associated with the over-exertion. Future study might need to explore game design elements that can accommodate high-exertion exercises.

Assemble it like this! - Is AR- or VR-based training an effective alternative to video-based training in manual assembly?

AR- and VR-based training is increasingly being used in the industry to train workers safely and effectively for new tasks. In this study, we investigated and compared the effects of AR-, VR- and video-based training on short- and long-term objective performance measures and subjective evaluations in a manual assembly task. Our results showed that there was no difference between AR-, VR- and video-based training concerning the objective performance measures task completion time and error count. However, in the subjective evaluations VR-based training showed a significantly higher perceived task load and a lower usability rating than the AR- and video-based training regimes. An exploratory analysis additionally revealed partially better results for AR than for VR after adjusting the data for the age of the participants. Future research should further investigate the advantage of AR- and video-based methods over VR when the age and technology experience of participants are taken into account.

Design guidelines for limiting and eliminating virtual reality-induced symptoms and effects at work: a comprehensive, factor-oriented review

Virtual reality (VR) can induce side effects known as virtual reality-induced symptoms and effects (VRISE). To address this concern, we identify a literature-based listing of these factors thought to influence VRISE with a focus on office work use. Using those, we recommend guidelines for VRISE amelioration intended for virtual environment creators and users. We identify five VRISE risks, focusing on short-term symptoms with their short-term effects. Three overall factor categories are considered: individual, hardware, and software. Over 90 factors may influence VRISE frequency and severity. We identify guidelines for each factor to help reduce VR side effects. To better reflect our confidence in those guidelines, we graded each with a level of evidence rating. Common factors occasionally influence different forms of VRISE. This can lead to confusion in the literature. General guidelines for using VR at work involve worker adaptation, such as limiting immersion times to between 20 and 30 min. These regimens involve taking regular breaks. Extra care is required for workers with special needs, neurodiversity, and gerontechnological concerns. In addition to following our guidelines, stakeholders should be aware that current head-mounted displays and virtual environments can continue to induce VRISE. While no single existing method fully alleviates VRISE, workers' health and safety must be monitored and safeguarded when VR is used at work.

Calibration of head mounted displays for vision research with virtual reality

Immersion in virtual environments is an important analog for scientists. Situations that cannot be safely organized in the real world are being simulated virtually to observe, evaluate, and train aspects of human behavior for psychology, therapy, and assessment. However, creating an immersive environment using traditional graphics practices may create conflict with a researcher's goal of evaluating user response to well-defined visual stimuli. Standard computer monitors may display color-accurate stimuli, but it is generally viewed from a seating position, where the participant can see real-world visual context. In this article, we propose a novel means to allow vision scientists to exert finer control over the participants visual stimuli and context. We propose and verify a device-agnostic approach to color calibration by analyzing display properties such as luminance, spectral distribution, and chromaticity. We evaluated five different head-mounted displays from different manufacturers and showed how our approach produces conforming visual outputs.

Using Immersive Virtual Reality in an Online Biology Course

Interest in virtual reality (VR) for teaching and learning in higher education is growing, given its many potential applications. VR offers a socially interactive environment with novel ways to engage students with materials, objects, and activities and provide students with experiences such as "field trips" that would be otherwise very difficult. Preliminary work indicates overall positive gains in student learning across disciplines compared to other technology and traditional techniques, although more studies are needed to better our understanding of this tool. We employed an "immersive" VR (with a head-mounted display) in an online course which provided students with the opportunity to interact with peers and engage in activities. We asked about perceptions of the learning experience with the technology and how using VR impacts students' performance. We also noted the benefits and challenges of VR in an online course. Students perceived VR as a helpful component of the course, although performance on the cardiovascular unit assessment did not differ compared to the previous semester without VR.

Supplementary Information

The online version contains supplementary material available at 10.1007/s41979-023-00095-9.

Wearable Motion Capture Devices for the Prevention of Work-Related Musculoskeletal Disorders in Ergonomics-An Overview of Current Applications, Challenges, and Future Opportunities

Work-related musculoskeletal disorders (WMSDs) are a major contributor to disability worldwide and substantial societal costs. The use of wearable motion capture instruments has a role in preventing WMSDs by contributing to improvements in exposure and risk assessment and potentially improved effectiveness in work technique training. Given the versatile potential for wearables, this article aims to provide an overview of their application related to the prevention of WMSDs of the trunk and upper limbs and discusses challenges for the technology to support prevention measures and future opportunities, including future research needs. The relevant literature was identified from a screening of recent systematic literature reviews and overviews, and more recent studies were identified by a literature search using the Web of Science platform. Wearable technology enables continuous measurements of multiple body segments of superior accuracy and precision compared to observational tools. The technology also enables real-time visualization of exposures, automatic analyses, and real-time feedback to the user. While miniaturization and improved usability and wearability can expand the use also to more occupational settings and increase use among occupational safety and health practitioners, several fundamental challenges remain to be resolved. The future opportunities of increased usage of wearable motion capture devices for the prevention of work-related musculoskeletal disorders may require more international collaborations for creating common standards for measurements, analyses, and exposure metrics, which can be related to epidemiologically based risk categories for work-related musculoskeletal disorders.

Nursing students’ experience of using HoloPatient during the COVID-19 pandemic: A qualitative descriptive study

Background

Due to the COVID-19 pandemic, nursing schools have implemented alternative approaches to teaching clinical competency. This study examined nursing students’ experiences of using HoloPatient to learn COVID-19-related patient care.

Methods

In this qualitative descriptive study, focus group interviews were held virtually with 30 nursing student participants in South Korea. Data were collected from January 25 to February 8, 2022 and analyzed using a mixed content analysis.

Results

Participants shared their experiences of using the HoloPatient, addressing advantages, challenges, and concerns associated with this new approach. Overall, they reported satisfaction associated with having gained patient assessment and critical thinking skills, self-confidence, and knowledge about the care of patients with COVID-19. Barriers identified included the program's novelty, inadequate number of devices, instructions in English, learning environment, and issues such as poor Wi-Fi access.

Conclusion

HoloPatient in nursing education can improve learning motivation, critical thinking skills, and confidence. Efforts should be made to engage users by providing an orientation, supplementary materials, and an environment conducive to learning.

Age and gender effects on presence, user experience and usability in virtual environments-first insights

Virtual Reality (VR) is applied in various areas were a high User Experience is essential. The sense of Presence while being in VR and its relation to User Experience therefore form crucial aspects, which are yet to be understood. This study aims at quantifying age and gender effects on this connection, involving 57 participants in VR, and performing a geocaching game using a mobile phone as experimental task to answer questionnaires measuring Presence (ITC-SOPI), User Experience (UEQ) and Usability (SUS). A higher Presence was found for the older participants, but there was no gender difference nor any interaction effects of age and gender. These findings are contractionary to preexisting limited work which has shown higher Presence for males and decreases of Presence with age. Four aspects discriminating this study from literature are discussed as explanations and as a starting point for future investigations into the topic. The results further showed higher ratings in favor of User Experience and lower ratings towards Usability for the older participants.

A mixed-reality stimulator for lumbar puncture training: a pilot study

BACKGROUND

The simulation is one of the basic methods of medical education, which is often used for procedural skills training. However, the existing simulator lacks internal anatomical landmarks. The study developed a mixed-reality stimulator and evaluated its usability and feasibility in lumbar puncture training.

METHODS

The study recruited 40 subjects, including medical students, residents and faulty with varied levels of experience. Before training, participants completed the questionnaire about the basic information and watched a presentation about mixed reality. After practicing on mixed-reality stimulator, which provided internal anatomical structure, the examination was carried out and the results were documented. At the end of the training, trainees completed a survey of MR technology.

RESULTS

In this study, participants generally believed that the MR technology was very realistic (90%), and that the presentation of internal anatomy could help the operation (95%). Moreover, 72.5% and 75%, respectively, strongly agreed that the MR technology promoted learning and should be used in medical training. After this training, the success rate of puncture and the puncture time were significantly improved in experienced and non-experienced participants.

CONCLUSION

The existing simulator was easy to be transformed into MR simulator. This study showed the usability and feasibility of MR simulator in lumbar puncture training. As a potentially good tool to simulated medical skills training, next, MR technology would be developed and evaluated in more clinical skills teaching scenarios.

The Effect of Augmented Reality and Privacy Priming in a Fashion-Related App: An Application of Technology Acceptance Model

In this research, we tested (a) the effects of augmented reality (AR) and (b) how the effects of AR could be moderated by privacy perceptions. We used a 2 eyewear app type (AR vs. non-AR) by 2 privacy priming (prime vs. no prime) between-subject experimental design, and 114 Korean adults participated in the experiment. Results showed that AR had a main effect on perceived ease of use but not on perceived usefulness. Instead, the effect of AR on perceived usefulness was moderated by privacy priming such that the positive effect of AR on perceived usefulness was weaker when privacy concern was salient. Moreover, the results provided support for a moderated mediation model in which the indirect effect of AR on intent to use the app via perceived usefulness was moderated by privacy priming. Theoretical and practical implications are discussed.

Feasibility and Acceptance of Augmented and Virtual Reality Exergames to Train Motor and Cognitive Skills of Elderly

The GAME2AWE platform aims to provide a versatile tool for elderly fall prevention through exergames that integrate exercises, and simulate real-world environments and situations to train balance and reaction time using augmented and virtual reality technologies. In order to lay out the research area of interest, a review of the literature on systems that provide exergames for the elderly utilizing such technologies was conducted. The proposed use of augmented reality exergames on mobile devices as a complement to the traditional Kinect-based approach is a method that has been examined in the past with younger individuals in the context of physical activity interventions, but has not been studied adequately as an exergame tool for the elderly. An evaluation study was conducted with seniors, using multiple measuring scales to assess aspects such as usability, tolerability, applicability, and technology acceptance. In particular, the Unified Theory of Acceptance and Use of Technology (UTAUT) model was used to assess acceptance and identify factors that influence the seniors’ intentions to use the game platform in the long term, while the correlation between UTAUT factors was also investigated. The results indicate a positive assessment of the above user experience aspects leveraging on both qualitative and quantitative collected data.

Impact of Virtual Reality Cognitive and Motor Exercises on Brain Health

Innovative technologies of the 21st century have an extremely significant impact on all activities of modern humans. Among them, virtual reality (VR) offers great opportunities for scientific research and public health. The results of research to date both demonstrate the beneficial effects of using virtual worlds, and indicate undesirable effects on bodily functions. This review presents interesting recent findings related to training/exercise in virtual environments and its impact on cognitive and motor functions. It also highlights the importance of VR as an effective tool for assessing and diagnosing these functions both in research and modern medical practice. The findings point to the enormous future potential of these rapidly developing innovative technologies. Of particular importance are applications of virtual reality in basic and clinical neuroscience.

The effectiveness of virtual reality, augmented reality, and mixed reality training in total hip arthroplasty: a systematic review and meta-analysis

BACKGROUND

Extended reality (XR), including virtual reality (VR), augmented reality (AR), and mixed reality (MR), has been used in the training of total hip arthroplasty (THA). This study aims to examine the effectiveness of XR training in THA.

METHODS

In this systematic review and meta-analysis, we searched PubMed (MEDLINE), EMBASE (OVID), Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science, and clinicaltrials.gov from inception to September 2022 for eligible studies. The Review Manager 5.4 software was applied to compare accuracy of inclination and anteversion, and surgical duration between XR training and conventional methods.

RESULTS

We identified 213 articles, of which 4 randomized clinical trials and 1 prospective controlled study including 106 participants met inclusion criteria. The pooled data indicated the XR training had better accuracy of inclination and shorter surgical duration than conventional methods (MD = -2.07, 95% CI [- 4.02 to -0.11], P = 0.04; SMD = -1.30, 95% CI [- 2.01 to -0.60], P = 0.0003), but the accuracy of anteversion was similar in the two groups.

CONCLUSIONS

This systematic review and meta-analysis found XR training had better accuracy of inclination and shorter surgical duration than conventional methods in THA, but the accuracy of anteversion was similar. Based on the pooled results, we suggested that XR training can better improve trainees' surgical skills than conventional methods in THA.

Promoting Social Participation and Recovery with Virtual Reality Based Interventions among people with Mental Health and Substance Use disorders: A Qualitative study (Preprint)

BACKGROUND

People with mental health disorders (MHDs) and substance use disorders (SUDs) are a highly vulnerable group, particularly affected by social exclusion, marginalization, and disconnectedness. Virtual reality technology holds a potential for simulating social environments and interactions to mitigate the social barriers and marginalization faced by people recovering from MHDs and SUDs. However, it is still unclear how we can harness the greater ecological validity of virtual reality-based interventions targeting social and functional impairments in individuals with MHDs and SUDs.

OBJECTIVE

The aim of this paper was to explore how service providers in community-based MHD and SUD health care services perceive the barriers to social participation among adults recovering from MHDs and SUDs to provide a broader understanding of how learning experiences can be modeled to promote social participation in virtual reality environments.

METHODS

Two semistructured, open-ended, and dual-moderator focus group interviews were conducted with participants representing different community-based MHD and SUD health care services. Service providers were recruited from their MHD and SUD services in our collaborating municipality in Eastern Norway. We recruited the first participant group at a municipal MHD and SUD assisted living facility for service users with ongoing excessive substance use and severe social dysfunctionality. We recruited the second participant group at a community-based follow-up care service aimed at clients with a broad range of MHDs and SUDs and various levels of social functioning. The qualitative data extracted in the interviews were analyzed, using reflexive thematic analysis.

RESULTS

The analysis of the service providers' perceptions of the barriers to social participation among clients with MHDs and SUDs revealed the following five main themes: challenging or lacking social connections, impaired cognitive functions, negative self-perception, impaired personal functioning, and insufficient social security. The barriers identified are interrelated in a cluster of cognitive, socioemotional, and functional impairments, leading to a severe and diverse complex of barriers to social participation.

CONCLUSIONS

Social participation relies on people's capability to use their present social opportunities. Promoting basic human functioning is key to promoting social participation among people with MHDs and SUDs. The findings in this study indicate a need to address cognitive functioning, socioemotional learning, instrumental skills, and complex social functions to meet the complexity and diversity of the identified barriers to social functioning in our target group. Virtual reality-based interventions for promoting social participation should be sequenced into distinct scenarios dedicated to specific learning goals to build complex learning in a step-by-step process based on successively more complex levels of human and social functioning.

“Everything looks the same”: wayfinding behaviour and experiences of stroke inpatients in rehabilitation clinics

Purpose

To examine stroke inpatients’ real-life wayfinding behaviour and how the built environment of rehabilitation clinics might influence their behaviour and experiences.

Methods

Stroke inpatients in seven rehabilitation clinics were observed (n = 70), each over the course of 12 consecutive hours. Their paths through the clinic and the locations of encountered wayfinding-related events were mapped on the floor plans and described in the written notes. The observations were supplemented by a survey asking patients about their wayfinding experiences.

Results

For a third of observed patients, at least one wayfinding-related event was observed on the observation day, and 50% of patients reported getting lost in their clinic at least once. Most wayfinding-related events occurred between patient rooms and therapy rooms, and patients frequently relied on backtracking or the help of the staff to find their way. Clinics’ layout organization was found to play a role in the wayfinding behaviour of patients.

Conclusions

Wayfinding is a common challenge that stroke inpatients encounter in rehabilitation clinics. Avoiding multiple decision nodes on the paths between patient rooms and therapy rooms and creating distinct identities for corridor segments in the decision nodes and the areas in front of elevators would likely improve wayfinding performance.

Extended reality as a means to enhance public health education

Technology has transformed the classroom and learning environments. From electronic whiteboards to tablet computers, educators now have access to a multitude of tools that enhance the learning experience. Educational technologies that rely on extended reality (XR) such as augmented and virtual reality are being used, or suggested for use, in various settings and often focus on technical fields such as medicine, dentistry, and aviation. Here, we propose that XR can be used in public health education to better prepare both undergraduate and graduate trainees for real world, complex public health scenarios that require public engagement, investigative skills, and critical decision making. Several opportunities for XR use are outlined that provide perspective on how XR can supplement traditional classroom instruction methods by providing an immersive, participatory training environment. XR offers an opportunity for public health students to gain confidence, have repeated simulated exposures in a safe and equitable environment, and build competency in critical functions they will likely perform as future public health professionals.

The Trends and Challenges of Virtual Technology Usage in Western Balkan Educational Institutions

Higher educational institutions in Western Balkan countries strive for continuous development of their teaching and learning processes. One of the priorities is employing state-of-the-art technology to facilitate experience-based learning, and virtual and augmented reality are two of the most effective solutions to providing the opportunity to practice the acquired theoretical knowledge. This report presents (apart from the theoretical introduction to the issue) an overall picture of the knowledge of AR and VR technology in education in Western Balkan universities. It is based on a semi-structured online questionnaire whose recipients were academic staff and students from universities in Albania, Kosovo, and North Macedonia. The questionnaire differed for each target group; the version for academics comprised 11 questions for 710 respondents, and the version for students comprised 10 questions for 2217 respondents. This paper presents and discusses the results for each question with the aim to illustrate Western Balkan countries’ current state of VR and AR application in education.

Global trends and hotspots in research on extended reality in sports: A bibliometric analysis from 2000 to 2021

Objective

Extended reality technologies (e.g. virtual reality (VR), augmented reality (AR) and mixed reality (MR)) are gaining popularity in sports owing to their unique advantages. This study aims to analyse the progress of the application of extended reality technology in sports and reveal its cooperative features, research hotspots and development trends.

Methods

We searched the literature in the Web of Science Core Collection (WoSCC) database within the period 2000 to 2021 and conducted a bibliometric analysis. The analysis methods included statistical, co-occurrence, hierarchical clustering and social network analyses.

Results

A total of 340 articles were gathered. The literature related to its research showed an increasing trend over time. The paper collaboration rate was 90.88% (309/340 papers), and the degree of author collaboration was 3.96 (1345/340). VR was found to be the most productive journal, and Queen's University Belfast was the most productive institution. The United States, China and the United Kingdom were the three main contributors to the field. The foundational themes in sports extended reality research were (i) sports games and extended reality systems, (ii) virtual simulation devices and artificial intelligence, (iii) sports training and performance and (iv) age-appropriate physical activity, sports rehabilitation and physical education.

Conclusion

The level of author collaboration was low, but the degree of author collaboration is largely on the rise. The closeness of the collaboration between institutions and countries was also low. In addition, the subject of sport extended reality is relatively fragmented. Therefore, more research is needed to strengthen it in the future.

Mild simulator sickness can alter heart rate variability, mental workload, and learning outcomes in a 360° virtual reality application for medical education: a post hoc analysis of a randomized controlled trial

Virtual reality (VR) applications could be beneficial for education, training, and treatment. However, VR may induce symptoms of simulator sickness (SS) such as difficulty focusing, difficulty concentrating, or dizziness that could impair autonomic nervous system function, affect mental workload, and worsen interventional outcomes. In the original randomized controlled trial, which explored the effectiveness of using a 360° VR video versus a two-dimensional VR video to learn history taking and physical examination skills, only the former group participants had SS. Therefore, 28 undergraduate medical students who participated in a 360° VR learning module were included in this post hoc study using a repeated measures design. Data of the Simulator Sickness Questionnaire (SSQ), heart rate variability (HRV) analysis, Task Load Index, and Mini-Clinical Evaluation Exercise were retrospectively reviewed and statistically analyzed. Ten (36%) participants had mild SS (total score > 0 and ≤ 20), and 18 (64%) had no SS symptom. Total SSQ score was positively related to the very low frequency (VLF) band power, physical demand subscale, and frustration subscale, and inversely related to physical examination score. Using multilevel modeling, the VLF power mediated the relationship between total SSQ score and physical examination score. Furthermore, frustration subscale moderated the mediating effects of the VLF power. Our results highlight the importance of documenting SS to evaluate a 360° VR training program. Furthermore, the combination of HRV analysis with mental workload measurement and outcome assessments provided the important clinical value in evaluating the effects of SS in VR applications in medical education.

How Virtual Reality Technology Has Changed Our Lives: An Overview of the Current and Potential Applications and Limitations

Despite virtual reality (VR) being initially marketed toward gaming, there are many potential and existing VR applications in various sectors and fields, including education, training, simulations, and even in exercise and healthcare. Unfortunately, there is still a lack of general understanding of the strengths and limitations of VR as a technology in various application domains. Therefore, the aim of this literature review is to contribute to the library of literature concerning VR technology, its applications in everyday use, and some of its existing drawbacks. Key VR applications were discussed in terms of how they are currently utilized or can be utilized in the future, spanning fields such as medicine, engineering, education, and entertainment. The main benefits of VR are expressed through the text, followed by a discussion of some of the main limitations of current VR technologies and how they can be mitigated or improved. Overall, this literature review shows how virtual reality technology has the potential to be a greatly beneficial tool in a multitude of applications and a wide variety of fields. VR as a technology is still in its early stages, but more people are becoming interested in it and are optimistic about seeing what kind of changes VR can make in their everyday lives. With how rapidly modern society has adapted to personal computers and smartphones, VR has the opportunity to become the next big technological turning point that will eventually become commonplace in most households.

Methodology for the Development of Augmented Reality Applications: MeDARA. Drone Flight Case Study

Industry 4.0 involves various areas of engineering such as advanced robotics, Internet of Things, simulation, and augmented reality, which are focused on the development of smart factories. The present work presents the design and application of the methodology for the development of augmented reality applications (MeDARA) using a concrete, pictorial, and abstract approach with the intention of promoting the knowledge, skills, and attitudes of the students within the conceptual framework of educational mechatronics (EMCF). The flight of a drone is presented as a case study, where the concrete level involves the manipulation of the drone in a simulation; the graphic level requires the elaboration of an experiential storyboard that shows the scenes of the student’s interaction with the drone in the concrete level; and finally, the abstract level involves the planning of user stories and acceptance criteria, the computer design of the drone, the mock-ups of the application, the coding in Unity and Android Studio, and its integration to perform unit and acceptance tests. Finally, evidence of the tests is shown to demonstrate the results of the application of the MeDARA.

The Effect of Simulation Fidelity on Transfer of Training for Troubleshooting Professionals: A Meta-Analysis

OCCUPATIONAL APPLICATIONSPeople in many occupations that involve using complex tools need to know how to troubleshoot those tools in real time and with minimum cost. Training troubleshooting professionals is thus a concern for various occupational sectors-particularly the military, aviation, power plant, and in industrial processes-and large investments have been made to create and use simulators that train troubleshooting skills. In the design and evaluation of simulators for troubleshooting, this review shows that no single level of simulation realism-or fidelity-works best in training, and that the effect of fidelity depends on trainees' prior skill level and the type of troubleshooting system (electronic or mechanical).